What is Irritable Bowel Syndrome (IBS) and how can it be managed?

What is IBS

IBS symptoms range from person to person both in severity and type however, the most common complaints are:

• Abdominal pain, cramping or bloating
• Bloating
• Excessive gas or wind
• Altered bowel motions such as constipation or diarrhoea (or alternating between both)
• A feeling of incomplete emptying of the bowel or sudden urgency

This unpleasant range of symptoms unfortunately is without clear cause. Research has shown that those with IBS may have a hypersensitive bowel however, the reason for this is largely unknown. Some other factors that may cause or worsen symptoms include gastroenteritis, stress, enzyme deficiencies and changes in the gut microbiome (via antibiotics, infection, or parasite).

Now it’s not all doom and gloom! Fortunately, lifestyle and dietary changes can help manage the condition long term.

How to manage IBS

There are a few simple dietary changes you can trial at home that may assist in managing IBS. Reducing your consumption of high-fat foods such as deep-fried items, spicy foods, coffee and alcohol can often improve symptoms. Additionally, improving stress management and practicing meditation has been found to be effective in reducing symptoms as well.

For persistent or severe symptoms, you may like to engage a dietitian to investigate further triggers such as FODMAPs.

What are FODMAPs

FODMAPs are a group of short-chain carbohydrates (sugars) found naturally in a range of foods and food additives. FODMAP is an acronym for:

• Fermentable (the process where undigested carbohydrates are broken down to produce gas)
• Oligosaccharides (ie. Fructans and GOS/Galactans)
• Disaccharides (ie. Lactose)
• Monosaccharides (ie. Fructose)
• And
• Polyols (ie. Sorbitol and Mannitol)

These sugars can be poorly absorbed which leads to them moving through the small intestine, drawing water into the bowel which may cause diarrhoea. When the sugars continue moving through to the large intestine, they act as a food source for the bacteria that live there. These bacteria digest the FODMAPs and release gas which may cause bloating, discomfort and pain as the sensitive nerve endings in the gut are stretched.

Some high FODMAP foods you may be eating regularly include onion, garlic, cow’s milk, avocado, apples and pasta….as well as a whole lot more!

Low FODMAP Diet

The Low FODMAP diet is an investigative diet that sees the removal and systematic reintroduction of FODMAPs with the goal of identifying trigger foods. The diet is completed in three phases:

• Phase 1 – Low FODMAP diet: Individuals follow a strict Low FODMAP diet by substituting high FODMAP foods for low FODMAP alternatives. We’d typically recommend this phase for no longer than four weeks.
• Phase 2 – FODMAP reintroduction: Once symptoms have reduced to a manageable level, one FODMAP at a time is reintroduced. This process identifies which FODMAPs, and how much of these FODMAPs, trigger symptoms. A dietitian can help determine the type and quantity of foods to reintroduce, monitor progress and interpret symptoms.
• Phase 3 – Maintenance: Once tolerance to types and amounts of FODMAPs has been determined, your diet can be personalised and liberalised. A dietitian can help ensure that your diet is nutritionally balanced, sustainable and enjoyable.

It’s important to note that everyone responds differently to the various types of FODMAPs – what may cause symptoms for your friend, might not bother you at all! To have a balanced, nutritionally adequate, and liberal diet long term, it is necessary to determine and restrict only those FODMAPs that cause you symptoms.

Takeaway message

The Low FODMAP diet is extremely effective in reducing symptoms in those with IBS. Identifying trigger foods can put your mind at ease and allow you to gain a bit of control back over your bowel. With that being said, it can be problematic if not followed appropriately (i.e., only attempting phase 1). If you’re interested in trying the Low FODMAP diet, please seek the help of a dietitian to help you through the process.

Before treating any symptoms, please seek medical advice to ensure all high-risk conditions such as Coeliac Disease and Inflammatory Bowel Disease have been ruled out.