Irritable Bowel Syndrome (IBS) is a common gastrointestinal condition (affecting around 10% of people).
People with IBS typically have non-specific symptoms, including diarrhoea, abdominal pain, gas, bloating, and constipation.
What causes IBS?
We tend to talk about the triggers of IBS as the causes are not exactly known. The causes of IBS could, however, be :
- hypersensitivity of the intestines
- problems with digestion (too fast or too slow)
- a “gut-brain” communication problem
- dysbiosis (altered gut bacteria)
- immune system problems
- genetics
- infections
IBS Triggers
There are many different triggers for IBS and these vary between sufferers. Some foods or eating patterns can trigger symptoms. Stress can also trigger symptoms.
Common food triggers include:
- FODMAPs
- Fatty Foods
- Caffeine
- Alcohol
- Spicy Foods
- Resistant starch (starch that isn’t fully broken down in the small intestine)
Stress triggers:
Stress, anxiety and depression are well known triggers of IBS symptoms. There’s a complex connection between the brain and the digestive system which is why our mood affects the gut.
When we experience stress or anxiety, our bodies produce respond by producing hormones such as adrenaline and corticotropin-releasing factor (CRF) ; a major mediator in the stress response. Stress hormones have a direct effect on the gut. They can cause a decrease in blood and oxygen flow to the stomach, increased acid secretion, increased gas production, speed up or slow down transit in the gut causing constipation or diarrhoea, make the gut more hyper-sensitive, and disrupt the gut bacteria.
Identifying and managing triggers is a crucial part of symptom management in IBS.
Treating IBS
Treatment for IBS involves a personalised plan which focuses on relieving individual symptoms to help you to live as comfortably as possible. Your plan will include changes to your lifestyle (dietary changes and managing stress and anxiety).
Dietary Treatment of IBS
The Low FODMAP diet helps to identify IBS triggers and reduce symptoms such as abdominal pain, bloating, constipation or diarrhoea. Before starting the Low FODMAP diet, however, you may need to make some basic “first line” changes to your diet.
The Low FODMAP Diet
The Low FODMAP diet is proven; three stage process designed to reduce IBS symptoms, to help you to discover dietary triggers and to put into place a personalised diet that allows you to eliminate or reduce your symptoms long term.
FODMAPs are carbohydrates which are poorly absorbed in the small intestine and which are then fermented in the large intestine, or bowel, by gut bacteria. The unabsorbed carbohydrates pull extra water into the bowel and are then rapidly fermented by bacteria to produce gases such as carbon dioxide, hydrogen and methane. This causes the uncomfortable symptoms of IBS.
The term FODMAP stands for:
Fermentable
Oligosaccharides – (e.g. fructans and galacto-oligosaccharides (GOS))
Disaccharides- (e.g. lactose)
Monosaccharides- (e.g. fructose)
And
Polyols – (e.g. sorbitol, mannitol, xylitol and maltitol)
You can find FODMAPs in a range of everyday foods such as wheat, rye, specific dairy products, some fruits and vegetables and particularly in onions, garlic, beans and pulses.
The Low FODMAP diet should be followed guidance and support. It is a three step process. You will need to go through each of the three stages to use the diet correctly.
The steps are:
Stage 1: 4-6 weeks low FODMAP exclusion diet
Stage 2: Structured reintroduction of FODMAP-containing foods
Stage 3: Long-term dietary personalisation
Before starting the Low FODMAP diet, your IBS diagnosis should be confirmed and other conditions should have been ruled out.
Stage One: Exclusion
Stage one is a short term, exclusion diet. During this stage, you should eliminate all FODMAP containing foods from your diet for 4-6 weeks.
This stage should not last for more than 6 weeks. Following the FODMAP exclusion diet for longer than 6 weeks could be harmful for your gut bacteria. It’s important to move to the next stage of the diet in order to find your triggers and to include more variety in your diet. Four weeks is usually enough time for the majority of people to see if the low FODMAP diet is going to reduce their symptoms. Once you have a reduction in symptoms, the reintroduction phase should be started. The exclusion stage should be started with guidance and support. People who try to start this phase without any support tend to struggle with the diet.
Stage Two : Re-introduction
This stage involves a staged process of re-introducing, or “challenging” foods containing FODMAPs. It is important that you move on to this stage as you will be able to determine which FODMAPs may be triggering your symptoms. The re-introduction phase is a staged, dosed, FODMAP challenge protocol. This means that you will be re-introducing or “challenging” each FODMAP, one at a time, to find which ones may trigger your symptoms.
Stage Three: Long Term Personalisation
Once you have completed each of the FODMAP “challenges”, you will have a personalised “prescription” with an idea of which FODMAPs trigger your IBS symptoms. You will also know how much of each FODMAP containing food you can tolerate. The aim of this stage is to increase diet variety and to make sure your diet is balanced- meaning you will be getting all of the important nutrients whilst maintaining symptom control.
It is important that you follow the Low FODMAP diet correctly and that you don’t just cut out all FODMAPs long term. It can be potentially damaging to your health to continue the exclusion stage of the diet long term and you may be cutting out foods that you enjoy for no reason.
FODMAPs Trained Dietitians
Dietitians are the only health professionals trained in guiding people through the FODMAPs Diet. Our Dietitians have completed advanced IBS training from Monash University, Australia and from Kings College, London.
FODMAPs Package
Our FODMAPs package consists of 3 extensive consultations – £300
This includes:
- 3 × 1 hour consultations (guidance in the three steps)
- personalised Low FODMAP meal guide
- FODMAP e-booklets
- support between sessions (using mobile app)
