Bloated? Tummy pain? – how low FODMAP can help you

Since starting my practice as a private dietitian, the most rewarding thing I have done is advising people with a new dietary treatment for IBS. For many of my patients seriously affected by IBS, it has been life changing. Have you heard of the low FODMAP diet?

What is IBS?

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Irritable Bowel Syndrome is a disorder where the bowel looks normal, but it doesn’t function properly. It is incredibly common, affecting about 1 in 5 people in the UK. Symptoms include bloating, abdominal pain, constipation and diarrhoea. The diagnosis of IBS is usually made when other conditions such as coeliac disease, Crohn’s Disease, colitis, have been ruled out.

Causes of IBS:

The causes of IBS are not fully understood, however, it is believed to be due to a number of complex factors:

  • genetic – tummy problems run in the family
  • gastroenteritis – alters the gut bacteria
  • antibiotics – alter the gut bacteria
  • stress
  • a highly sensitive gut that is more sensitive to gas forming foods
  • food intolerances e.g. lactose intolerance

Until recently, dietary advice given by health professionals for IBS has been, at best, vague and unsatisfactory. For many people the NICE guidelines, used in the NHS by GPs for treatment of IBS, aren’t very successful. Current advice from your GP may include: reduce stress, adjust fibre intake, regular meals, restrict caffeine, fruit juice, fruit and sorbitol, exercise and probiotics. Medications such as laxatives, anti-diarrheals, anti-spasmodics and anti-depressants are often prescribed. Unfortunately, IBS patients can be left frustrated because these medications in conjunction with the dietary and lifestyle changes are unsatisfactory solutions.

New low FODMAP diet: 75% success

The low FODMAP diet has been published in international medical journals and is now accepted and recommended as one of the most effective dietary therapies for IBS. The low FODMAP diet significantly reduces symptoms in 75% of people. FODMAPs are indigestible sugars which ferment in the gut causing bloating, diarrhoea, constipation and gut pain. By reducing the amount of FODMAP foods in your diet, IBS symptoms can be dramatically reduced or resolved.shutterstock_52604065

Some common high FODMAP foods include wheat (so in bread, pasta, biscuits etc), apples, pears, garlic, onions, lentils, beans, some vegetables, milk, and some artificial sweeteners. The low FODMAP diet involves many dietary changes that are best described to you in consultation with a dietitian. Additionally, not everyone reacts to the same FODMAPs, which is why it is important to have the advice of an experienced dietitian to help you negotiate the various phases of the diet.

Where do I start?

The low FODMAP diet is carried out in two stages. The aim is to identify the FODMAP foods causing problems that are specific to YOU. Every person reacts differently to each food category, and can tolerate certain amounts.

Phase 1 –  all high FODMAP foods are eliminated for 2-4 weeks. Symptom relief can be experienced with in days.

Phase 2 – a sequential reintroduction of FODMAP food categories over a few weeks. This allows you to identify the foods causing you problems.

A dietitian with experience in the low FODMAP diet can guide you through the phases of the diet, providing practical advice, menu ideas that suit your lifestyle and food preferences, advice on reading food labels etc. Appointment information

2013 – the year of chronic sleep deprivation

So following a month long sabbatical from blogging, I’m hoping to get back on the wagon!

I took a bit of a break because four months of getting up at 5am to write blogs and do client admin everyday (including holidays, weekends etc), took it’s toll and I was getting burnt out. Existing on 5 hours of brokenimages sleep is doable over the short term, but chronic sleep deprivation was not compatible with looking after 3 children, a husband, shopping, cooking, cleaning and trying to build a business! Husband Dec works long hours (today, New Year’s Day when most have the day off, he’s leaving at 7am and home 7/8pm…..ish) so I’m on my own with the kids pretty much all the time. I’m not complaining, just telling it how it is.

Chronic sleep deprivation was making me tired and a bit (!) cranky with the kids, leading to a vicious circle of them and me being grumpy and stressed. Getting three children out the door to school on a cold winter morning with packed lunches, school bags, coats, hats, gloves, scooters and to the gates ON TIME with no tears on the way is a major achievement!

I was also becoming dependant on coffee fixes. I LOVE coffee, but was having up to 5 cups most days. I don’t think coffee is a bad thing as it does have health benefits. However, for me 5 cups a day didn’t feel right (although could be considered within recommended limits). ‘Needing’ the coffee fix was probably purely psychological……..I was telling myself that it would get me through, and that coffee was good for me. If I had stopped and asked if I really wanted it in the physical sense the answer was ‘no’. Although I love the taste, it made me feel a bit bleurgh and with a dull headache.

The Nutrition Business

From the business perspective, tiredness meant I was losing sight of where I was going. My original plan about this time last year was to stay broad with the types of patients I would advise and to see where the road took me. I have 12 years experience of working with both children and adults in most dietetic specialities within the NHS. But the chronic tiredness meant a fuzzy head and I couldn’t see the woods for the trees. Any business advisor will tell you that you need to focus on your niche. Over the last month, with 7 hours sleep under my belt each day, the fog has cleared and I have been able to identify that my speciality is becoming digestive health. About 70% of my clients contact me for help with gut problems, usually a diagnosis of Irritable Bowel Syndrome.

A recent development in treatment of IBS is the low FODMAP diet. It sounds gimmicky, but I shutterstock_52604065can assure you it is not another fad diet. One in 5 people suffer, and the scientific evidence is proving that it is extremely successful for 75% of people. Results are fast (symptoms can be resolved with in a few days) and although it doesn’t cure IBS, the change to people’s lives is wonderful to see. Professionally, helping people with IBS using this method is truly the most rewarding thing I have done.

My plan for 2014 is to set up a dedicated private IBS Clinic in Kingston where I can devote my time to helping people with IBS. Skype appointments are also a definite possibility too giving access to consultations for people unable to travel to KIngston. Currently there are very few NHS dietitians experienced in the low FODMAP diet (it is quite a complicated to start with) and waiting lists are long. The big hurdle is letting people know about the clinic and the effectiveness of the treatment. Advertising, marketing and publicising my service is very new to me. As a dietitian working in the NHS it is not something I had to think about! I’m working with Sue at B1 Creative who is helping me with the marketing side of things…..firstly a nice poster to put up in GP surgeries, libraries and anywhere else that will oblige!

Today, New Year’s Day, we’re having Dec’s family this evening for a turkey dinner. It’s a Danaher family tradition to have a repeat of Christmas Day, minus the presents. Wish me luck……..I’ve never done the turkey before. Here’s the menu:

  • Tomato Soup with wheaten bread

    It all got a bit much for Sarah while cooking the turkey

    It all got a bit much for Sarah while cooking the turkey

  • Turkey, stuffing, roast potatoes, carrots, broccoli, gravy
  • Christmas Crumble with vanilla ice cream and custard

How hard can it be?! If I’m not losing the plot, I’ll post some pictures of the preparation. Wish me luck!

Tummy trouble?

It’s known that about 1 in 6 people suffer from Irritable Bowel Syndrome, with symptoms of bloating, diarrhoea, constipation, pain and wind. These are things that you may just put up with, but can be distressing and have an effect on your quality of life. You may have some vague ideas to connections with some foods, and maybe stress, but it can be very hard to pinpoint particular causes.

shutterstock_52604065For those who have been diagnosed with IBS, until now, NHS treatment has been vague, with only a 30% success rate. Advice has been to increase fibre (often making things worse!), cut out alcohol, high fat foods, and to eat regular meals.

NEW IBS TREATMENT FROM MONASH UNIVERSITY, PERTH & GUY’S & ST THOMAS’ HOSPITAL, LONDON

There is now a new dietary treatment called the ‘low FODMAP diet’ which results in an impressive reduction in symptoms. FODMAP is an acronym for a group of carbohydrates that are rapidly fermented in the gut causing the symptoms. High FODMAP foods are varied and range from wheat & dairy, to apples, onions and garlic, some sweeteners, and lentils to name a few.

Not everyone with IBS has an intolerance to all of the high FODMAP foods, which is why it is very helpful to have the input of a dietitian to guide you through the elimination and reintroduction of FODMAP foods.

The success rate is impressive, with up to 86% of people having a significant improvement of their symptoms. For some, the improvement in quality of life is staggering.

Sasha Watkins, a spokeswoman for the British Dietetic Association, explains: ‘Treatment for IBS sufferers is often limited, which is why the emerging success of the low-FODMAP diet – an approach that helps patients discover the precise foods that trigger their symptoms – is excellent news.’

Peter Irving, consultant gastroenterologist at Guys and St Thomas’, says: ‘I can now refer IBS patients for dietetic advice with a greater degree of confidence that their quality of life will improve.’

As a dietitian experienced in the low FODMAP diet, I have seen wonderful improvements in my IBS patients. Most don’t have to restrict their diet of all FODMAP foods in the long term, as together, we have identified their particular problem FODMAP foods.

For more information or a low FODMAP diet consultation, contact me with the form below.