Diet Tips:A bit of bloating is beneficial

By Dr Jaci Barrett

Bloating is one of the most common gastrointestinal symptoms. It can occur as a sensation of gas stretching the gut, with or without actual distension, when the abdomen is visually swollen. Bloating often results in significant discomfort and/or pain and is a major complaint in many patients with irritable bowel syndrome.

One of the major aims of the low FODMAP diet is to reduce bloating by restricting short chain carbohydrates from the diet that are fermented by gut bacteria. The fermentation process is responsible for the gas release and distension of the gut that leads to bloating. 
As we have pointed out previously, the low FODMAP diet should only be followed strictly short term. 

The diet should be relaxed long term to ease the burden of following the diet, but more importantly to reintroduce some FODMAPs back into the diet for their potential benefits. This benefit arises from the fermentation of FODMAPs by gut bacteria – the reason we restrict FODMAPs in the first place – but small amounts of FODMAPs are fuel for good bacteria and is likely to be important in long term gut health.

Many people try the reintroduction or rechallenge phase and state they have failed - their symptoms returned on reintroduction of the foods and they went back to a strict low FODMAP diet. This will be necessary for symptom control only in the minority of extremely sensitive individuals. For everyone else, it may be that smaller amounts of FODMAPs need to be trialed, and in fact, the return of symptoms needs to be looked at in a different way.


When you experience symptoms, it is vital that you are tuned in to the severity. Pain and significant discomfort are not OK and you can discuss these outcomes with your treating dietitian who can advise further on future challenges and food trials you may better tolerate. But for many people, the reintroduction of FODMAPs, or FODMAP ingestion when eating, results in gas production and a little bloating. The initial thought is that there has been a reaction and the food should again be removed from the diet, but we ask you to think about it in a different light.

Fermentation and gas production after eating high FODMAP foods is beneficial to the gut. If you experience some gas related symptoms that are tolerable and perhaps just include some mild bloating and flatus, this could be a good sign that you are providing fuel that encourages good bacteria in your gut. Everyone experiences some bloating and flatus and it is important not to immediately consider these as ‘symptoms’ of IBS, rather they should be considered a normal part of healthy digestion (as long as there is no significant discomfort or pain!).

So remember, a little gas is a good thing.

           

Diet Tips:Timing of symptoms

By Dr Jaci Barrett (APD)

IBS is very common, but the symptoms are varied – constipation, diarrhoea, alternating bowel habit, bloating, abdominal distension, abdominal pain, excessive gas and borborygmi (intestinal noises). Some people experience all of these symptoms at some time or another, while others have more specific symptoms, for example where bloating is the major symptom. When symptoms are experienced, people often consider what they most recently ate to determine the trigger food. Were there FODMAPs in that meal? What other foods could have contributed? Many times we hear patients state that within minutes of food hitting their stomach, they are on the toilet with urgency, diarrhoea and abdominal cramps. Is this possible?

Let’s consider the anatomy of the human gastrointestinal system:

Bowel transit studies indicate that in healthy individuals, the time taken for a substance to move from the mouth to the anus is somewhere between 12 and 48 hours.

The small intestine is particularly long – 6 metres in fact. The large intestine is ~1.5 metres long. So given the time it takes for food to move through the gut, symptoms experienced immediately after swallowing a suspect food cannot be attributed to the fermentation of FODMAPs ….

So how does this immediate symptom induction occur in some people?

The most likely explanation is the impact of hormones and nerve regulators that are triggered when we eat. For instance, when food enters the stomach, hormones such as cholecystokinin and secretin are released. These hormones stimulate the production of enzymes that aide digestion. In addition, when the stomach is stretched by the entry of food, nerves in the digestive system are stimulated. These nerves stimulate the movement of intestinal muscles which push food and digestive juices through the gut.

Because digestion takes many hours to days, the intestinal tract is always full of digestive contents from previous meals, and as a meal is consumed, these existing intestinal contents are moved through the intestines. So if the existing intestinal contents contain FODMAPs or other problem food components, symptoms may be experienced upon eating that have nothing to do with the current meal and everything to do with the previous meal/s. These delayed symptoms can be confusing and may have you pinpointing the wrong trigger food.

So what is the take home message? Consider previous meals you have eaten and whether they could have played a role, or whether there are other complicating factors such as stress that has had an impact on bowel function. If you are still confused and unable to work out what is causing your symptoms, keep a list of foods you have eaten over the 48 hours prior to experiencing symptoms and show this to your dietitian to utilise his/her food detective expertise!

 

 

Diet Tips:Alleviating symptoms

By Shirley Webber

We’ve all eaten something that just doesn’t sit well and resulted in symptoms. Most frequently when we are eating out and have had less control over what we are eating. Following a low FODMAP diet can help manage symptoms but what can you do when you’re in the middle of experiencing those symptoms?

Symptoms vary from one person to the next including bloating, abdominal pain, distention, constipation, diarrhea, altered bowl habits, excessive gas and intestinal noises, or any combination of these. Each symptoms has its own management strategy.

We are going to bring you some tips to help alleviate symptoms over the coming weeks, including ideas to help with acute symptoms which occur quickly after you have eaten a trigger food, as well as ideas to help prevent symptoms from occurring in the future.

We will start the first blog of the series with some information for those that suffer constipation as a major symptom.

Constipation can be alleviated by:

• Ensuring that your diet includes foods rich in insoluble and soluble fibres. Insoluble fibre gives bulk to your stool and soluble fibre forms a gel in the gut that helps stools to move through the gastrointestinal tract. Introducing these fibres gradually will help to avoid exacerbating your symptoms.
• If constipation is severe and laxative medication is required, take this as prescribed by your doctor.
• Drink plenty of water throughout the day.
• Exercise regularly to help to get things moving. Try going for a walk, taking the stairs instead of the lift or escalator, join a yoga or Pilates class or go for a jog. It doesn’t have to be intense exercise but any little bit of physical activity will help.
• If you have the urge to open your bowels, GO - even if it means using a public toilet or the toilet at work or school. You may also need to make time to open your bowels by getting up a little earlier in the morning and leaving time for a drink and breakfast.
• Fibre supplements may be recommended by health professionals for those struggling with constipation. Use these as prescribed.

Please see the blog attached for more details:
http://fodmapmonash.blogspot.com.au/2015/12/ibs-constipation.html       

Diet Tips:Alleviating Symptoms Part 3

Abdominal Pain and Bloating
By Shirley Webber

This week we are highlighting some strategies to manage abdominal pain and bloating that generally occur due to a build up of gas in the intestinal tract. These are the most common IBS symptoms.

·       Often a heat pack placed on the area of pain can help to loosen up the muscles and alleviate some of the pain and discomfort with cramping. A heat pack also allows more blood to flow to the area where the heat is placed and can assist in relieving the cramping.

·       Over the counter medication such as Buscopan or Mintec may help with managing symptoms. Ask your pharmacist what they would recommend.

·       Stretch it out – sometimes a bit of Pilates or yoga stretching can help with relieving some of the gas that is built up in the gastrointestinal tract reducing the pressure on the gut and therefore reducing the pain.

·       Better out than in. If you do have gas then it is okay to let it out. If you’re in a closed environment and feeling uncomfortable to deflate, go for a walk outside or move away from others. Remember gas is a sign of a healthy gut – see a previous blog post on this http://fodmapmonash.blogspot.com.au/2016/02/a-bit-of-bloating-is-beneficial.html

           

Diet Tips:NEW US RESEARCH: The Low FODMAP diet superior for the relief of abdominal pain and bloating

The Low FODMAP Diet & mNICE Diet Compared

By Dr Jane Varney

 

An interesting study was published by our colleagues at the University of Michigan this week (1). The US study compared the effect of two dietary interventions on IBS symptoms in people with diarrhoea predominant IBS (IBS-D). The interventions in question were the low FODMAP diet and a more traditional dietary approach, known as mNICE (modified guidance from the National Institute for Health and Care Excellence).

Ninety-two eligible subjects were recruited into the study, all of whom had IBS-D and most of whom were female (71%). Participants were randomised to either a low FODMAP diet or the mNICE diet for 4 weeks. Because this was also not a feeding study, a dietitian taught participants how to follow their respective diets, but participants were required to put this advice into practice and prepare their own meals. Resources developed at Monash and Michigan Universities were used to teach participants how to follow the low FODMAP diet. Guidance given to the mNICE group included to eat small frequent meals, to avoid trigger foods and to avoid excess alcohol and caffeine. This guidance was considered ‘modified’, because high FODMAP foods were not specifically excluded as would typically be the case on this diet.

 

 The study revealed a number of interesting findings:

·         The diets were equally effective at providing ‘adequate relief’ of overall IBS symptoms, with improvements experienced in 41% of participants in the mNICE group and 52% of participants in the low FODMAP group.

·         More participants in the low FODMAP group experienced an improvement in abdominal pain, 51% versus 23%, p=0.008.

·         The greatest benefit of the low FODMAP diet was for relief of abdominal pain and bloating, with improvements in stool consistency, stool frequency and urgency also observed in this group.

Take home messages:

·         The low FODMAP and mNICE diets improve symptom control in roughly half of all people with IBS-D.

·         The low FODMAP diet may be a superior choice for the relief of some symptoms, namely abdominal pain and bloating

 

1. Eswaran SL, Chey WD, Han-Markey T, Ball S, Jackson K. A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D. Am J Gastroenterol. 2016.

Link to full research article: http://www.nature.com/ajg/journal/vaop/ncurrent/full/ajg2016434a.html