Theres a slow diffusion of knowledge among physicians about food intolerance, said Peter Green, director of the Celiac Disease Center at Columbia University in New York. Green, a physician, typically tries to rule out gluten, fructose and other intolerances, as well as bacterial overgrowths, he said. If theyre excluded, well say, Theres this new diet thats come out of Australia, and well give them the Fodmap diet, Green said. Typical Meals A typical days meals might include a poached egg with spinach plus a banana for breakfast, followed by a ham and salad sandwich on gluten-free bread for lunch, and a dinner of grilled chicken, baked potato with sauteed spinach and capsicum, seasoned with the green part of a spring onion, salt, pepper, olive oil and pine nuts. Lactose-free yogurt with blueberries, or peanut butter on a celery stick may serve as suitable snacks, according to the Digestive Health Foundation in Melbourne . Because it avoids foods with high-fructose corn-syrup, it can be difficult to procure appropriate products in the U.S. where the ingredient is widespread, he said, in everything from jelly to ketchup. Laden With Fodmaps Usual diets here in the U.S. are laden with Fodmaps, Portland dietitian Catsos said. Doctors have pushed high-fiber diets and fiber supplements almost across the board for IBS patients. Therefore, health-conscious Americans are guzzling smoothies filled with yogurt and fruit, juicing, eating loads of cruciferous vegetables, beans and high-fiber nutrition bars and nuts, then they wonder why their IBS has gotten worse. Researchers at Kings College London adapted the low-Fodmap diet and implemented it at Guys and St Thomas hospitals. They compared it with standard advice based on the U.K.s National Institute for Health and Clinical Excellence guidelines and found it reduced flatulence and other symptoms in at least six out of seven patients, compared with half following the NICE- based advice, according to research published last October.
Trying to beat IBS? Cut out cabbage and honey: It may have an indigestible name… but the FODMAP food plan stops symptoms in 75 per cent of cases
The new diet is low in FODMAPs. FINDING THE TRIGGERS Established treatments centre on trying to calm symptoms, with anti-spasmodic medications, adjustments in fibre intake, stress management or taking small, regular meals. National Institute for Health and Clinical Excellence guidelines suggest that sufferers may also benefit from limiting gas-producing food ingredients, such as resistant starch (found in some processed and reheated food) and sorbitol (a sweetener found commonly in sugar-free chewing gums). But as 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. TRIAL AND ERROR Developed by a team at Monash University in Melbourne, Australia, the low-FODMAP diet has been shown to work in a placebo-controlled trial, and is more effective than all other previous dietary treatments for IBS. It has also been successfully adapted in the UK by researchers at Kings College, London, and implemented at Guys and St Thomas NHS Foundation Trust in London. 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. The precise cause of IBS is unclear, but stress and problems with the immune system or how gut muscles squeeze food through the bowel may play a part HONEY TRAP Patients on the diet go for eight weeks without consuming any FODMAP-rich foods which include honey, wheat, apples, pears and stone fruits (such as plums and peaches), along with the onion family and artichokes. Traditionally windy foods such as cabbage and beans must also be given up, as must polyol sweeteners (such as sorbitol, mannitol and xylitol), which are often added to sugar-free varieties of mint, chocolate and chewing gum. EASY DOES IT After the eight weeks are up during which time the gut is rested and it is expected that symptoms will subside the period of reintroducing the offending FODMAPs, group by group, begins. The aim is for sufferers to discover which fermentable carbohydrates they are most sensitive to, and to identify their individual tolerance level so that they can plan a diet that suits them. For example, to check tolerance to the m, or monosaccharide in the acronym FODMAP, people would start with a teaspoon of honey, which is very rich in the monosaccharide fructose, and build up gradually, says Sasha Watkins. ASK THE EXPERTS Heidi Staudacher, who delivers FODMAPs training to dieticians, says IBS sufferers should not try the plan without medical supervision. Information on the internet or in books is often conflicting or out of date, she says. Advice from a registered dietician with whom patients are likely to need up to three one-hour sessions is crucial for good results, and should be obtained after appropriate assessment by a GP or gastroenterologist. An increasing number of privately registered dieticians are now offering FODMAPs advice costing 55 to 80 for an hour-long session. Traditionally ‘windy’ foods such as cabbage (left) must be given up, along with honey, which is rich in FODMAP GETTING OVER YOUR FEAR Emma Carder, a FODMAPs-trained freelance dietician based in the North West, says: In my experience, people require the most help after the elimination stage, when they can feel so much better that they are reluctant to start reintroducing foods.