OH! Magazine - Australian Version January 2018 | Page 8

( NUTRITION )
FODMAPS &
IRRITABLE BOWEL SYNDROME
Dr Joanna explains this concerning health condition.

rritable bowel syndrome or IBS

is thought to affect one in seven
adults, making it one of the most
common gut disorders. It is characterised
by bloating, excessive gas, visible
distension of the abdomen and
alterations to bowel habits with either
diarrhoea, constipation or a combination
of both.
I
In the old days IBS was the label given
when doctors could find nothing
medically wrong to explain the
symptoms. It was largely thought that
stress and anxiety had a role to play,
perhaps even be the cause, and patients
were sent away with little to help them.
The idea that stress and anxiety are
involved was not in fact wrong, as they
very much can be part of the story. Just
think about what happens when you’re
nervous or excited about something – you
often find yourself running to the loo and
will almost certainly have butterflies in
your stomach. This shows us that the
hormones involved in the stress response
affect the gut. However, we now
understand a lot more about what is
going on with IBS. It is not just all in
your head and there is much you can do
to gain control of your symptoms.
See your doctor
It’s vitally important that you don’t
self-diagnose IBS. Your first step, if you
haven’t already done so, is to see your
GP who will likely refer you to a
gastroenterologist for further testing.
The symptoms of IBS can be similar to a
number of different, serious bowel
disorders, including inflammatory bowel
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OH! MAGAZINE ( JANUARY 2018 )
disease, coeliac disease and bowel
cancer. These must be ruled out first
before a diagnosis of IBS can be made.
Some FODMAPs also tend to pull water
into the bowel and this can result in
diarrhoea, as well as contribute to
bloating and discomfort.
What are FODMAPs?
In recent years researchers have
identified a group of short-chain
carbohydrates that are key in producing
the symptoms of IBS in most patients.
These are collectively called FODMAPs,
which stands for fermentable,
oligosaccharides, disaccharides,
monosaccharides and polyols. These
carbohydrates are types of sugars that
occur widely in healthy foods, but they
cause problems in some people. They are
poorly absorbed in the small intestine
and so enter the colon where they are
rapidly fermented by the resident gut
bacteria – your microbiota.
Some people also have a flurry of
bacteria growing in the wrong place.
Most of our microbiota is found down at
the latter part of the gastrointestinal
tract, in the colon. But for several
reasons these bacteria can migrate up
into the small intestine. This is called
‘small intestinal bacterial overgrowth’ or
SIBO for short.
The problem with SIBO is that the small
intestine is a far narrower section of the
bowel, and if gas and excess fluid is
found here, then pain, discomfort and
bloating can become significant.
What foods are high in FODMAPs?
How do FODMAPs cause IBS symptoms?
The four main groups of FODMAPS are:
Fermentation is generally a good thing
and essential for the health of the bowel.
In fact, many of the products of
fermentation, particularly short-chain
fatty acids such as butyrate, are
important for maintaining our physical
and mental health. However, the other
product of fermentation is gas.
If the production of gas is excessive, or
that gas becomes trapped due to
constipation, the result is pain, bloating,
flatulence and discomfort. Interestingly,
it may also come down to our perception
of pain in the gut. It seems that some
people with IBS have a hypersensitive
gut. The same amount of gas may be
produced in two people, yet only be
perceived as uncomfortable and painful
in the one with IBS.
1. Foods that contain much more fructose
than glucose. This is because
glucose helps with the absorption of
fructose. While most of us can
happily absorb fructose, it is
estimated that 30 to 40 per cent of
people do not resulting in a fructose
party in the colon for the microbiota!
Foods that contain fructose in
excess of glucose include asparagus,
artichokes, sugar snap peas, apples,
figs, cherries, mango, pears,
watermelon, honey and many fruit
juices.
2. Foods that contain lactose. Some
people continue to produce the
enzyme lactase required to break
down the milk sugar, lactose.