Nutrition with irritable bowel syndrome

An apple a day keeps the doctor away: everyone has probably heard this sentence at some point. But what happens if that one apple a day leads to stomach ache, bloating, diarrhoea or constipation? And if the same thing happens with mangoes, plums, broccoli, milk, pulses and a long list of other foods?

Irritable bowel syndrome can thoroughly spoil your enjoyment of food. Some people get the complaints listed above even from small amounts, while others have a higher tolerance threshold. But eating with irritable bowel syndrome can still be enjoyable, and symptoms can be avoided.

The term “FODMAP” appeared in science a few years ago, for the first time in 2005 at Monash University in Melbourne. It covers a list of foods that can cause complaints in people with a sensitive gastrointestinal tract. “FODMAP” is an acronym (a short word formed from the first letters of several words) and stands for “Fermentable Oligo-, Di- and Monosaccharides And Polyols”.

More precisely, these are:

• Oligosaccharides: fructans (inulin), fructooligosaccharides (FOS), galactooligosaccharides (GOS: raffinose, stachyose)
• Disaccharides: lactose (milk sugar)
• Monosaccharides: fructose (fruit sugar)
• Polyols: sorbitol, mannitol, maltitol, xylitol, polydextrose and isomalt

While you will certainly have heard of lactose or fructose or seen them on a packet, most of the other terms are rather unfamiliar. They are a group of different carbohydrates and sugar alcohols (polyols) that are contained in many natural and processed foods. But FODMAPs are not bad in themselves. They also bring positive properties with them.

One positive property of some FODMAPs is that of a prebiotic, which has a similar effect to a probiotic: it helps good bacteria in the gut to grow, bifidobacteria for example.

Some of them are also fibre, which reaches the large intestine undigested and there swells up with water and increases the volume of the stool. That stimulates bowel activity, the stool takes on a soft consistency and going to the toilet becomes easier. This is one of the reasons why you should always drink enough water with a meal rich in fibre.

Further plus points:

• Fibre increases satiety.
• It delays the uptake of glucose into the bloodstream, which lowers the blood sugar value.
• It lowers the blood lipid values.

So in healthy people eating FODMAPs is mainly positive. It looks different for people with irritable bowel syndrome, whose gastrointestinal tract is overwhelmed by many foods from this group. One of the tasks of the small intestine is to absorb (that is, to take up) the usable nutrients from food and to carry them through the intestinal lining into the body. In people with irritable bowel syndrome it does not manage this sufficiently. The nutrients reach the large intestine, where they are fermented into short chain fatty acids and gases such as hydrogen and methane. Bloating follows. That is a fact worth taking into account when eating with irritable bowel syndrome.

So how do you know whether you have an irritable bowel with an intolerance of FODMAPs, or an intolerance that concerns only fructose, lactose, histamine, gluten and so on? In most cases a visit to the doctor helps first of all. Your GP can be the first point of contact for advice on the subject of intolerance and can refer you to a specialist who tests for the suspected intolerance. You will probably end up in one of these two specialist fields:

1. The internist and gastroenterologist tests for:

• Lactose intolerance (breath test)
• Fructose intolerance (breath test)
• Sorbitol intolerance (breath test)
• Coeliac disease/gluten intolerance (IgA antibodies)

2. The skin doctor (dermatologist) tests for:

• Food allergy test (for example a skin prick test)
• IgE antibody testing for allergies (blood test)
• Histamine intolerance (DAO)

The diagnosis of irritable bowel syndrome itself is a little more complicated. Since there are a great many different symptoms and forms, with irritable bowel syndrome only a process of exclusion helps. So you rule out other diseases and intolerances one by one until you know that you are suffering from irritable bowel syndrome. That is what the FODMAP diet is for.

For 4 to 6 weeks you go without all foods with a high FODMAP potential. If the irritable bowel symptoms improve, an oversensitivity of the gastrointestinal tract is likely. It is important, however, that you do not stop eating altogether, but still supply your body with enough fibre. You can manage that with vegetables (courgettes or carrots for example), pseudocereals (buckwheat or quinoa for example) and fruit (raspberries or kiwis for example).

Once the stomach and bowel area has completely calmed down, you start allowing certain foods again, one after another, and observe how the body reacts. Since every person and every gut is different, it may well be that one person tolerates 2 or 3 apples well, while another gets a rumbling stomach from a single apple segment a day. And a third can eat apples endlessly, but tolerates no plums at all and reacts with diarrhoea, constipation and so on.

It is best to keep a food diary in which you note the connections between foods and complaints. (For example: what did I eat? How do I feel afterwards? What complaints do I have?)

The aim of this procedure is to set up your diet with irritable bowel syndrome entirely individually: without side effects, but healthy and tasty and well supplied with nutrients.

One question everyone is probably asking by now is: which foods are low in FODMAPs and which are high in FODMAPs? We have put together a list of foods for irritable bowel syndrome that you can use as a guide for the FODMAP diet. As always, though, one thing holds true: every gut is different, so try it out for yourself.

Alongside a suitable diet for irritable bowel syndrome, there are some preparations that can help to reduce inflammation and support the body in healing. Besides the medicines your doctor prescribes, these food supplements can be a good idea:

• B vitamins have a positive effect on the regeneration of the intestinal lining after inflammation
• Omega 3 fatty acids reduce inflammation in the body
• Vitamin D gives the immune defences a push and generally supports wellbeing
• High quality probiotics displace germs that make you ill and strengthen the protective function of the gut barrier

The nutrition scientists at Foodpunk can help you set up your diet for irritable bowel syndrome in the best possible way, starting with the FODMAP diet, in which foods with a high value are excluded. That way you do not have to spend 4 to 6 weeks puzzling over what you can even cook for yourself, but have tasty recipes friendly to an irritable bowel, which support the goal of your FODMAP diet, the diagnosis, perfectly.

With the swap calculator you can change the recipes after the exclusion phase and gradually try out foods with a higher FODMAP value. As soon as you have successfully found out which foods you tolerate well with your irritable bowel syndrome, our experts will create an individual nutrition plan for you, in which all the foods you do not tolerate are excluded. That way you can be sure that none of the factors that trigger your complaints ends up in the pot by accident. And the best part: no more going round in circles wondering whether and how you can adapt a recipe for yourself. We take care of that. For you it is simply: mind off, enjoyment on. At last.