Irritable Bowel Syndrome (IBS) ad low FODMAP diet

by Dr Harold Gunatillake

There is no proper medicine to cure chronic irritable bowel syndrome, other than by dietetic discipline. This is a very common malady among Asians including Sri Lankans due to spicy carb varieties of food they eat, and silently suffer with the condition. In this syndrome you suffer with abdominal pain and cramping, a bloating feeling, gaseous embarrassing moments, constipation, followed by diarrhoea and mucus in your stools, with bleeding and with progressing weight loss. These symptoms are present in any chronic abdominal dysfunction, and may take time to suspect IBS through evaluation process.

It is a chronic recurrent progressive condition and all investigations prove negative and the diagnosis is made on having a typical history through trial and error. The causes are not known, but many factors can play a part. The walls of the small and large bowel muscles contract and relax in a coordinated rhythm as the food you eat passes through the stomach through your intestinal tract and your rectum.

Barium enema x rays show the spastic nature of the disease in the large bowel. Endoscopy may not reveal any positive findings, other than to rule out conditions like ulcerative colitis, Crohn’s and

The answer to your problem is not chemicals but starting on a low FODMAP diet, which is considered as the established treatment for people with IBS.
Dr Sean Bennet from the University of Gothenburg in Sweden has stated that for the right people, a low FODMAP diet can be highly effective.

What is low FODMAP diet?

There are certain foodstuffs that are known to worsen your symptoms. So FODMAP includes such food and stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) diet includes certain carbohydrates, foods such as wheat, barley, onion and legumes, foods rich in free fructose (including many fruits), and artificially sweetened products.

If you do not respond on this diet may have more abnormalities in your gut bacterial profiles, needs further investigations. Those who respond to this low FODMAP diet should continue same for the rest of your life.

Vegetables to be avoided are: Asparagus, artichokes, onions (all), leek bulb, garlic, legumes/pulses, sugar snap peas, onion and garlic salts, beetroot, Savoy cabbage, celery, sweet corn

What is allowed are: Alfalfa, bean sprouts, green beans, bok choy, capsicum (bell pepper), carrot, chives, fresh herbs, choy sum, cucumber, lettuce, tomato, zucchini.
So, the foods that Sri Lankans are addicted to like ‘Pol Sambol’, dhal and curries made from cabbage and other crucifers that accompany your rice is questionable, better avoid.

Eating rice is okay, but you need to avoid wheat products like bread and cakes and sweetmeat.

Beverages containing artificial sweeteners should be avoided.

Avoid excess fructose, fruits like Apples, Mango, Pear, Watermelon, high fructose corn syrup containing sodas and so on.
Lactose containing foods like ice-cream, custards, dairy desserts, evaporated milk, yoghurt, soft cheeses like ricotta cottage, should be avoided.
Galacto-Oligosaccharides are beans-baked beans, kidney beans, lentils and chickpeas should be avoided.
Polyols like apples, apricots, Pears plums prunes mushrooms should be avoided.

Rapidly fermentable short-chain carbohydrates that cannot be absorbed are called FODMAPS the presence of FODMAPs causes water to be dragged into the small intestine. Also as they are not absorbed, FODMAPs travel through your gut to the large intestine. When bacteria in your large gut have access to FODMAPs, they use them for energy to survive. The bacteria rapidly ferment FODMAPs and produce gas as a result. Excess gas production and water retention causes the intestines to expand. When the intestinal wall stretches from distension, the highly connected nerves around the intestines send signals to the brain.

People with IBS have very sensitive intestines, so these signals contribute to the pain they experience. To reduce FODMAP intake and to alleviate the distension, bloating and other symptoms of IBS, Monash University have developed the low FODMAP diet. People with medically diagnosed IBS should consult a dietician about trialling the diet. The Monash University Low FODMAP Diet app has been developed as a tool to help people with IBS manage their diet and alleviate symptoms
It is best that you get more information on low FODMAP diet through an experienced dietitian who specialises in teaching the low FODMAP diet.

Good advice by Dr harold