How To Eat More Foods With IBS (Food Allergy vs Intolerance)

How Common Are Food Allergies & Intolerance’s?

In Australia and New Zealand, food allergies affect;

  • 10% or 1 in 10 infants
  • 4-8% or 1 in 20 children aged up to 5 years old
  •  About 2% or 2 in 100 adults

The most common triggers for food allergies are;

  • Wheat
  • Egg
  • Cow’s milk
  • Soy
  • Shellfish
  • Peanut
  • Tree nut
  • Sesame
  • Seafood

A child having a food allergy may not necessarily mean that it will continue into adulthood. Studies currently show that one third of adults under 30 years old, who have food allergies are food allergies that continued from childhood. Peanut allergies have been shown to be more likely to continue into adulthood with this occurring in 80% of people with a peanut allergy. Other food allergies that are more likely to continue into adulthood are tree nut, seed and seafood allergies. Whereas egg and shellfish allergies have been shown to be less likely to continue into adulthood.

There is currently limited information available about the prevalence of food intolerance’s. However, in 2011-12 the Australian Bureau of Statistics found that 17% of Australians aged over 2 years of age avoided eating a particular food because of a food allergy or intolerance. This is 3.7 million people in Australia.

Is Food Allergy Increasing?

This is question that I get asked quiet often and is an area where extra research is needed, and is currently being conducted, to be able to fully understand.

In Australia, the USA and UK hospital admissions have more than doubled for anaphylaxis, which is a severe type allergic reaction, in the past 10 years. In Australia, hospital admissions due to anaphylaxis related to food allergies in infants and children up to 4 years old is even greater and is five times higher than it was 10 years ago.

As I mentioned above, we currently don’t have any clear answers or information about why the prevalence of food allergies in increasing, particularly in children, however there are a number of suggested possibilities which include;

  • Waiting or delaying introducing food containing known food allergens such as peanuts and egg.
  • The way that foods are processed. For example, boiled peanuts compared to roasted peanuts.
  • The hygiene hypothesis. This suggests that a higher risk of developing a food allergy is associated with a lower exposure to infections during early childhood.
  • The way that we were born, caesarean section vs vaginal birth, as this impacts on the amount and diversity of the different types of bacteria in our gut microbiome. The diversity of gut bacteria is lower in infants born via caesarean section and the composition of their gut microbiome is different to those born vaginally. Vaginal births are associated with a lower risk of not only food allergies, but also eczema and asthma.

What is a Food Allergy?

A food allergy is when our immune system reacts to a food protein that the body wrongly thinks is harmful which causes a person to have a reaction and get symptoms. There are different types of food allergies which can cause different reactions. Some reactions can happen quickly and usually occur within 30 minutes, however, can also occur up to 2 hours of eating a particular food. This is known as an IgE-mediated food allergy and symptoms can include;

  • Hives
  • Swelling of the lips, tongue, throat, face and eyes
  • Stomach pain
  • Vomiting
  • Difficulty breathing and dizziness
  • Anaphylaxis

Some symptoms can be more delayed and can occur between 2 hours and 2 days after consuming a food. These reactions involve a different part of the immune system and are known as non-IgE mediated food allergies. It’s important to note that non-IgE medicated food allergy reactions can have both an immediate and delayed onset. Symptoms from this type of reaction usually involve the skin, stomach and digestive system and can include;

  • Nausea
  • Vomiting
  • Diarrhoea
  • Constipation
  • Skin reactions such as eczema

Types of Allergic Reactions to Food

Most people in Australia aren’t aware of the signs and symptoms of food allergy or that there are even different types of symptoms and reactions that people can have.

Although symptoms of a food allergy are usually obvious, it is really important to know the difference between a mild to moderate and severe allergic reactions as these can be life-threatening. These types of allergic reactions are common in Australia and New Zealand.

Mild to Moderate Reactions

Symptoms of a mild to moderated food allergy include;

  • Stomach pain
  • Vomiting
  • Hives or welts on the skin
  • Swelling of the lips, face or eyes

Anaphylaxis (Severe) Reactions

Anaphylaxis can be a life-threating reaction to a food allergen, and it should always be treated as a medical emergency. Anaphylaxis can be prevented by avoiding any food or foods that people know have an allergen in them and immediately administering adrenaline via an autoinjector if a reaction occurs. It is really important to know that not all people with food allergies will have an anaphylactic reaction.

Symptoms of anaphylaxis include;

  • Difficulty breathing or noisy breathing
  • Persistent cough or wheezing
  • Swelling of the tongue
  • Swelling or tightness in the throat
  • Finding it hard to talk or speaking with a hoarse voice
  • Ongoing dizziness and/or collapse
  • Paleness or limpness in young children

What is a Food Intolerance?

A food intolerance is not the same as a food allergy as a person’s reaction or symptoms caused by a food intolerance does not involve the immune system and are rarely life-threatening. A food intolerance is when a person cannot properly digest or fully break down and absorb certain foods. The most common food intolerance is lactose which is found in dairy foods.

There is a wide range of symptoms to food intolerance’s which are individual to each person. Symptoms can occur quickly or can also be delayed. Symptoms usually involve the stomach and digestive system and can include;

  • Bloating
  • Diarrhoea
  • Excessive wind
  • Stomach cramps

What are Natural Food Chemicals?

Chemical sensitivities or intolerances are due to naturally occurring chemicals found in foods and include salicylates, amines, and glutamate. When ingested these chemicals cause reactions by irritating nerve endings in different parts of the body which leads to symptoms. These symptoms can be different in each person. These can include;

  • Bloating
  • Nausea
  • Stomach discomfort or pain
  • Diarrhoea
  • Headaches and migraines
  • Hives and swelling
  • Sinus trouble
  • Mouth ulcers

How an Elimination Diet Can Help

Determining the dietary triggers to your food allergies or intolerance’s is incredibly important. This will allow you to know which foods you can and cannot eat safely and which foods are likely to trigger your symptoms. It will also allow you to avoid unnecessarily restricting foods from your diet.

Managing a food allergy or intolerance may involve a temporary elimination diet. This is the only reliable way to confirm if diet is playing a role in your symptoms. This can be a big adjustment to your current diet and eating habits and may seem difficult and overwhelming at first. You may feel that meals times become more complicated or that eating out is no longer fun. However, you can relax! There are so many easy strategies that an Accredited Practising Dietitian (APD) will be able to provide you with so that you can still enjoy your activities and have pleasure from eating.

It is very important to remember that an elimination diet should only be completed under the supervision on an APD and only for a short amount of time. This is due to the fact that people following a restrictive diet, such as an elimination diet, are more at risk of nutrient deficiencies. An APD will provide you with appropriate substitutes to your favourite foods while ensuring you are getting all the nutrition you need with a healthy, balanced diet and a wide variety of foods.

If you’re newly diagnosed with IBS and bloating and told by your doctor to follow the FODMAP diet, but now you have no idea where to start, you’re not alone because 1 in 5 Australians have IBS. But you don’t have to be that person that lives with it for the rest of your life uncontrolled. You can manage it by following the FODMAP diet so that you can eliminate bloating and go out and enjoy the weekend with your friends, apply for coaching.

References

  1. Agostoni C, Decsi T, Fewtrell M et al (2008). Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition. 46(1): 99-110.
  2. Anderson AS (2008). Increase in hospitalisations for anaphylaxis in the first two decades of life. Journal of Allergy and Clinical Immunology. 121(2): Abstract 104, S27.
  3. Australian Bureau of Statistics (ABS). Australian Health Survey: Nutrition First Results – Foods and Nutrients, 2011-12 [Internet]. Cited 2019 June 1. Available from:https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Food%20avoidance%20due%20to%20allergy,%20intolerance%20or%20ethical%20religious%20reasons~600
  4. Australasian Society of Clinical Immunology and Allergy (ASCIA). Food Allergy [Internet]. Cited 2019 May 28. Available from: https://www.allergy.org.au/patients/food-allergy/food-allergy
  5. Australasian Society of Clinical Immunology and Allergy (ASCIA). Food Intolerance [Internet]. Cited 2019 May 28. Available from: https://www.allergy.org.au/patients/food-other-adverse-reactions/food-intolerance
  6. Dominguez-Bello MG, Costello EK, Contreras M, Magris M, Hidalgo G, Fierer N et al (2010). Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proceedings of the National Academy of Sciences of the USA. 107: 11971-5.
  7. Gandy J & the British Dietetic Association. Manual of Dietetic Practice–Fifth Edition. 2014: 663-695.
  8. Greer FR, Sicherer SH, Burks AW et al (2008). Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics. 121(1): 183.
  9. Grundy J, Matthews S, Bateman B et al (2002). Rising prevalence of allergy to peanut in children: Data from 2 sequential cohorts. Journal of Allergy and Clinical Immunology. 110(5): 784-9.
  10. Gupta R, Sheikh A, Strachan DP et al (2007). Time trends in allergic disorders in the UK. Thorax. 62(1): 916.
  11. Kramer MS & Kakuma R (2006). Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev. 3: CD000133.
  12. Mullins RJ (2007). Paediatric food allergy trends in a community-based specialist allergy practice, 1995-2006. Med J Aust. 186(12): 618-21.
  13. Noel RJ, Putnam PE, Rothenberg ME (2004). Eosinophilic esophagitis. New England Journal of Medicine. 351: 940–941.
  14. Poulos LM, Waters AM, Correll PK et al (2005). Trends in hospitalizations for anaphylaxis, angioedema, and urticaria in Australia, 1993-1994 to 2004-2005. Journal of Allergy and Clinical Immunology. 120(4): 878-84.
  15. Sampson HA (2004). Update on food allergy. Journal of Allergy and Clinical Immunology. 113(5): 805-19.
  16. Sheikh A, Hippisley-Cox J, Newton J et al (2008). Trends in national incidence, lifetime prevalence and adrenaline prescribing for anaphylaxis in England. Journal of the Royal Society of Medicine. 101(3): 139-43.
  17. Tarini BA, Carroll AE, Sox CM et al (2006). Systematic review of the relationship between early introduction of solid foods to infants and the development of allergic disease. Archives of Pediatrics & Adolescent Medicine.160(5): 502.
  18. Van Nimwegen FA, Penders J, Stobberingh EE, Postma DS, Koppelman GH, Kerkhof M, et al (2011). Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy. Journal of Allergy and Clinical Immunology. 128.

10 Ways To Increase Fibre to Eliminate Bloating & Constipation

What is Fibre?

Fibre is an important nutrient in improving our overall health. Fibre is the edible parts of plants that are unable to be digested, or broken down, and absorbed in our small intestine. These are then either partly or fully broken down by the bacteria in our large intestine.

In Australia, it is currently recommended that women consume 25g of fibre per day and men consume 30g of fibre per day. However, most Australians currently do not consume enough fibre.

Types of Fibre

There are three different types of fibre. As you will see below, they each affect the function of our gut in different ways and have numerous health benefits.

Soluble Fibre

Soluble fibre is mainly found in the cells of plants and includes pectins, gums and mucilage. This form of fibre assists with delaying or slowing down the speed that our stomach empties. This not only helps us feel fuller for longer, but also helps to keep our blood sugar levels stable and lower cholesterol. Soluble fibre is found in foods such as oats, barley, vegetables, fruit and legumes.

Insoluble Fibre

Insoluble fibre is the building block for plant cell walls and include cellulose, hemicelluloses and lignin. This type of fibre helps to keep our stools soft by absorbing water throughout our gut. This assists with preventing constipation and keeping our bowel movements regular. Insoluble fibre also helps to keep us fuller for longer and supports keeping our gut microbiome happy and healthy. It is found in foods such as the skins of fruit and vegetables, seeds, nuts and wholegrain cereals and breads.

Resistant Starch

Resistant starch is not digested or broken down in the small intestine. This means that when it gets to our large intestine it is fermented by the bacteria in our bowel to produce gas. This promotes good bacteria and forms short-chain fatty acids (SCFA). These play an important role in our gut health and maintaining a healthy microbiome. They may also help to protect against bowel cancer and assists with lowering cholesterol levels. Resistant starch is found in rice, under-cooked pasta, unripe bananas, cooked and cooled potato.

Health Benefits of Fibre

Adequate fibre intakes have been shown to decrease a person’s risk of developing chronic diseases such as bowel cancer, cardiovascular disease and diabetes. Fibre can also help with making us for fuller for longer after meals and plays a vital role in making sure our gut is working normally and keeping our gastrointestinal system healthy.

Eating enough fibre has been shown to;

  • Decrease cholesterol levels.
  • Lower blood pressure.
  • Control our blood glucose levels.
  • Improve and prevent constipation.
  • Decrease loose stools, manage diarrhoea and the symptoms associated with diarrhoea such as stomach pain, cramps and wind.
  • Increase the number of good bacteria in our gut.

My Expert Tips for Increasing Your Fibre Intake

The easiest way to make sure that we are getting enough fibre each day is by eating a healthy balanced diet with a wide variety of foods. This is easily achieved by ensuring that we eat foods from each of the 5 food groups. These are grains (cereals), meat and/or alternatives, fruit, vegetables and dairy and/or alternatives.

My expert tips for increasing your fibre intake are;

  1. Include at least 1-1.5 cups of vegetables with your lunch.
  2. Include at least 1.5-2 cups of vegetables with your dinner.
  3. Include vegetables as snacks.
  4. Choose wholegrain and/or high fibre breads, cereals, pastas and rice instead of refined or white versions of these foods.
  5. Eat at least 2 pieces of fruit each day.
  6. Use fruit for snacks and desserts.
  7. Add fruit to your breakfast cereal, smoothies or yoghurt.
  8. Keep edible skins on your fruit and vegetables.
  9. Try having a small handful of nuts or seeds as snacks.
  10. Add legumes such as beans or lentils to your meals.

When we increase our intake of fibre it is important that we also make sure that we are drinking enough water throughout the day. As mentioned above, fibre absorbs water in our gut to assist with keeping our stools soft and preventing constipation. Not drinking enough fluid can result in fluid not being absorbed from our gut into our stools. This can result in harder stools and cause stomach pain or discomfort and constipation.

If you’re struggling with bloating and aren’t sure what to eat, I show my clients step by step how to follow the FODMAP diet to eliminate bloating and live their best life. Being diagnosed with IBS doesn’t have to be a punishment when you know what to do, how to eat and how to live your best life and I’ll show you that when we work together, apply for coaching.

References

  1. Dhingra D, Michael M, Rajput, H & Patil RT (2012). Dietary fibre in foods: a review. Journal of Food Science and Technology. 49(3): 255–266.
  2. Li YO & Komarek AR (2017). Dietary fibre basics: Health, nutrition, analysis, and applications. Food Quality and Safety. 1: 47–59.
  3. Mohammadi AA, Jazayeri S, Khosravi-Darani K, Solati Z, Mohammadpour N, Asemi Z, et al (2016). The effects of probiotics on mental health and hypothalamic-pituitary-adrenal axis: a randomized, double-blind, placebo-controlled trial in petrochemical workers. Nutritional Neuroscience. 19(9):387-95.
  4. National Health and Medical Research Council. Eat for Health-Educator Guide. Canberra; 2013:11-23.
  5. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand-Executive Summary. Canberra; 2006.
  6. Sekirov I, Russell SL, Antunes LCM, Finlay BB (2010). Gut microbiota in health and disease. Physiological Reviews. 90: 859-904.

Identify What The Gut Microbiome Is (To Manage Bloating & IBS)

What is the Gut Microbiome?

Did you know that our gut bacteria and gut microbiome can influence our overall health? This includes Irritable Bowel Syndrome (IBS), heart disease, our immune system, mental health, body weight and sleep patterns.

The gut microbiome is very complex and can vary from person to person. It is a term used to describe the large and diverse group of microorganisms, also sometimes referred to as stomach bacteria or gut bugs, that live in our gastrointestinal tract. The diversity and amount of these bacteria increase throughout the gut from the stomach, to the small intestine and then large intestine or colon.

FUN FACT – Did you know that your colon has the most amount of gut bacteria?

Diet and the Gut Microbiome

Our diet significantly affects the makeup and diversity of our gut microbiome. The composition of our gut microbiome can begin to change in as little as one day after changing our diet. This can influence our overall health by the products that are made when the bacteria in our colon breaks down or ferments the nutrients that we have eaten in our diet.

These are mainly certain types of carbohydrates called fructans (including inulin and oligofructose) and fibre (including resistant starch, wheat bran, beta-glucan and psyllium). These are also known as prebiotics and produce short-chain fatty acids (SCFA). These help to protect our gastrointestinal tract, speed up repair of any damage in our gastrointestinal tract and reduce inflammation.

It is also important to remember that although diet has a major impact on the gut microbiome, some medications and conditions can also alter its composition. These include constipation, IBS, inflammatory bowel disease and some nutritional supplements.

What are Prebiotics?

Prebiotics have been scientifically shown to impact the gut microbiome in healthy people, however there is limited evidence for their use in different diseases. Prebiotics are known for promoting “good bacteria” in our gut which assists with improving our overall gut health. As mentioned above, these are natural non-digestible nutrients, particularly carbohydrates and fibre found in the food that we eat. Prebiotics include fructo-oligosaccharides and galactooligosaccharides. These are found in foods such as bananas, onions, garlic, leeks, asparagus, artichokes, soybeans and whole-wheat foods.

What are Probiotics?

Probiotics is a term used to describe live microorganisms such as bacteria or yeast. They are commonly referred to as “good bacteria” and are found naturally in our gut. Health benefits, particularly in the gastrointestinal tract, may be seen when enough are consumed. The most common probiotic bacteria are from the Lactobacillus and Bifidobacterium species. Probiotics are currently being added to a number of different foods including yogurt, cereal, cheese, milk, juice and even chocolate. They are also available as supplements. However, it is important to remember that there is no guarantee that the probiotics added to foods will have health benefits. There is currently limited evidence supporting the use of probiotics as scientific research does not reliably show that they modify the gut microbiome. However, some strains are used in the management of some conditions such as IBS.

Follow My 5 Easy Steps to Keep Your Gut Healthy Like a Pro!

STEP 1: Increase Your Intake of Fruit

Try and eat at least 2 pieces of fruit each day. Choose a variety of different types and colours of fresh fruit that are in season and try using fruit for snacks and desserts. They are a good source of vitamins, including vitamin C, and folate and provide potassium, dietary fibre and carbohydrates in the form of natural sugars. Edible skins are particularly high in fibre, but fibre is also in the fruit flesh.

STEP 2: Increase your intake of Vegetables

Try and eat at least 2.5 cups each day. Include a variety of different types and colours including beans and legumes. Try new ways of cooking with vegetables like roasting, baking, barbequing and stirfrying. Including these in your diet can provide a range of nutrients as they are a good source of vitamins, minerals and dietary fibre.

STEP 3: Include a wide variety of wholegrain breads, cereals and pastas in your diet

These provide more dietary fibre, vitamins and minerals than refined or white versions of grain (cereal) foods. Eating wholegrain and/or high fibre cereal foods will not only keep your gut bacteria happy but can help reduce the risk of heart disease, type 2 diabetes, excessive weight gain, and some cancers.

STEP 4: Limit your Intake of Red Meat

Great substitutes are poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans. It is currently recommended that no more that 455g of cooked lean red meat is eaten per week as eating larger amounts can be linked with a higher risk of developing bowel cancer. Eating large amounts of protein from animal sources has also been shown to alter our gut microbiome. This can decrease the amount and diversity of the gut bacteria found in our gastrointestinal tract.

STEP 5: Make Sure you Drink Plenty of Water

Drinking enough water helps make sure that we do not get dehydrated and can also assist with decreasing our risk of constipation. You may have heard a lot about how much water we should drink, such as 8 cups or 2 litres per day, however as we are all different, there is no one amount that is recommended for everyone. The best way to judge if you are drinking enough water is by looking at the colour of your urine. Dark urine likely means that you may be dehydrated and have not had enough fluid, while clear urine means you may be drinking too much. Aim for a pale-yellow colour as this is likely to indicate you are well hydrated.

If you’re struggling with bloating and aren’t sure what to eat, I show my clients step by step how to follow the FODMAP diet to eliminate bloating and live their best life. Being diagnosed with IBS doesn’t have to be a punishment when you know what to do, how to eat and how to live your best life and I’ll show you that when we work together, apply for coaching.

References

  1. Collins SM (2014). A role for the gut microbiota in IBS. Nature Reviews Gastroenterology & Hepatology. 11: 497-505.
  2. Fraher MH, O’Toole PW, Quigley EMM (2012). Techniques used to characterize the gut microbiota: a guide for the clinician. Nature Reviews Gastroenterology & Hepatology. 9: 312-22.
  3. National Health and Medical Research Council. Eat for Health-Educator Guide. Canberra; 2013:11-23.
  4. Sekirov I, Russell SL, Antunes LCM, Finlay BB (2010). Gut microbiota in health and disease. Physiological Reviews. 90: 859-904.

The Journey Towards Managing Your Bloating & IBS (FODMAP Diet Phase 1-3)

What is the FODMAP Diet?

The FODMAP diet is a therapeutic diet and is often recommended to those who have Irritable Bowel Syndrome (IBS). IBS is a common gastrointestinal disorder that affects 1 in 7 adults and is characterised by symptoms that are not explained by other disorders such as coeliac disease and inflammatory bowel disease. The most common symptoms of IBS include; stomach pain, bloating, wind, diarrhoea, constipation and nausea.

These symptoms can lead to stress and anxiety and affect our quality of life. The exact cause of IBS is not completely understood, however there are a number of things that may trigger symptoms (to learn more about IBS read my “Identify Your IBS Type To Manage Bloating & IBS)” blog).

The dietary cause of the symptoms associated with IBS is largely due to a group of carbohydrates called FODMAPs. This is an acronym which stands for;

  • Fermentable
  • Oligosaccharides
  • Disaccharides
  • Monosaccharides
  • And Polyols

Examples of FODMAPs include fructose, lactose, fructans and sorbitol. These carbohydrates, or sugars, can be poorly absorbed in the small intestine and fermented or broken down in the large intestine. This produces gas which leads to the symptoms associated with IBS. FODMAPs are also small and increase the amount of water delivered throughout the gut. This is called an osmotic effect. The gas produced by the large intestine in combination with this osmotic effect can cause changes to our gut motility or it’s movement. This can result in the symptoms of constipation and/or diarrhoea.

FODMAPs are found in many common foods including fruit, vegetables, grains and dairy. Although these carbohydrates are poorly absorbed in everyone, they are believed to affect and cause symptoms in people with conditions such as IBS as their guts are more sensitive. It’s important to remember that FODMAPs are not the cause of IBS, however limiting these in the diet can help control IBS symptoms.

Did you know that a low FODMAP diet can help improve gut symptoms in up to 75% of people with IBS?

In order to follow a low FODMAP diet it is vital that you plan ahead as the diet can be quite restrictive and involves a number of changes to your diet. This means that you are more at risk of nutrient deficiencies. Therefore, it is recommended that the FODMAP diet be completed under the supervision on an Accredited Practising Dietitian (APD) as they are able to provide you with appropriate low FODMAP substitutes to your favourite foods while ensuring you are getting all the nutrition you need with a healthy, balanced diet and a wide variety of foods. Studies also show that those with IBS who follow the low FODMAP diet with the assistance of an APD can get better relief from their symptoms.

The 3 Phases of the FODMAP Diet

There are 3 phases to the FODMAP diet.

Phase 1 – Low FODMAP or Elimination Phase.

This usually occurs over 2-6 weeks. This phase of the diet requires people to avoid any high FODMAP foods and substitute these with low FODMAP alternatives. Restricting high FODMAP foods enables us to determine if someone is responding to the low FODMAP diet and whether it is resulting in a decrease in their IBS symptoms.

The low FODMAP diet can be restrictive and people often struggle with the amount of variety in their diet and also flavour. FODMAPs also contain fibre and are natural prebiotics, so those on a low FODMAP diet can struggle with meeting their fibre requirements which can lead to constipation. So, a big consideration is the long-term consequences of a low FODMAP diet. And this is one of the reasons why it is only recommended for a short period of time of 2-6 weeks.

Phase 2 – Reintroduction or Challenge Phase

This usually takes around 6-8 weeks to complete. This phase involves the challenging or reintroduction of each of the FODMAP groups in a systematic way that is well planned to ensure that the results you get are clear and accurate. During this phase people continue to follow the low FODMAP diet as their base diet, with each FODMAP group being challenged one at a time. A dietitian will give advice and guidance on which food to use for challenging, the order to reintroduce them and also the amount.

This phase helps to determine if FODMAPs may be triggering a person’s symptoms. It not only helps to identify which FODMAPs may be triggering a person’s symptoms, but also how much. This is a particularly important part of the diet as it will identify whether a person may be able to have a particular FODMAP or tolerate a small, medium or large amount of a FODMAP before getting symptoms.

Phase 3 – FODMAP Personalisation

This is where different FODMAP groups are added back into the diet based on the results from a person’s challenges. This phase is a particularly important phase of the FODMAP diet as it enables us to develop a long-term balanced diet to ensure people are able to maintain a healthy gut to improve their overall health and quality of life.

Expert Tips for Phase 1

My expert tips to follow during the elimination phase of the FODMAP diet are;

  1. Find a low FODMAP substitute for any high FODMAP foods in the diet so that those following the diet can still enjoy all the meals they love.
  2. Include foods from all 5 food groups to make sure that all nutritional requirements are met and to decrease the risk of developing a nutrient deficiency.

Strategies to add flavour without adding high FODMAP foods are also important. My expert tips are:

  1. Use spices or herbs like basil, chili, cumin, ginger, pepper, rosemary or thyme on meat, fish, chicken, or vegetables.
  2. Use maple syrup instead of honey to sweeten baked goods or cereal.
  3. Avoid flavouring foods with onion or garlic powder.
  4. Drink water, regular or decaffeinated coffee or black tea instead of herbal teas and fruit drinks or juices.

Expert Tips for Phase 2

The main thing that I hear clients struggle with and are concerned about during this phase of the FODMAP diet is managing a potential flare up of their symptoms during
the challenges. My expert tips to help with this are:

  1. Take time to relax. This can include relaxation tapes, yoga, or massage as these may help improve gut symptoms.
  2. Participate is regular exercise such as walking, cycling, swimming.
  3. Take time when eating meals and make sure food is chewed well. Eating fast can result in us swallowing more air which can lead to symptoms such as bloating.
  4. Keep a food and symptom diary during each of the FODMAP challenges to help identify which FODMAPs caused symptoms.
  5. Using hot packs is also a great option to help improve gut symptoms.

Expert Tips for Phase 3

As the name suggests, this personalisation phase is individual for everyone. My expert tips to follow during the personalisation phase of the FODMAP diet are;

  1. Let the results of the challenge phase guide the order in which each FODMAP is reintroduced back into the diet.
  2. Reintroduce foods that were well tolerated first.
  3. Try not to become disheartened if symptoms are experienced. Some gut symptoms from time to time are quite normal. We only need to become concerned if our symptoms are staring to impact on our ability to do our usual activities and quality of life.
  4. Keep track of any symptoms that may be experienced. It can be helpful to rate symptoms on a scale of 1-10, with 1 being no symptoms and 10 being severe symptoms.

If you’re newly diagnosed with IBS and bloating and told by your doctor to follow the FODMAP diet, but now you have no idea where to start, you’re not alone because 1 in 5 Australians have IBS. But you don’t have to be that person that lives with it for the rest of your life uncontrolled. You can manage it by following the FODMAP diet so that you can eliminate bloating and live your best life, apply for coaching.

References

  1. Gandy J & the British Dietetic Association. Manual of Dietetic Practice–Fifth Edition. 2014: 460-466.
  2. Gibson PR, Shepherd SJ (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology. 25: 252–258.
  3. Monash University. The 3 steps of the FODMAP diet [Internet]. Cited 2019 April 22. Available from: https://www.monashfodmap.com/blog/3-phases-low-fodmap-diet/
  4. Monash University. Monash University Low FODMAP DietTM Application for Android. Cited 2019 April 22.
  5. National Institute for Health and Care Excellence (NICE) (2008). Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. CG61.
  6. Tuck C & Barrett, J (2017). Re-challenging FODMAPs: the low FODMAP diet phase two. Journal of Gastroenterology and Hepatology. 32 (Suppl 1): 11–15.

5 Steps To Manage Bloating On a Low FODMAP Diet

Did you know that our gut bacteria and gut microbiome can influence our overall health? This includes Irritable Bowel Syndrome (IBS), heart disease, our immune system, mental health, body weight and sleep patterns.

What is the Gut Microbiome?

The gut microbiome is very complex and can vary from person to person. It is a term used to describe the large and diverse group of microorganisms, also sometimes referred to as stomach bacteria or gut bugs, that live in our gastrointestinal tract. The diversity and amount of these bacteria increase throughout the gut from the stomach, to the small intestine and then large intestine or colon. Did you know that your colon has the most amount of gut bacteria?

Diet and the Gut Microbiome

Our diet significantly affects the makeup and diversity of our gut microbiome. The composition of our gut microbiome can begin to change in as little as one day after changing our diet. This can influence our overall health by the products that are made when the bacteria in our colon breaks down or ferments the nutrients that we have eaten in our diet.

These are mainly certain types of carbohydrates called fructans (including inulin and oligofructose) and fibre (including resistant starch, wheat bran, beta-glucan and psyllium). These are also known as prebiotics and produce short-chain fatty acids (SCFA). These help to protect our gastrointestinal tract, speed up repair of any damage in our gastrointestinal tract and reduce inflammation.

It is also important to remember that although diet has a major impact on the gut microbiome, some medications and conditions can also alter its composition. These include constipation, IBS, inflammatory bowel disease and some nutritional supplements.

The Importance of Fibre

Fibre is an important nutrient in improving our overall health. Adequate fibre intakes have been shown to decrease a person’s risk of developing chronic diseases such as bowel cancer, cardiovascular disease and diabetes. Fibre can also help with making us for fuller for longer after meals and plays a vital role in making sure our gut is working normally and keeping our gastrointestinal system healthy.

Eating enough fibre has been shown to;

  • Decrease cholesterol levels.
  • Control our blood glucose levels.
  • Improve constipation.
  • Decrease loose stools, manage diarrhoea and the symptoms associated with diarrhoea such as stomach pain, cramps and wind.
  • Increase the number of good bacteria in our gut.

Fibre is the edible parts of plants that are unable to be digested, or broken down, and absorbed in our small intestine. These are then either partly or fully broken down by the bacteria in our large intestine.

In Australia, it is currently recommended that women consume 25g of fibre per day and men consume 30g of fibre per day. However, most Australians currently do not consume enough fibre.

For those with IBS, it can be difficult to eat enough fibre when following a low FODMAP diet because they are eating less of these carbohydrates that contain fibre and are also natural prebiotics. Prebiotics are known for promoting “good bacteria” in our gut which assists with improving our overall gut health. Prebiotics have been scientifically shown to impact the gut microbiome in healthy people.

Follow My 5 Easy Steps to Keep Your Gut Healthy Like a Pro!

STEP 1: Increase Your Intake of Fruit

Try and eat at least 2 pieces of low FODMAP fruit each day such as  strawberries, unripe bananas, grapes, rockmelon, pineapple, oranges and kiwifruit. Choose a variety of different types and colours of fresh fruit that are in season and try using fruit for snacks and desserts. They are a good source of vitamins, including vitamin C, and folate and provide potassium, dietary fibre and carbohydrates in the form of natural sugars. Edible skins are particularly high in fibre, but fibre is also in the fruit flesh.

STEP 2: Increase your intake of Vegetables

Try and eat at least 2.5 cups of low FODMAP vegetables each day such as whole broccoli, spinach, potatoes, carrots, tomatoes, red capsicum, eggplant and bok choy. Include a variety of different types and colours including low FODMAP beans and legumes. Try new ways of cooking with vegetables like roasting, baking, barbequing and stir-frying. Including these in your diet can provide a range of nutrients as they are a good source of vitamins, minerals and dietary fibre.

STEP 3: Include a wide variety of wholegrain breads, cereals and pastas in your diet

These provide more dietary fibre, vitamins and minerals than refined or white versions of grain (cereal) foods. Eating wholegrain and/or high fibre cereal foods will not only keep your gut bacteria happy but can help reduce the risk of heart disease, type 2 diabetes, excessive weight gain, and some cancers. Low FODMAP options include spelt and gluten, wheat and rye free products.

STEP 4: Limit your Intake of Red Meat

Great substitutes are poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans. It is currently recommended that no more that 455g of cooked lean red meat is eaten per week as eating larger amounts can be linked with a higher risk of developing bowel cancer. Eating large amounts of protein from animal sources has also been shown to alter our gut microbiome. This can decrease the amount and diversity of the gut bacteria found in our gastrointestinal tract.

STEP 5: Make Sure you Drink Plenty of Water

Drinking enough water helps make sure that we do not get dehydrated and can also assist with decreasing our risk of constipation. You may have heard a lot about how much water we should drink, such as 8 cups or 2 litres per day, however as we are all different, there is no one amount that is recommended for everyone. The best way to judge if you are drinking enough water is by looking at the colour of your urine. Dark urine likely means that you may be dehydrated and have not had enough fluid, while clear urine means you may be drinking too much. Aim for a pale-yellow colour as this is likely to indicate you are well hydrated.

If you’re struggling with bloating and aren’t sure what to eat, I show my clients step by step how to follow the FODMAP diet to eliminate bloating and live their best life. Being diagnosed with IBS doesn’t have to be a punishment when you know what to do, how to eat and how to live your best life and I’ll show you that when we work together, apply for coaching.

References

  1. Collins SM (2014). A role for the gut microbiota in IBS. Nature Reviews Gastroenterology & Hepatology. 11: 497-505.
  2. Fraher MH, O’Toole PW, Quigley EMM (2012). Techniques used to characterize the gut microbiota: a guide for the clinician. Nature Reviews Gastroenterology & Hepatology. 9: 312-22.
  3. Gibson PR, Shepherd SJ (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology. 25: 252–258.
  4. Hong SN, Rhee PL (2014). Unraveling the ties between irritable bowel syndrome and intestinal microbiota. World Journal of Gastroenterology. 20: 2470-81.
  5. National Health and Medical Research Council. Eat for Health-Educator Guide. Canberra; 2013:11-23.
  6. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand-Executive Summary. Canberra; 2006.
  7. Sekirov I, Russell SL, Antunes LCM, Finlay BB (2010). Gut microbiota in health and disease. Physiological Reviews. 90: 859-904.

Identify Your IBS Subtype To Manage Bloating & IBS

What is Irritable Bowel Syndrome (IBS)?

IBS is a common functional gastrointestinal disorder that affects 1 in 7 adults. It is characterised by symptoms that are not explained by other disorders such as coeliac disease and inflammatory bowel disease. The symptoms associated with IBS can vary from person to person. This includes the frequency severity and the types or number of symptoms experienced. The most common symptoms of IBS include;

  • Stomach pain or discomfort
  • Bloating
  • Wind
  • Diarrhoea
  • Constipation
  • Nausea

These symptoms can lead to stress and anxiety and affect our quality of life. The exact cause of IBS is not completely understood, however there are numerous factors that are believed to potentially trigger symptoms. The main cause is thought to be enteric nervous system dysfunction. This is the main and most important nervous system in our gastrointestinal tract (GIT). It is often referred to as our “second brain” and plays an important role in regulating the function of our GIT including motility or its movements and the transit of the contents within it. Others include low grade inflammation, gut hypersensitivity, delayed gastric emptying, acute gastroenteritis and lifestyle factors including psychological stress and life events.

How is IBS Diagnosed?

There are currently no medical tests available that can diagnose IBS. Your doctor is likely to take a detailed medical history and complete a physical exam to eliminate whether your symptoms may be caused by another medical condition. Your Dietitian will take a detailed medical, lifestyle and dietary history including the type and severity of symptoms you have been experiencing.

Once other conditions have been ruled out a set of diagnostic criteria called the Rome IV Criteria for Diagnosing IBS will be used to confirm if you have IBS. This includes whether you have been experiencing recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, which is associated with 2 or more of the following;

  • Related to defecation (may be increased or unchanged by defecation)
  • Associated with a change in stool frequency
  • Associated with a change in stool form or appearance

What are IBS Subtypes?

IBS subtypes are determined on how often very loose or very hard stools occur. Percentages are used to assist with determining how frequently different stool types are occurring and are based on stool form on days with at least one irregular bowel movement.

There are three main subtypes of IBS;

  • IBS-C: constipation predominant
  • IBS-D: diarrhoea predominant
  • IBS-M: mixed bowel habits

There is also a fourth IBS subtype, IBS-U: unclassified. This is used when a person meets the diagnostic criteria for IBS, however their bowel habits cannot be accurately categorised into one of the 3 subtypes above.

It is important to remember that IBS subtypes are not separate conditions and that a subtype can be re-classified based on changes to a person’s bowel habits. Symptom quantity, intensity, and severity can also vary from person to person.

IBS subtypes

How Knowing Your IBS Subtype Can Manage Your IBS Symptoms

Knowing your IBS subtype is important as they each have different clinical signs and symptoms and management strategies vary between the different subtypes. Knowing your IBS subtype means that the management of your IBS can be individually tailored to your meet your specific needs which will assist with improving your symptoms.

Through changes to your diet and lifestyle, the nutritional management of IBS aims to improve your quality of life and decrease the frequency and severity of your symptoms. A dietitian will be able to work with you to develop a personalised management plan to ensure this occurs whilst you are getting all the nutrition you need with a healthy, balanced diet and a wide variety of foods.

The dietary cause of the symptoms associated with IBS is largely due to a group of carbohydrates called FODMAPs (Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). Examples of FODMAPs include fructose, lactose, fructans and sorbitol. These carbohydrates can be poorly absorbed in the bowel, which leads to the symptoms associated with IBS. Did you know that a low FODMAP diet can help improve gut symptoms in up to 75% of people with IBS? It’s important to remember that FODMAPs are not the cause of IBS, however limiting these in the diet can help control IBS symptoms. Studies also show that those with IBS who follow the low FODMAP diet with the assistance of an Accredited Practising Dietitian can get better relief from their symptoms.

If you’re newly diagnosed with IBS and bloating and told by your doctor to follow the FODMAP diet, but now you have no idea where to start, you’re not alone because 1 in 5 Australians have IBS. But you don’t have to be that person that lives with it for the rest of your life uncontrolled. You can manage it by following the FODMAP diet so that you can eliminate bloating and go out and enjoy the weekend with your friends, apply for coaching.

References

  1. Gandy J & the British Dietetic Association. Manual of Dietetic Practice–Fifth Edition. 2014: 460-466.
  2. Gibson PR, Shepherd SJ (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology. 25: 252–258.
  3. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). Functional bowel disorders. Gastroenterology. 130: 1480–1491.
  4. National Institute for Health and Care Excellence (NICE) (2008). Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. CG61.
  5. Schmulson MJ & Drossman DA (2017). What Is New in Rome IV. Journal of Neurogastroenterology and Motility. 23:151-163.