How To Manage Diarrhoea

What is Diarrhoea?

Diarrhoea is a relatively common digestive issue that most people will experience at some stage throughout their lives. Diarrhoea is when we pass loose or watery stools more than 3 times a day, or more often than what is normal for you. It can range from being mild to severe and is some cases even life-threatening due to dehydration. Diarrhoea related illnesses are one on the highest causes of death worldwide. There are a few factors that can contribute to the occurrence of diarrhoea including changes to diet and lifestyle, medical conditions, stress and anxiety, infection and some medications.

Diarrhoea occurs when our intestines are unable to properly absorb the nutrients and fluid during digestion. The nutrients in the food that we eat are absorbed in our small intestine. The undigestible parts of our food then pass through to the large intestine, or colon, which absorbs most of the remaining fluid. The remaining waste is then formed into stools and collects in the end of the colon and rectum and passed out of the body during a bowel movement.

Diarrhoea can be described as being either acute or chronic. So, what’s the difference?

Acute diarrhoea: This occurs suddenly and is when we experience 3 or more loose watery stools a day which lasts for less than 2 weeks. Most of the time acute diarrhoea will resolve itself after 1-2 days. It is usually treated by replacing any fluid or electrolytes that have been lost.

Chronic diarrhoea: This is when we have had diarrhoea lasting more than 4 weeks. Chronic diarrhoea may be caused by an underlying condition such as inflammatory bowel disease (IBD), coeliac disease or irritable bowel syndrome (IBS).

What is Functional Diarrhoea?

What this means is that there is not a physical or physiological cause for your diarrhoea. A person may be otherwise healthy, however despite this, is still having trouble with experiencing a normal bowel movement. Although the prevalence of functional diarrhoea hasn’t been well studied, it is reported to occur in 1.5% to 17% of people. It is characterised by ongoing loose watery stools that do not meet the criteria for IBS, however you may experience abdominal pain or bloating.

Once other conditions have been ruled out a set of diagnostic criteria called the Rome IV Criteria for Diagnosing Functional Diarrhoea will be used to confirm if you have this. This includes whether you have had;

  • Loose or watery stools occurring in more than 25% of stools without predominate stomach pain or bloating.

You must also meet the following;

How Often Should I Have a Bowel Movement?

This is a question that I get asked quiet frequently by my clients. What is considered normal can be different from person to person as everyone’s gut and lifestyles are different, but it can range from multiple times per day to three times per week.

What’s important to remember is that occasional changes to your bowel habits are normal and having more frequent bowel movements does not mean that you have diarrhoea, as long as you are not experiencing any pain and are following your usual bowel habits. You only need to keep an on eye out for it if you start experiencing changes to your bowel habits. As I have mentioned, everyone is different, so if you have been having more than what’s “normal” for you, it may mean that you have diarrhoea.

How Do I Know if My Stools Are Normal?

The Bristol Stool Chart below is a great tool to use help you figure out if your stools are healthy or if there is anything to be concerned about. It shows the different types of stools that you can have.

  • Types 1 or 2 indicate that you have constipation.
  • Types 3 and 4 are healthy stools.
  • Type 5 means that your stools are progressing towards diarrhoea.
  • Type 6 or 7 indicate that you have diarrhoea.

Bristol Stool Chart

Symptoms of Diarrhoea

There are so many different symptoms that can be experienced with diarrhoea and it’s important to remember that these will vary from person to person.

Common symptoms can include;

  • Frequent loose, watery stools
  • Urgency to have a bowel movement
  • Bloating
  • Abdominal pain or cramps
  • Nausea
  • Vomiting

Serious symptoms can include;

  • Blood in your stools
  • Fever
  • Pus in your stools
  • Painful bowel movements
  • Ongoing vomiting
  • Unable to keep fluids down

Causes of Diarrhoea

Causes of Acute Diarrhoea

  • Stress and anxiety
  • Gastroenteritis
  • Food poisoning
  • Viruses such as calici virus, adenovirus and rotavirus
  • Travelling, this is sometimes referred to as “travellers’ diarrhoea”
  • Tropical diseases such as typhoid and cholera
  • Bacteria such salmonella, campylobacter and shigella
  • Parasites such as giardia lamblia, cryptosporidium and tapeworm
  • Alcohol
  • Caffeine
  • Medications such as antibiotics which have short-term use

Causes of Chronic Diarrhoea

  • Food Allergies
  • Food intolerances such as lactose intolerance
  • Irritable bowel syndrome, particularly IBS-D
  • Bile acid malabsorption
  • Coeliac disease
  • Inflammatory bowel disease (crohn’s disease or ulcerative colitis)
  • Chronic constipation
    • This can cause the bowel to become blocked with hard stools. This can lead to the bowel leaking watery stools around the blockage. This is called overflow diarrhoea.
  • Hormonal disorders such as hyperthyroidism & diabetes
  • Bowel Cancer
  • Medications including antibiotics, antacids that contain magnesium, laxatives and those to treat cancer

My Expert Tips to Help You Manage Diarrhoea

  1. Choose foods that are high in soluble fibre.
    • These include oats, high-fibre cereals, barley, white bread, white rice, pasta and bananas.
    • Peel the skin off fruit and vegetables.
    • Soluble fibre slows digestion which helps with absorbing excess fluid in your bowel and makes your stools firmer.
  2. Eat foods with protein every day.
    • Choose lean meats including chicken and beef, fish, eggs and tofu.
  3. Drink plenty of fluids to avoid dehydration.
    • This can include water, diluted juice or cordial and herbal teas.
    • Drink them at room temperature.
    • If you are experiencing severe diarrhoea, oral rehydration solutions such as Hydralyte may be helpful.
  4. Eat small, frequent meals throughout the day rather than large meals.
    • Try to eat every 2-3 hours.
    • Be sure to include a range of foods from all the 5 food groups including grains, proteins, dairy and alternatives, peeled fruit and vegetables.
  5. Take time to relax and decrease stress and anxiety.
    • This can include relaxation tapes, yoga, or massage as these may help improve gut symptoms.
    • Try gentle exercise such as walking.
  6. Avoid alcohol, juice, soft drinks and caffeinated drinks such as tea and coffee.
  7. Reduce your intake of insoluble fibre.
    • Avoid unpeeled fruits and vegetables, bran, wholemeal bread, wheat-based cereals, brown rice, dried beans, nuts and seeds.
    • You can replace wholegrain breads and cereals with white versions of these.
  8. Fibre supplements containing soluble fibre may also be helpful.
    • These include psyllium, oats and methylcellulose.
    • Make sure to increase your intake of these slowly.
  9. Limit your intake of high fat and spicy foods.
    • Avoid take-away and deep-fried foods, pastries, cream sauces, chips, butter and sausages.
    • Avoid foods with chilli in them.
  10. Avoid “sugar free” foods and those with artificial sweeteners such as chewing gum and lollies.
  11. Try a probiotic. Although everyone is different and what works for one person may not work for another, there is some evidence to suggest that probiotics containing Bifidobacterium infantis 1×108 may help improve diarrhoea.
  12. Manage any underlying conditions that may be contributing to your diarrhoea such as IBD or speak with your doctor about investigating and eliminating any potential medical conditions that may be causing your diarrhoea.
  13. If you have IBS go back to basics by following the low FODMAP diet until your diarrhoea has improved.
  14. Speak with an Accredited Practising Dietitian to get tailored advice and management strategies to improve your diarrhoea.
  15. If diarrhoea is severe you may need anti-diarrhoeal medication. Make sure to speak with your doctor to see which is most suitable for you.

If you’re struggling with diarrhoea and aren’t sure what to eat, I show my clients step by step how to follow the FODMAP diet to eliminate diarrhoea 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. Bijkerk CJ, Muris JWM, Knottnerus JA, et al (2004). Systematic review:the role of different types of fibre in the treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 19:245–51.
  2. Chey WD, Kurlander J & Eswaran S (2015). Irritable bowel syndrome: a clinical review. The Journal of the American Medical Association. 313:949-58.
  3. Drossman DA (2016). Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology. 150:1262–1279.
  4. Gandy J & the British Dietetic Association. Manual of Dietetic Practice–Fifth Edition. 2014: 420-467.
  5. Gorbach SL (1997). Treating diarrhoea. BMJ. 314(7097):1776-7.
  6. Lacy BE, Mearin F, Chang L et al (2016). Bowel Disorders. Gastroenterology. 150:1393-1407.e5.
  7. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). Functional bowel disorders. Gastroenterology. 130: 1480–149.
  8. National Health and Medical Research Council. Eat for Health-Australian Dietary Guidelines. Canberra; 2013.
  9. 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.
  10. Schmulson MJ & Drossman DA (2017). What Is New in Rome IV. Journal of Neurogastroenterology and Motility. 23(2): 2093-0879.
  11. Thomas PD, Forbes A, Green J et al (2003). Guidelines for the investigation of chronic diarrhoea, Second edition. Gut. 52(Suppl V): v1–v15.
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How To Eat Healthy To Manage Bloating On a FODMAP Diet

In Australia, this week in Smart Eating Week which aims to help increase awareness of health and nutrition within the community. We often talk about healthy eating for the general population, but what about those with specific medical conditions needing to follow a specific diet?

In this blog I will focus on irritable bowel syndrome (IBS) and the FODMAP diet. The FODMAP diet can be challenging to follow. I often get new clients, who have tried it own their own, saying that they struggle with limiting the different foods and have been restricting their diet more than they need too. In this blog I will share with you some simple smart eating tips to help you eat healthy and meet all your nutritional needs while on the FODMAP diet.

What are FODMAPs & What is The FODMAP Diet?

IBS is a common functional gastrointestinal disorder that affects 1 in 7 adults or 15% of the population worldwide. It is described by symptoms that are not explained by other conditions such as coeliac disease and inflammatory bowel disease. To learn more about IBS read my “Identify Your IBS Type To Manage Bloating & IBS)” blog here. 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.

The dietary cause of the symptoms associated with IBS is largely due to a group of carbohydrates called FODMAPs. This sounds like a really technical word, but it is just an acronym used to describe a group of carbohydrates, or sugars, which are found in a lot of everyday foods including fruit, vegetables, grains and dairy. It stands for;

  • Fermentable
  • Oligosaccharides
  • Disaccharides
  • Monosaccharides
  • And
  • Polyols

Examples of FODMAPs include fructose, lactose, fructans and sorbitol. 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.

The FODMAP diet is a therapeutic diet and is often recommended to those who have IBS. This means that it is actually used as part of the medical management or treatment for those with IBS. A low FODMAP diet can help improve gut symptoms in up to 75% of people with IBS. To learn more about FODMAPs and the FODMAP diet read my “The Journey Towards Managing Your Bloating (FODMAP Phase 1-3)” blog here.

Why is Healthy Eating on a FODMAP Diet Important?

When following a low FODMAP diet it is important to 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 of a specialised Accredited Practising Dietitian (APD), such as myself, as we 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 FODMAP diet with the assistance of an APD can get better relief from their symptoms.

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 natural prebiotics. Prebiotics are known for promoting diversity and increase the number of 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. 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.

Healthy eating is also the key to feeling your best, both now and in the long-term. Nutrition plays an important role in the everyday functions of our bodies. Maintaining a healthy diet gives your body the energy and nutrients it requires to function. It also has numerous health benefits including lowering your risk of developing diabetes, heart disease, excessive weight gain and some cancers. A healthy diet can also improve your mental health by improving your mood, increasing your concentration and decreasing feelings of fatigue, anxiety and depression. The best way to get in all the nutrients you need is to eat a variety of low FODMAP foods from the five different groups every day. I will discuss these is detail below.

Healthy Eating on a Low FODMAP Diet – The 5 Food Groups

Vegetables and Legumes

Including these in your diet can provide a range of nutrients as they are a good source of vitamins, minerals and dietary fibre. Vegetables can help decrease the risk of developing some chronic diseases including heart disease and some cancers. They are low in energy/calories, so incorporating a high variety of these into your diet can help to maintain a healthy weight. All vegetables also provide vitamin C. Low FODMAP vegetables including capsicum, broccoli, bok choy and tomatoes are particularly high in vitamin C. Legumes and beans, such as canned lentils, are also a good source of protein, iron, zinc and carbohydrate.

How Much Should You Aim For?

  • Women 19 years old & above = 5 serves per day.
  • Men aged 19-50 years = 6 serves per day.
  • Men aged 51-70 years = 5½ serves per day.

What is a low FODMAP Serve?

  • ½ cup cooked green or orange vegetables
    • Whole broccoli, spinach, carrots or kent pumpkin.
  • ½ cup canned lentils
  • 1 cup green leafy or raw salad vegetables
    • Most lettuce varieties and leafy greens are low FODMAP at this serving size.
  • ½ cup or ½ cob sweet corn
  • ½ medium potato or other starchy vegetables
    • Sweet potato, taro or cassava are low FODMAP at a serving size of ½ cup.
  • 1 medium common tomato

Fruit

Fruit are a good source of vitamins, including vitamin C, and folate and provide potassium, dietary fibre and carbohydrates in the form of natural sugars. As with vegetables, including fruit in your diet each day can help reduce the risk of some chronic diseases, including heart disease and some cancers. They are also low in energy, so including these in your diet can help maintain a healthy weight.

How Much Should You Aim For?

  • Men & Women 19 years old & over = 2 serves per day.

What is a low FODMAP Serve?

  • 1 medium unripe banana or orange
  • 2 small kiwi fruits or mandarins
  • 1 cup diced fruit
    • Cantaloupe, pineapple, strawberries, grapes
  • Or only occasionally: 125ml (½ cup) cranberry juice (with no added sugar)

Grains (Cereal)

Grain foods provide us with a range of different nutrients including carbohydrates, protein, dietary fibre and a wide range of vitamins and minerals including folate, thiamine, riboflavin, niacin, vitamin E and iron. Try and 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 these 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.

How Much Should You Aim For?

  • Men aged 19-70 years & Women aged 19-50 years = 6 serves per day.
  • Women aged 51-70 years = 4 serves per day.

What is a low FODMAP Serve?

  • 1 slice bread
    • Keep in mind that although most breads are low FODMAP at 1 slice, they can become high FODMAP at 2 slices.
    • Low FODMAP options at 2 slices include sourdough, spelt and gluten free white bread.
  • ½ medium roll or flat bread
    • As above regarding low FODMAP options.
  • ½ cup cooked rice, gluten free pasta, gluten free noodles, quinoa
  • ½ cup cooked porridge
  • 2/3 cup low FODMAP cereal flakes
  • ¼ cup fruit free muesli
  • 3 low FODMAP crispbreads or crackers

Lean Meats & Alternatives

These are a good source of protein, iron, zinc and other minerals and B group vitamins. Great substitutes for lean meats are poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans. Just remember that vitamin B12 is only naturally found in animal-based foods, but can also be found in fortified plant-based products. The iron and zinc in animal-based foods is also more easily absorbed by the body than the iron and zinc from eggs and plant foods.

It is currently recommended that no more that 350g of cooked lean red meat is eaten per week as eating larger amounts can be linked with a higher risk of developing chronic diseases such as heart disease, diabetes and 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.

Fish and seafood are sources of long chain omega-3 polyunsaturated fatty acids. Eating fish regularly is linked with a lower risk of heart disease, stroke, dementia and age-related macular degeneration.

How Much Should You Aim For?

  • Women aged 19-50 years & Men aged 51 years & above = 2½ serves per day.
  • Men aged 19-50 years = 3 serves per day.
  • Women aged 51 years & above = 2 serves per day.

What is a low FODMAP Serve?

  • 65g cooked lean meats such as beef, lamb, veal, pork, goat or kangaroo
  • 80g cooked lean poultry such as chicken or turkey
  • 100g cooked fish fillet or one small can of fish
  • 2 large eggs
  • 1 cup or canned legumes/beans such as lentils
  • 170g firm tofu
  • 30g low FODMAP nuts, seeds, peanut butter

Dairy & Alternatives

These are an excellent source of calcium and very few other foods in the Australian diet are as high in calcium as dairy foods. They are also a good source of other nutrients including protein, potassium, magnesium, iodine, riboflavin, zinc and vitamin B12. Eating dairy foods and alternatives also help lower the risk of high blood pressure, heart disease, stroke, type 2 diabetes and some cancers. The best choices for those with high cholesterol are low or reduced fat varieties. Many dairy products also contain prebiotics which means they help to increase the diversity of your gut bacteria and keep your gut microbiome healthy.

How Much Should You Aim For?

  • Men aged 19-70 years & Women aged 19-50 years = 2½ serves per day.
  • Women aged 51 years & over = 4 serves per day.

What is a low FODMAP Serve?

  • 1 cup fresh lactose free milk
  • 2 slices of hard cheese
  • ¾ cup lactose free yoghurt
  • 1 cup soy (made from soy protein) or rice milk with added calcium

15 Smart Eating Tips on a FODMAP Diet

  1. Plan ahead and stock up on easy nutritious foods like;
    • Low FODMAP wholegrain cereals and other grain foods.
    • Lactose free milk
    • Canned lentils
    • Eggs
    • Frozen or canned foods without added sugars or added salt
    • This way you can eat at home more often and cook meals yourself by adding fresh ingredients that you know will be low FODMAP.
  2. Choose a variety of different types and colours of fresh vegetables and fruits that are in season.
  3. Try new ways of cooking with low FODMAP vegetables like roasting, baking, barbequing and stir-frying.
  4. Add extra low FODMAP vegetables and legumes to your recipes.
  5. Include at least 1-1.5 cups of low FODMAP vegetables with your lunch.
    • Such as whole broccoli, spinach, potatoes, carrots, tomatoes, red capsicum, eggplant and bok choy.
  6. Include at least 1.5-2 cups of low FODMAP vegetables with your dinner.
  7. Try and eat at least 2 pieces of low FODMAP fruit each day.
    • Such as strawberries, unripe bananas, grapes, cantaloupe, pineapple, oranges and kiwifruit.
  8. Add fruit to your breakfast cereal, smoothies or yoghurt.
  9. Keep edible skins on your fruit and vegetables.
  10. Try having a small handful of nuts or seeds as snacks.
  11. Use fruit for snacks and desserts.
  12. Include 2 serves of fish or seafood into your diet per week.
  13. Include at least 1 or 2 meat-free and plant-based meals each week.
    • You can include eggs, legumes (like canned lentils) and firm tofu, nuts and seeds.
  14. Include small amounts of foods rich in unsaturated fats such as;
    • Oils, spreads, nut butters/pastes and avocado.
  15. Limit your intake of packaged and processed foods as these can often be high in saturated fat, sodium and added sugar and also hidden FODMAPs.

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. Brown K et al (2012). Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients. 4:1095– 119.
  2. Collins SM (2014). A role for the gut microbiota in IBS. Nature Reviews Gastroenterology & Hepatology. 11: 497-505.
  3. Gandy J & the British Dietetic Association. Manual of Dietetic Practice–Fifth Edition. 2014: 460-466.
  4. Gibson PR & Shepherd SJ (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology. 25: 252–258.
  5. Heart Foundation. Dairy and Heart Healthy Eating: Position Statement. National Heart Foundation of Australia; 2019.
  6. Heart Foundation. Meat and Heart Healthy Eating: Position Statement. National Heart Foundation of Australia; 2019.
  7. Hills RD et al (2019). Gut Microbiome: Profound Implications for Diet and Disease. Nutrients. 11:1613.
  8. National Health and Medical Research Council. Eat for Health-Australian Dietary Guidelines. Canberra; 2013.
  9. National Health and Medical Research Council. Eat for Health-Educator Guide. Canberra; 2013.
  10. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand-Executive Summary. Canberra; 2006.
  11. 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.

Gluten Free, Low FODMAP Banana Muffins with Lemon Icing

Makes 12Muffins
Gluten Free
Dairy Free
Low FODMAP
Vegetarian
Low Natural Food Chemical Option Available

Ingredients:

Cake:
125g Nuttelex Lite (or other dairy free spread)
¾ cup raw sugar
2 eggs
2 cups mashed ripe bananas (around 4 bananas)
1 tsp baking soda
2 tbsp hot rice milk
2 cups gluten free plain flour
1 tsp baking powder

Icing:
2 cups icing sugar
¼ cup softened Nuttelex Lite (or other dairy free spread)
2 tbsp lemon juice
1 tsp grated lemon rind

Method:

  1. Preheat oven to 180ºc.
  2. Cream butter and sugar until light and fluffy.
  3. Add eggs one at a time, beating well after each addition.
  4. Add mashed banana and mix thoroughly.
  5. Stir baking soda into hot milk and add to creamed mixture.
  6. Sift flour and baking powder and fold into mixture.
  7. Lightly grease a 12-hole muffin tray and fill holes evenly with mixture, around 2/3 of the way.
  8. Place in the oven and cook for 15-20 minutes or until golden brown.
  9. Remove from oven, allow to cool in the tray for 5 minutes, then place on a cooling rack until completely cooled.
  10. Sift icing sugar into a bowl.
  11. Add Nuttelex.
  12. Add enough lemon juice so that it is a spreadable consistency when mixed.
  13. Add lemon rind and mix.
  14. Ice each muffin, use around a 1 tbsp quantity per muffin.
  15. Serve and Enjoy!

Tips:

  1. To make this recipe low in natural food chemicals;
    • Swap the banana for tinned pears in syrup or poach 4 pears until soft and mash.
    • Replace lemon juice and lemon rind in icing for 1 tsp of citric acid or serve without icing.
  2. Once cooled these store really well in the freezer in either a zip lock bag or airtight container, just leave the icing off.
  3. If you are wanting a simpler version of this, you can replace the baking soda, rice milk, baking powder and plain flour with gluten free self-raising flour.

Nutritional Information (Per Serve):

nutrition info

Food Group Servings (Per Serve):

food group info


If you’re looking for support on how to follow the FODMAP diet so that you can eliminate your bloating and live your best life, apply for coaching.


Cashew & Chive Hummus (Low FODMAP Option)

Serves 10Dip
Gluten Free
Dairy Free
Low Natural Food Chemical
Vegetarian & Vegan
Low FODMAP Option Available

Ingredients:
½ cup unsalted cashews
1 x 420g can chickpea, rinsed and drained
1 tbsp fresh chives
¼ cup rice bran oil
¼ cup water
Pinch of salt

Method:

  1. Place all ingredients into a food processor and process on high until blended together and smooth.
  2. Serve and Enjoy!

Tips:

  1. Serve this dip with some tasty wholegrain crackers and/or vegetables sticks.
    • Peeled carrot, cucumber and celery are great moderate natural food chemical choices.
    • If you are very sensitive, celery is a low food chemical option.
  2. This dip is also great to use in sandwiches in the place of butter or margarine.
  3. To make this recipe low FODMAP;
    • Either remove the cashews or replace them with unsalted peanuts.
    • Keep your serving size to ¼ cup or less.

Nutritional Information (Per Serve):

nutrition info

Food Group Servings (Per Serve):

food group info


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.


How FAD Diets Are Stopping You From Relieving Bloating in IBS

This is a slightly unusual post for me as I usually stay away from weight loss topics. The reason? I believe there are a lot of other factors that we can work on to improve our overall health and well-being and a number on a scale is just a very small piece to the puzzle and an overly simplistic way of categorising our health status.

In saying that, this time of year is usually associated with people looking to make a change to their weight, eating habits and/or lifestyle. All you have do is a quick Google search for “how to improve my gut health” or “best weight loss diet” and it will come up with an endless amount of fad diets.

What’s not often spoken about is how these diets may be affecting our gut health in Irritable Bowel Syndrome (IBS). In this blog I will share with you the impact that fad diets can have on your gut health and IBS and my expert tips for spotting a fad diet.

What is a Fad Diet?

Fad diets are diets that become popular quickly. They can also be called a popular diet or a diet cult. They offer quick fix solutions and promises of weight loss or other health benefits that are not scientifically proven. They are usually highly restrictive and eliminate either whole food groups (particularly grains or dairy) or a combination of different foods. This usually results in rapid short-term weight loss; however, most do not lead to keeping the weight off long-term. They often offer expensive and unnecessary supplements or food products, such as shakes, in place of the eliminated foods.

They can be difficult to stick due to their restrictive nature and therefore most people end up craving the foods they have been missing which leads to over-eating, usually on less healthy options, and weight regain. Unfortunately, many aim to take advantage of people who may have a history of yo-yo dieting, wanting to change their appearance, lose weight or improve their health.

Detox Diets

Detox diets have grown in popularity over recent years. These diets are another form of fad diet. They are usually a short-term diet, but this can range from days to months. They claim to eliminate harmful toxins from your body and provide your body with nutrients. They also claim to improve digestion, energy, hair, skin and nails as well as quick weight loss, boosting your immune system and getting rid of cellulite. Detox diets can include supplements, teas, herbs and colon cleanses. The whole idea of detox diets has no scientific basis. Our body is amazing and does a fantastic job of detoxing and removing waste and toxins from it, all on its own, via our liver, kidneys, lungs, gut and even skin.

Common Fad & Detox Diets

There are countless fad and detox diets currently available, so I am unable to cover them all, but I will briefly discuss the most common ones that I get asked questions about the most from my clients.

Paleolithic (Paleo) Diet

The Paleo diet is based on the notion that we should only eat foods that were available to our ancestors as our genetic makeup is more suited to hunter-gather paleolithic foods than our modern diet. It claims to improve our overall health and “cure” diseases such as diabetes, obesity, heart disease, osteoporosis and cancer. It includes meat, poultry, seafood, nuts, non-starchy vegetables and fruits. However, eliminates grains, dairy, legumes and processed foods.

The evidence supporting this diet is based on limited anthropologic (which is the science of humans, particularly their ancestors, cultural and physical development) findings. Although we don’t have very much research on the topic, the research we do have shows that those in the paleolithic era ate varied diets based on plants and game meats, which included grains and legumes, along with a variety of other plants. However, this is often not acknowledged by those supporting the diet.

This diet eliminates foods that are important sources of nutrients which are proven to decrease our risk of developing chronic diseases, which the diet claims to “cure”. These include prebiotics and fibre which are vital for gut health and also help lower cholesterol and calcium which is essential for preventing osteopenia and osteoporosis.

Autoimmune Protocol (AIP) Diet

The AIP diet is often referred to as a stricter version of the paleo diet. It’s based on the principle that a “leaky gut” is the cause of all autoimmune conditions.

Before I go any further, I think it’s important to address the term “leaky gut”, I hear this get thrown around so often lately and is blamed as the underlying cause of all gut health issues, particularly in the alternative health space. However, this is not something you will hear an evidenced-based health or medical professional diagnosis you with. Why? There is no standard definition on what leaky gut actually is and there are no reliable or clinically proven tests to diagnose it. It actually refers to something called intestinal barrier dysfunction. In a normal healthy gut, there are things called tight junctions. These hold the cells that line the gut together and help prevent things that may be harmful from passing from the gut into the body. If or when leaky gut does occur, it as a result of another condition, such as coeliac disease, inflammatory bowel disease (IBD) or gut infections, which cause inflammation in the gut and can damage these tight junctions.

Of course, it you do a quick Google search on “how to heal a leaky gut” it will come up with endless treatments such as special diets and gut health supplements. The truth is that there just aren’t any treatments for leaky gut and there is limited scientific evidence supporting any of these treatments. So, I would recommend that you save you money.

So now that we have addressed leaky gut, let’s get back to the AIP diet. As with the paleo diet it mainly includes meat and vegetables and is incredibly restrictive. You are usually required to follow this diet for several weeks before you can introduce other foods.

Due to it being so restrictive, it can be difficult to follow, particularly as it can significantly impact your day to day life. It is also important to remember that there is no one size fits all approach when it comes to food and nutrition and managing autoimmune conditions. There has also only been 1 scientific paper published on the AIP diet, which was conducted on a small group of only 15 people with IBD, had no control group and was not randomized, so was not a good quality scientific study. There are currently no conclusive clinical studies on the role that diet plays in leaky gut and autoimmune diseases. Although diet can play a role in inflammation, it is not the only strategy that can be used, therefore it’s incredibly important to speak to your doctor or a dietitian about dietary and lifestyle changes that can be made to assist with improving inflammation.

Ketogenic (Keto) Diet

Ketogenic diets were first discovered to show benefits in managing children’s epilepsy and have been around for over 100 years. Although these diets are still used to treat epilepsy in children, they have recently gained a lot of popularity for their supposed benefits for managing a variety of other conditions including type 2 diabetes , obesity and heart disease. As the name suggests, they aim to get your body into ketosis, which occurs when there is a lack of glucose in your body for your body to use as energy. This then uses your bodies fat stores to create ketones, which can be used as energy.

What’s important to mention is that, unlike for the use in children with epilepsy, there is no one single definition or evidenced based guidelines for what the ketogenic diet is or how it should be implemented. All the studies that have been conducted used different macronutrient quantities, so different fat and carbohydrate ratios, went for different lengths of time and used different types of people in their studies. Therefore, being able to say exactly what the modern-day ketogenic diet is and how it should specifically be implemented and followed in near impossible.

Despite its claims studies have shown that, when compared to a low-fat diet, the ketogenic diet does not result in clinically significant weight loss after 1 year. Although the diet can improve HDL or “good” cholesterol and triglycerides, it also increases LDL or “bad” cholesterol which can increase your risk of cardiovascular disease (CVD). No benefits or improvements were also seen on blood pressure, insulin sensitivity or HbA1c levels (this is a blood test used to determine your average blood sugar levels over 2-3 months).

There are also several side-effects that are associated with the ketogenic diet including constipation and/or diarrhoea (which are symptoms we aim to eliminate in IBS), headaches, muscle cramps, bad breath and fatigue. People also find it difficult to stick to the diet over the long-term.

Gut and Psychology Syndrome (GAPS) Diet

The GAPS diet is a strict elimination diet that is based on animal fats, meat, fish, eggs, probiotic foods and vegetables. It eliminates grains, pasteurised dairy, starchy vegetables and refined carbohydrates and requires you to take several different supplements. The full GAPS diet goes for 1.5–2 years. It claims that conditions affecting the brain are caused by a leaky gut. It is promoted as a natural “cure” for neurological conditions including autism, ADD and ADHD, depression, bipolar disorder and eating disorders. It also claims to be able to help children with food allergies and intolerances.

There is currently no scientific evidence to support any of the claims made by the GAPS diet. Any supposed benefits from the diet are solely based on testimonials. It is a very restrictive diet that is required to be followed for a long period of time, which makes it hard to stick to. It is also recommended for young people, which it can be particularly harmful for, and puts them at risk of malnutrition. Those with autism may also not as readily accept new foods or modifications to their diet, due to these reasons they may already be on a restrictive diet to start with. Restrictive diets are also not recommended for those with eating disorders, which this diet claims to cure. If you are considering this diet please seek the advice of your doctor or dietitian.

Celery Juice

This has become really popular over the last 12 months or so and is one that my clients as me about quiet frequently. It claims to repair gut damage, improve digestion, detoxify your gut and body, decrease inflammation, help with constipation, get rid of leaky gut, decrease bloating and wind, balance blood pH and decrease your risk of developing conditions such as high blood pressure and cancer. Having celery juice is fine as, like other vegetables juices, it does contain vitamins and mineral, but all the claims that it can detox the body and “cure” a variety of conditions particularly in regard to gut health are not evidence based or scientifically proven.

Juicing celery also removes most of the fibre, which are prebiotics that help to keep our gut happy and support a healthy gut microbiome. It’s also often recommended to people with IBS to “cure” their symptoms, but celery is actually high in the FODMAP mannitol. FODMAPS are well known and scientifically proven to cause gut symptoms in those with IBS and are usually limited on a FODMAP diet. In additional, multiple stalks of celery are needed to make the juice, this means that people are likely to consume a much larger amount of mannitol which can cause bloating and painful wind. The compounds in celery juice can also increase the side effects of some medications and stop them from working properly. These include blood pressure and anti-anxiety medications.

The Effect on Your Gut Health

What is the Gut Microbiome?

The human gut has a hundred trillion micro-organisms living within it, which are mostly bacteria. These are referred to as the gut microbiota. Whereas, the microbiome is the combination of all the genetic material of the microbiota. The gut microbiome is very complex, and everyone has a very unique microbiome. 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?

Factors that determine and influence our gut microbiome include our diet, lifestyle, genetics and environment. For example, the way that we were born, caesarean section vs vaginal birth, 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. Our diet significantly affects the makeup and diversity of our gut microbiome and accounts for around 57% of the changes seen in our gut microbiota. The composition of our gut microbiome can begin to change in as little as one day after changing our diet. This means that our diet has huge potential to make positive changes to our gut microbiome which are associated with improvements to our health.

Effects of the Gut Microbiome on Our Health

Research shows that our gut microbiome effects both our physical and mental health. Changes to the composition of the gut microbiome have been associated with a number of chronic diseases including CVD, type 2 diabetes, IBD, autoimmune diseases, overweight and obesity and some skin conditions such as psoriasis.

It is also believed to regulate the gut-brain axis which is how your gut and your brain communicate with each other. Research suggests that a disturbance and reduced diversity of gut bacteria can have a link to increased feelings of anxiety and depression, due to less serotonin and dopamine being produced. It can also impact our overall mood and appetite regulation. You can read more about the gut-brain axis in my “How the Gut Works with the Brain to Manage IBS” blog here.

Our gut microbiota, particularly in the colon, breaks down or ferments the nutrients that we have eaten in our diet. These are mainly certain types of carbohydrates called fructans and fibre. 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.

The Effect of Fad Diets on Your Gut Health & Overall Health

As I mentioned above, these diets often remove whole foods groups and cut out key nutrients which have been proven to decrease our risk of developing chronic diseases. This can result in a variety of symptoms including;

  • Dehydration
  • Constipation
  • Lethargy and fatigue
  • Confusion or difficulty concentrating
  • Inadequate intakes of vitamins and minerals, resulting in an increased risk of nutrient deficiencies.

Removing whole food groups also limits our intake of prebiotics and fibre which are important for keeping our gut microbiome healthy and happy. Prebiotics are known for promoting diversity in our gut which assists with improving our overall gut health. Adequate fibre intakes have been shown to decrease our risk of developing chronic diseases such as bowel cancer, CVD 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.

Unfortunately, there is no miracle diet or strategy to help us lose weight and keep it off over the long-term. As fad diets restrict food groups and nutrients they can come with a number of health risks and only offer a short-term solution as they are often unsustainable. Studies also show that at the 2-5 year mark most people regain all their weight. We also do not know if they are safe over the long term or if they can lead to an increase risk of developing diseases.

My Tips for Spotting a Fad Diet

  1. It removes whole foods or food groups and replaces them with supplements, teas or diet pills.
  2. It limits your food choices and advises you not follow a balanced diet with a variety of different foods.
  3. It is recommended by unqualified people, such as celebrities or nutrition “experts” without any valid credentials or qualifications.
  4. It promises you a quick fix.
  5. It promises that you can rapidly lose more than 1 kg of body fat per week.
  6. It offers no evidence to support any of its claims and makes a claim based on a single study or testimonials only, such as from celebrities or “before” and “after” photos.
  7. It sounds too good to be true or makes unrealistic promises. This is usually promising weight loss without having to make any lifestyle changes.
  8. It has really strict rules that focus on weight loss.
  9. It claims that food can change your body chemistry such as pH.
  10. It recommends you only eat foods in a specific combination which is based on your blood group or genetic type.
  11. It claims you need to “detox” your body.
  12. It only focuses on your appearance.
  13. It claims you can live without food or by only having liquid meals.
  14. It tells you that being overweight is due to you have a food allergy or yeast infection.
  15. It is based on a “secret” that doctors haven’t discovered yet.

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. Anderson JW, Konz EC, Fredericj RC & Wood CL (2001). Long-term weight-loss maintenance: a meta-analysis of US studies. The American Journal of Clinical Nutrition. 75(5): 579–584.
  2. Brown K et al (2012). Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients. 4:1095– 119.
  3. Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition. 110(7):1178-87.
  4. Collins SM (2014). A role for the gut microbiota in IBS. Nature Reviews Gastroenterology & Hepatology. 11: 497-505.
  5. Cordain L (2011). The Paelo diet. Revised ed. Hoboken (NJ): John Wiley & Sons.
  6. Dietitians of Canada. Nervous System – Pediatric/Paediatric Epilepsy: Ketogenic Diet. In: Practice-based Evidence in Nutrition® [PEN]. Cited 2020 January 08. Available from: http://www.pennutrition.com.
  7. Eaton SB, Konner MJ, Cordain L (2010). Diet-dependent acid load, Paleolithic [corrected] nutrition, and evolutionary health promotion. American Journal of Clinical Nutrition. 91(2):295-7.
  8. Eisenstein M (2010). Evolution: the first supper. Nature. 468(7327):S8-9.
  9. 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.
  10. Gardner CD, Trepanowski JF, Del Gobbo LC, Hauser ME, Rigdon J, Ioannidis JPA, et al (2018). Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the DIETFITS randomized clinical trial. Journal of the American Medical Association. 20;319(7):667-79.
  11. Gibson S (2008). ‘Sugar sweetened soft drink and obesity: a systematic review of the evidence from observational studies and interventions’. Nutrition Research Reviews. 21 (2): 134-147.
  12. Gupta L, Khandelwal D, Kalra S, Gupta P, Dutta D, Aggarwal S (2017). Ketogenic diet in endocrine disorders: Current perspectives. Journal of Postgraduate Medicine. 63(4):242-51.
  13. Kausman R (2004). If not dieting, then what? Allen & Unwin, Australia.
  14. Klein AV & Kiat H (2015). Detox diets for toxin elimination and weight management: a critical review of the evidence. Journal of Human Nutrition and Dietetics. 28(6):675-86.
  15. Henry AG, Brooks AS & Piperno DR (2011). Microfossils in calculus demonstrate consumption of plants and cooked foods in Neanderthal diets (Shanidar III, Iraq; Spy I and II, Belgium). Proceedings of the National Academy of Sciences of the United States of America. 108(2):486-91.
  16. Hills RD et al (2019). Gut Microbiome: Profound Implications for Diet and Disease. Nutrients. 11:1613.
  17. Jakovljevic V, Raskovic A, Popovic M & Sabo J (2002). The effect of celery and parsley juices on pharmacodynamic activity of drugs involving cytochrome P450 in their metabolism. European Journal Of Drug Metabolism And Pharmacokinetics. 27(3), 153-156.
  18. Lach G et al (2018). Anxiety, depression and the microbiome: A role for gut peptides. Neurotherapeutics. 5(1):36-59.
  19. Mann T, Tomiyama AJ, Westling E, Lew A-M, Samuels B & Chatman J. (2007). Medicare’s search for effective obesity treatments: diets are not the answer. The American Psychologist. 62(3), 220–233.
  20. Martinez C, Gonzalez-Castro A, Vicario M, Santos J (2012). Cellular and molecular basis of intestinal barrier dysfunction in the irritable bowel syndrome. Gut and liver. 6(3):305-15.
  21. Matricon J, Meleine M, Gelot A, Piche T, Dapoigny M, Muller E, et al (2012). Review article: Associations between immune activation, intestinal permeability and the irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 36(11-12):1009-31.
  22. Mills S et al (2019). Precision Nutrition and the Microbiome, Part I: Current State of the Science. Nutrients. 11:923.
  23. National Health and Medical Research Council (2003). Dietary Guidelines for Australian Adults. A guide to healthy eating. Australian Government Department of Health and Ageing, Canberra.
  24. National physical activity guidelines for Australians. Department of Health and Ageing, Australian Government.
  25. Sebastian A, Frassetto LA, Sellmeyer DE, Merriam RL, Morris RC Jr (2002). Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. American Journal of Clinical Nutrition. 76(6):1308-16.
  26. Sekirov I, Russell SL, Antunes LCM, Finlay BB (2010). Gut microbiota in health and disease. Physiological Reviews. 90: 859-904.
  27. Singh R et al (2017). Influence of diet on the gut microbiome and implications for human health. Journal of Translational Medicine. 15:73.
  28. Sumithran P & Proietto J (2008). Ketogenic diets for weight loss: a review of their principles, safety and efficacy. Obesity Research & Clinical Practice. 2(1):I-II.

Golden Syrup & Pear Muffins (Low FODMAP Option)

Makes 12
Gluten Free
Dairy Free
Vegetarian
Low Natural Food Chemicals
Low FODMAP Option Available

Ingredients:
1 cup brown rice flour
½ cup gluten free corn flour/corn starch
½ cup tapioca flour
1 tsp xanthum gum
1 tsp bicarbonate soda
2 tsp gluten free baking powder
40g Nuttelex Lite
2 eggs
½ cup golden syrup
2 medium pears, peeled, cored & grated
¾ cup rice milk
1 tsp vanilla essence

Method:

  1. Preheat oven to 170ºc.
  2. Sift and combine flours, xanthum gum, bicarbonate soda and baking powder into a medium bowl.
  3. In a separate bowl combine golden syrup and eggs. Mix well.
  4. Add Nuttelex, rice milk and vanilla essence to the bowl with golden syrup and eggs and mix well until combined.
  5. Add grated pears to egg and golden syrup mixture and mix until well combined.
  6. Add pear mixture to flour mixture and combine well.
  7. Lightly grease a 12-hole muffin tray and fill holes evenly with mixture, around 2/3 of the way.
  8. Place in the oven and cook for 15-20 minutes or until golden brown.
  9. Remove from oven, allow to cool in the tray for 5 minutes, then place on a cooling rack until completely cooled.
  10. Serve and Enjoy!

Tips:

  1. To make this low FODMAP simply swap the pears for 2 cups of strawberries.
  2. If you do not have brown rice flour, corn flour or tapioca flour you can replace these, along with the xanthum gum, bicarbonate soda & baking powder, with 2 cups of gluten free self-raising flour.

Nutritional Information (Per Serve):

Nutrition Info

Food Group Servings (Per Serve):

Food Groups


If you’re looking for support on how to follow the FODMAP diet so that you can eliminate your bloating and live your best life, apply for coaching.


Cheesy Pumpkin & Zucchini Low FODMAP Fritters

Makes 8
Gluten Free
Vegetarian
Low FODMAP

Ingredients:
400g kent pumpkin, skin removed and grated
1 large zucchini, grated
2 large eggs
½ cup grated light tasty cheese
½ cup of gluten free breadcrumbs
½ tsp cayenne pepper
Extra Virgin Olive Oil
Salt to taste

Method:

  1. In a large bowl combine pumpkin, zucchini, cheese, eggs, breadcrumbs, cayenne pepper and salt to taste and stir combine well.
  2. Coat the bottom of a fry pan with olive oil over medium-high heat.
  3. Divide mixture into 8 and spoon onto fry pan to form fritters.
  4. Cook on each side until golden, about 5 minutes on each side.
  5. Keep each batch warm in the oven while the rest are cooking.
  6. Serve and Enjoy!

Tips:

  1. Serve these delicious fritters with steamed low FODMAP vegetables or a salad of your choice.

Nutritional Information (Per Serve):

Pumk & Zucc Nutrition Info

Food Group Servings (Per Serve):

Cauli & Broc Food Groups


I support women with IBS to regain control of their gut issues. If you’re struggling with bloating, constipation or diarrhoea & looking to find a solution, apply for coaching here — I show you step by step how to discover what foods are triggering your symptoms so that you can eat without fear and improve your quality of life.


 

Gluten Free Pear & Rhubarb Crumble (Low FODMAP Option)

Serves 10
Gluten Free
Dairy Free
Vegetarian and Vegan
Low FODMAP Option Available

Ingredients:

Filling:
3 medium pears
1½ cups chopped rhubarb
¼ cup caster sugar
1 tsp vanilla essence
½ tsp ground cinnamon

Crumble:
1 cup almond meal
4 tbsp gluten free plain flour
60g Nuttelex Lite
3 tbsp brown sugar
½ cup desiccated coconut
1 tsp maple syrup
Pinch of cooking salt

Method:

  1. Preheat oven to 180ºc.
  2. Peel, core and slice pears.
  3. Put pears and chopped rhubarb in a saucepan, add caster sugar, vanilla and cinnamon.
  4. Heat gently for 10 minutes or until fruit is soft.
  5. Pour into a medium rectangular baking dish. I used a 38cm x 25cm glass baking dish.
  6. Put all crumble ingredients into food processor and mix or pulse until the mixture resembles chunky crumbs.
  7. Sprinkle the crumble mixture over the fruit.
  8. Place in the oven and bake for approximately 35 minutes or until golden brown.
  9. Serve and Enjoy!

Tips:

  1. To make this low FODMAP simply swap the pears for 3 cups of strawberries.

Nutritional Information (Per Serve):

Nutritional Info

Food Group Servings (Per Serve):

Food Groups


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.


Manage Constipation in 4 Steps

Have you ever had trouble having a bowel movement or experienced constipation? If you answered yes, then you definitely know what it feels like when your gut is giving you the silent treatment!

Some quick facts about constipation;

  • It affects 1 in 10 children and is responsible for 3-5% of all visits to a paediatrician.
  • 1 in 5 adults experience constipation.
  • It affects both men and women but is more of a common complaint in women.
  • The likelihood of experiencing constipation increases as we get older, particularly once we are over the age of 65 years.

What is Constipation?

Constipation is a common medical concern in both Australia and other developed countries. Constipation is defined as when a person is unable to empty their bowels, finding it more difficult to have a bowel movement or having more infrequent bowel movements than what is normal for them.

Constipation can be described as being either acute or chronic. So, what’s the difference?

Acute constipation: This usually lasts for a short period of time and occurs infrequently. It is likely related to changes to dietary habits, such as not eating enough fibre, changes to routine or short-term use of certain medications (I will talk more about this later!)

Chronic constipation: This means that you have been experiencing difficulty with having a bowel movement for a long period of time. Whilst this can also be related to dietary habits, particular medical conditions can also play a role (I will also talk more about this later!) If constipation has been experienced for a long period of time, it can sometimes be referred to as “functional”.

What is Functional Constipation?

What this means is that there is not a physical or physiological cause for your constipation. A person may be otherwise healthy, however despite this, is still having trouble with experiencing a normal bowel movement. This condition can often run in families and studies have shown that 1/3 of people with functional constipation will have family members with similar bowel issues.

Once other conditions have been ruled out a set of diagnostic criteria called the Rome IV Criteria for Diagnosing Functional Constipation will be used to confirm if you have this. This includes whether you have been experiencing 2 or more of the following, for the last 3 months with symptoms starting at least 6 months before diagnosis;

  • Straining during more than ¼ (25%) of bowel movements.
  • Lumpy or hard stools more than ¼ (25%) of bowel movements.
  • Sensation of incomplete evacuation more than ¼ (25%) of bowel movements.
  • Sensation of anal or rectal obstruction/blockage more than ¼ (25%) of bowel movements.
  • Manual manoeuvres to facilitate more than ¼ (25%) of bowel movements (such as digital evacuation, or support of the pelvic floor).
  • Fewer than 3 spontaneous bowel movements per week.

You must also have both of the following;

How Often Should I Have a Bowel Movement?

This is a question that I get asked quiet frequently by my clients. What is considered normal can be different from person to person as everyone’s gut and lifestyles are different, but it can range from multiple times per day to three times per week.

What’s important to remember is that having less frequent bowel movements does not mean that you are constipated, as long as you are not experiencing any pain and are following your usual bowel habits. You only need to keep an on eye out for it if you start experiencing changes to your bowel habits. As I have mentioned, everyone is different, so if you have been having less than what’s “normal” for you, it may mean that you are constipated.

Tips to help determine if your bowel motions are regular enough;

  1. Aim for a bowel movement every 1-2 days that is soft and easy to pass.
  2. If you are not sure, you may find keeping a bowel diary helpful.
    • You can record how often you are having a bowel movement.
    • The type (for example, whether it is hard or soft).
    • How easy it is to pass (did you need to strain excessively?)
    • Have you been experiencing any other symptoms (such as wind, bloating or stomach pain).
  3. Keep in mind, that if you are eating less than usual for any reason, you should still be having regular bowel movements.

Symptoms of Constipation

There are so many different symptoms that can be experienced with constipation and it’s important to remember that these will vary from person to person.

Some common signs and symptoms can include;

  • Stomach pain, bloating and discomfort
  • Wind
  • Feeling tired and fatigued
  • A decrease in appetite
  • Feeling full quickly after meals
  • Bowel obstruction or blockage
  • Excessive straining or difficulty having a bowel movement
  • A feeling of not being completely empty
  • Passing hard or lumpy stools
  • Infrequent bowel movements
  • Worsening of IBS symptoms, such as abdominal pain, excessive wind, bloating and/or distension.

Other symptoms can include;

  • Anal fissure. This is when trying to pass large, hard stools can cause a small tear in the lining of the anus. It can cause pain, stinging and bright red blood, which is often noticed in the toilet or on toilet paper.
  • Faecal overflow or incontinence. This occurs mainly in children and the elderly who have been experiencing chronic constipation. This leads to a loss of awareness of needing to have a bowel movement and unintentional soiling of underwear.

Causes of Constipation

As mentioned above, constipation may have no underlying cause, such as in those with functional constipation, or can be the result of another cause. This can sometimes be referred to as secondary constipation.

Medical causes of constipation include;

  • Pain relief medications
    • Codeine
    • Oxycodone
    • Morphine
  • Anti-nausea medications
    • Ondansetron
  • Other drugs or medications
    • Anti-depressants
    • Chemotherapy
  • Some nutritional supplements
    • Iron supplements
    • Calcium supplements
  • Excessive laxative use
  • Hormonal and metabolic conditions
    • Underactive thyroid
    • Diabetes
  • Some medical conditions
    • Coeliac disease
    • IBS
    • Haemorrhoids
    • Diverticulitis
  • Certain diseases
    • Colorectal cancer
    • Metastatic stomach cancer
  • Neurological disorders
    • Parkinson’s disease
    • Stroke
  • Cow’s milk allergy
    • Studies have shown that this can cause severe constipation in some infants and children.
  • Pregnancy
  • Menstruation
    • This may be due to changes in hormones that can affect bowel habits.
  • Slow gut motility

Lifestyle factors that can cause constipation;

  • Not drinking enough fluid or dehydration
  • Decreased mobility
  • Inadequate fibre intake
  • Physical inactivity
  • Ignoring the urge to have a bowel motion
  • Sedentary lifestyle
  • Stress
  • Changes to your daily routine

My Expert Tips to Help You Manage Constipation

1. Increase Your Intake of High Fibre Foods
Fibre helps to keep our stools soft by absorbing water throughout our gut. This assists with preventing constipation and keeping our bowel movements regular. So, high fibre foods help improve constipation by holding liquid in the stools and keeping them soft (to learn more fibre you can read my “10 Ways to Increase Fibre to Eliminate Bloating & Constipation” blog here). It also helps to keep us fuller for longer and supports keeping our gut microbiome happy and healthy.

In Australia, it is currently recommended we consume;

  • 14-22g per day for children.
  • 25g per day for women.
  • 30g per day for men.

However, despite all the benefits of adequate fibre intakes, most Australians currently do not consume enough fibre.

The easiest way to make sure that you 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 you 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.
  11. Add high fibre foods slowly to your diet to avoid getting symptoms such as wind, bloating, cramps and diarrhoea.

2. Eat 2 Kiwifruit Each Day

Eating kiwifruit regularly has been shown to help relieve the symptoms on constipation. It is a simple, natural and budget friendly strategy to help with improving your bowel movements. Studies have shown it to be a safe alternative to other strategies as it seems to have very little, if any, side effects.

Eating 2 kiwifruit each day helps to increase how often you have a bowel movement and improves laxation, which means it makes it easier to have a bowel movement. However, keep in mind that improvements in your bowel movements will only be seen while you are regularly eating kiwifruit and will decrease if you stop eating them.

So how does the humble kiwifruit do all this?

This is thought to be because of the fibre content in kiwifruit as it helps with absorbing water throughout your gut, which bulks up your stools and improves laxation. It also contains an enzyme called actinase which is believed to also help with laxation by making it easier for the contents of your gut to move through it.

3. Increase Your Fluid Intake

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

4. Increase Your Physical Activity

Being physically active every day and decreasing the amount of time you spend engaging in sedentary behaviour is not only important for improving constipation but is also vital for your overall health and wellbeing.

My expert tips for increasing your physical activity are;

  1. Be sure to include regular activity in your day. Australia’s Physical Activity and Sedentary Behaviour Guidelines are a really good starting point.
  2. Doing any type physical activity is better than not doing any.
    • Find an activity that you enjoy doing and start with 5-10 minutes and gradually build up to the recommended amount.
  3. Be active on most, preferably all, days of the week.
  4. Add 2½ to 5 hours of moderate or 1¼ to 2½ minutes of vigorous intensity physical activity each week.
    • This can be included as 30-60 minutes of moderate intensity activity (such as brisk walking or gardening) per day OR
    • 75 to 150 minutes of vigorous intensity activity (such as swimming or running) each week.
  5. Do muscle strengthening activities on at least 2 days each week.
  6. Sit less, move more.
  7. Limit the amount of time you spend sitting for long periods of time.
  8. Break up long periods of sitting as often as you possibly can.
    • This can include getting up from your desk once an hour and going for a short walk.

If you’re newly diagnosed with IBS and constipation 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 constipation and live your best life, apply for coaching.


References

  1. Australian Government: Department of Health. Australia’s Physical Activity and Sedentary Behaviour Guidelines [Internet]. Cited 2019 November 30. Available from:https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#npa1864
  2. Barbara G, Fukudo S, Drummond L, et al (2018). Tu1644 – Green Kiwifruit Compared to Psyllium for the Relief of Constipation and Improving Digestive Comfort in Patients with Functional Constipation and Constipation Predominant Irritable Bowel Syndrome — Analysis of Three International Trial Centres. Gastroenterology. 154:S-979-S-980.
  3. Beck DE (2008). Evaluation and Management of Constipation. The Ochsner Journal. 8:25–31.
  4. Bharucha AE (2007). Constipation. Best Practice & Research: Clinical Gastroenterology. 21:709-31.
  5. Bijkerk CJ, Muris JWM, Knottnerus JA, et al (2004). Systematic review:the role of different types of fibre in the treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 19:245–51.
  6. Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P & Talley NJ (2005). Systematic review on the management of chronic constipation in North America. The American Journal of Gastroenterology. 100(suppl 1):S5–S21.
  7. Chan AO, Leung G, Tong T, et al (2007). Increasing dietary fiber intake in terms of kiwifruit improves constipation in Chinese patients. World Journal of Gastroenterology. 13:4771-5.
  8. Chang CC, Lin YT, Lu YT, et al (2010). Kiwifruit improves bowel function in patients with irritable bowel syndrome with constipation. Asia Pacific Journal of Clinical Nutrition. 19:451-7.
  9. Chey WD, Kurlander J & Eswaran S (2015). Irritable bowel syndrome: a clinical review. The Journal of the American Medical Association. 313:949-58.
  10. Ford AC, Moayyedi P, Lacy BE, et al (2014). American college of gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. The American Journal of Gastroenterology. 109 Suppl 1:S2-S26.
  11. Gastroenterological Society of Australia (GESA), Digestive Health Foundation. (2010). Constipation Information Sheet.
  12. Klauser AG, Beck A, Schindlbeck NE, et al (1990). Low fluid intake lowers stool output in healthy male volunteers. Z Gastroenterol. 28:606-9.
  13. Lacy BE, Mearin F, Chang L, et al (2016). Bowel Disorders. Gastroenterology. 150:1393-1407.e5.
  14. Li YO & Komarek AR (2017). Dietary fibre basics: Health, nutrition, analysis, and applications. Food Quality and Safety. 1: 47–59.
  15. National Health and Medical Research Council. Eat for Health-Educator Guide. Canberra; 2013:11-23.
  16. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand-Executive Summary. Canberra; 2006.
  17. Rush EC, Patel M, Plank LD, et al (2002) . Kiwifruit promotes laxation in the elderly. Asia Pacific Journal of Clinical Nutrition. 11:164-8.
  18. Sanchez MI & Bercik P (2011). Epidemiology and burden of chronic constipation. Canadian Journal of Gastroenterology and Hepatology. 25: 11B-L 15B.
  19. Suares NC & Ford AC (2011). Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and metaanalysis. American Journal of Gastroenterology. 106:1582–91.
  20. Suares NC & Ford AC (2011). Systematic review: the effects of fibre in the management of chronic idiopathic constipation. Alimentary Pharmacology & Therapeutics. 33:895–901.
  21. Tack, J et al (2006). Functional gastroduodenal disorders. Gastroenterology. 130, 1466-1479.
  22. Tucker DM, Sandstead HH, Logan GMJr, et al (1981). Dietary fibre and personality factors as determinants of stool output. Gastroenterology. 81:879–83.
  23. Voderholzer WA, Schatke W, Muhldorfer BE, et al (1997). Clinical response to dietary fibre treatment of chronic constipation. American Journal of Gastroenterology. 92:95–8.
  24. Vrees MD & Weiss EG (2005). The evaluation of constipation. Clinics in Colon and Rectal Surgery. 18:65–75.

Bloat Friendly Fruit Salad

Serves 6Fruit Salad.jpg
Gluten Free
Vegetarian & Vegan
Low FODMAP Option Available

Ingredients:
🍊4 x Mandarins
🍓250g/1 Punnet Strawberries
🥝4 x Kiwi Fruit
🍒250g Cherries
🍐2 x Pears

Method:

  1. Simply peel the mandarins and wash the cherries and then wash and cut all the other fruit up to your preferred size.
  2. Place in a bowl, cover with cling wrap and refrigerate. I find that this stays fresh in the fridge for around 3 days.

Tips:

  1. To make this low FODMAP simply remove the pear and limit your intake of cherries to no more than 2 at a time.
  2. Alternatively, you could replace these with cantaloupe and/or grapes.
  3. 1 cup or fruit salad = 1 serve of fruit and with this fruit salad recipe you will meet your recommended 2 serves of fruit each day.

Nutritional Information (Per Serve):

Nutrition Info

Food Group Servings (Per Serve):

Food Group Servings


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.