I have had Ulcerative Colitis, a form of Inflammatory Bowel Disease (IBD), for over 40 years. Fortunately mine is relatively mild and I have not had to have surgery and it now 4 years since my last major flare up. However between flare ups I do suffer from Irritable Bowel Syndrome (IBS) to which people with IBD are prone because of the mess IBD makes of one’s bowel.
Last year my IBD consultant at York Hospital agreed to refer me to a dietitian to try a Low FODMAP diet to see if it would help with my IBS.
FODMAPs are fermentable carbohydrates, or Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides and Polyols. Recent research has shown that these carbohydrates contribute to IDS symptoms.
In September I started on the diet. This had to be followed strictly for 6 weeks initially. I found this fairly easy to do provided one avoided processed food. Eating out however was near impossible.
High FODMAP foods to be avoided include all wheat products (bread, flour, pasta etc.), pulses, onions, garlic, milk, various fruits including apples, pears and peaches, cashews, honey and fructose syrup. The good news was that all meats, maize (corn), and some fruits and vegetables were ok as were lactose free dairy products.
For the first 3 weeks of the diet I noticed little change and was beginning to think the diet would not help me. But then over the next 3 weeks my IBS improved significantly and became better than for many years. Yes, the FODMAP diet was working for me! According to my dietitian it improves the IBS of over 75% the people referred to her.
The FODMAP diet is not however intended to be followed for the long term. It is important to reintroduce FODMAPS to make one’s diet more varied and healthy (and also to make it easier to eat out etc.). To enable this one must try and identify to which FODMAPs one is most sensitive to because not everyone reacts to all FODMAPS and different FODMAPS can be tolerated in different amounts.
During this reintroduction phase, one remains on the diet but tries one high FODMAP food at a time, known as a challenge. The quantity of the food is increased over three days. If adverse symptoms are obtained, that challenge can be abandoned but another high FODMAP food cannot be tried until the symptoms have subsided. In this way one develops an idea of which high FODMAP foods one can tolerate and to what extent.
Most high FODMAP foods fall into one or more groups and if one can tolerate one food in the group one can probably tolerate others. Unfortunately that is not the case with fructans. Foods high in fructans have to be individually tested.
These challenges take a lot of time and in my experience the results are not totally clear. Some foods I reacted strongly to. These included sweet potato (mannitol part of the polyol group), and cashews (galacto-oligosaccharide group). However I did seem pretty tolerant of mango (fructose group). Milk (lactose) was more confusing. Initially it seemed ok but by day 3 I was having bad symptoms. Likewise for avocado (sorbitol a part of the polyol group). I take this to mean that I have some tolerance but should avoid large quantities. I reacted badly to both garlic and onion (members of the Fructans group). This is annoying as they are so widely used and so difficult to avoid when eating out.
So to conclude, I am very pleased that I tried the Low FODMAP Diet. In the past I have been unable to associate any particular food with the causing of my IBS symptoms. Now I know to totally avoid certain foods where possible and to try and reduce others. If I start having symptoms I know I can switch to low FODMAP foods and things should improve. As eating high FODMAPs does no permanent damage, one can afford to be fairly relaxed when eating out. In a restaurant, when choosing from a menu, I try and avoid dishes that I think may be high FODMAP– but sometimes I take a risk because I really fancy a dish. When having a meal at friends or families I normally would not mention my diet. Although I try and have lactose free milk and yogurt at home, I am relaxed about having some normal milk and yogurt when it is not easily avoided.
The great thing is that I now have some control.