IBS, FODMAPs and Gastrointestinal Issues

Digestive disorders can be frustrating, painful, demoralising and isolating. From IBS and FODMAPS, IBD (including Crohn’s and Ulcerative colitis), food intolerances, gastroparesis, GORD, SIBO coeliac disease to diverticulitis – there are so many issues that can affect our digestion and therefore enjoyment of food. Unfortunately not all tests reveal a diagnosable condition, and this can make it even more confusing to know what to do.

Irritable Bowel Syndrome and Food Intolerances

While the internet can be a great source of information, it is not an ideal place to seek information to diagnose or treat one’s health. This is definitely the case when it comes to gut issues, as there are are so many conflicting ideas regarding the management of IBS and functional gastrointestinal disorders. Unfortunately there is no magic cure for IBS or Food intolerances, nor is there an easy diagnostic test (like a blood tes). For information regarding unorthodox tests please see the Australian Society of Clinical Immunology Fact sheethere. Nonetheless, there are many things you can do that may help ease your symptoms.

Medically diagnosed IBS is diagnosed by a medical professional (either GP or specialist gastroenterologist) and is diagnosed based on the length of time you have been experiencing symptoms, their severity and after eliminating other gut disorders. Symptoms include abdominal pain, bloating, distension, wind and/or irregular bowel patterns (constipation, diarrhoea or alternating periods of both). While the disorder definitely affects the transit of food through the gastrointestinal tract, it also impacts how the brain interprets signals from the intestinal nerves, such that it is commonly regarded that people with IBS are more highly sensitive to the sensations of bloating, distension, wind , constipation etc. Due to the somewhat embarrassing nature of IBS, it is a problem that can have significant impacts on a person’s life – from diet, education, work, personal and social relationships, travel, self-image and psychological well-being.

Treatment

There are potentially many things that can trigger IBS and gut symptoms, and as a Dietitan, my job is to work with you to systematically help identify what food and/or lifestyle intervention is helpful for you. I am experienced in a range of specialised elimination diets that are designed specifically for detecting food intolerances, including the Monash Low FODMAP diet and the RPAH Elimination diet. If eliminating FODMAPS or Food chemicals (RPAH elimination Diet) has been successful in reducing your symptoms after 2-6 weeks, I will guide you through a systematic food challenge protocol to help you identify which foods are triggering your symptoms, with the aim of broadening your diet as much as possible. Other factors we discuss include stress, hormones and gut dysbiosis (or the balance of bacteria in your gut).

Monash Low FODMAP Diet watch here

What if you had a Second Brain? watch here

Inflammatory Bowel Disease –
Crohn’s disease and Ulcerative Colitis

Both Crohn’s disease and Ulcerative Colitis involve inflammation of the gut lining. In Crohn’s disease the inflammation can occur anywhere along the gastrointestinal tract (from mouth to anus), and extends through the full thickness of the tissue, while in Ulcerative colitis, the inflammation is confined to the colon and is only on the superficial layer.

Treatment

You may already have been prescribed medications by your doctor(s) to help reduce the inflammation in your GIT, however it also important to consider the role of your diet in managing your symptoms. This is because the inflammation throughout the bowel has a significant impact on the absorption of nutrients, and consequently, what I consider in an assessment is whether you are getting adequate nutrition. Similarly, I can give you advice on how to incorporate anti-inflammatory foods, how to limit foods that may be causing inflammation, and what nutrients are particularly important for enhancing gut repair. Likewise during flare-ups when your appetite is low, I can help you prevent weight loss, maintain your electrolytes, and prevent nutritional deficiencies via food or supplements.

There is also some emerging evidence on the role of supplemental probiotics in helping to reduce inflammation in Ulcerative Colitis. Given there are so many different types of expensive probiotics on the market, my role is to advise you which strain has been clinically tested to reduce symptoms in IBD patients, and at what dose. Likewise, there is evidence that a Low-FODMAP diet may be of benefit for some people with symptoms of gas, bloating and diarrhoea. As a dietitian trained in the Monash Low-FODMAP diet, I can guide you through food triggers like FODMAPS (Fructose, lactose, polyols – or sugar alcohols, fructans – in wheat/barley/rye, etc) and other common food triggers. This may also be a helpful part of symptom management.

“The most beautiful people we have known are those who have known defeat, known struggle, known suffering, known loss, and found their ways out of the depths. These persons have an appreciation, a sensitivity and an understanding of life that fills them with compassion, gentleness and a deep loving concern. Beautiful people do not just happen.”

Elizabeth Kubler-Ross

Coeliac disease is a lifelong condition that requires  strict adherence to a gluten free diet.

It is genetically based (so often runs in families and is also linked to Type 1 diabetes and Hashimotos Thyroiditis) and is the result of the bodies own immune system attacking the lining of the small bowel (vili)  resulting in less absorptive surface and fewer digestive enzymes. This often leads to malabsorption of food, and to the symptoms many people experience – diarrhoea, abdominal distension, bloating, fatigue, weight loss, anaemias, steatorrhea (fatty diarrhoea) and/or peripheral neuropathy.

Testing

All people with GI symptoms should be tested for Coeliac disease. While approximately 1% of the population have coeliac disease, it is estimated 80% of people who have coeliac disease remain undiagnosed.

Because eating Gluten – found in wheat, barley, rye and oats – is the major trigger for the development of the disease, it is also recommended that 1st line relatives (parents, siblings, children) of those diagnosed, people with Type 1 diabetes, thyroid disorders, elevated transaminases, short stature, delayed puberty and fatal loses should be tested as well.

If you have unexplained gut symptoms and are concerned you have Coeliac Disease, either book in for a comprehensive assessment, or talk with your GP who can begin the process of testing. In the first instance this involves simple blood tests and depending on your results, may be followed by a small bowel biopsy. It is important that you are consuming adequate amounts of gluten, when these tests are being performed in order to ensure the tests are as accurate as possible.

Treatment

Early diagnosis and treatment, together with regular follow-ups with a dietitian, are necessary to ensure nutritional adequacy and to prevent malnutrition while adhering to a gluten free diet. While the main “treatment” is remaining Gluten-free for life, there are often other nutritional deficiencies to correct in the short term including  Iron and calcium. Likewise, due to the removal of many grains, learning to incorporate other grains and being aware of eating enough fibre is something else I am able to give you lots of information on.

In the early stages after being diagnosed it can feel quite overwhelming, so my job as your dietitian is to break down all the information you need to know so that it doesn’t feel so daunting. I am available via email or phone to answer questions and support you through the process of going gluten free, while providing you with as many or as few resources as you need to help you feel independent.

If you have any questions or would like to book in for an appointment, call my Orange rooms on 6360 2388, or Dubbo on 6885 1696, or you can book online in Orange below: