If you suffer from uncomfortable and sometimes embarrassing bloating, you’re not alone. The good news is you can use food to trump tummy troubles. HFG dietitian Melissa Meier explains how!
How often do you wake up with what feels like a fairly flat stomach — only to find your clothes unbearably tight round your middle by the end of the day? In fact, feeling occasionally bloated or windy is actually quite normal.
“But if you’re bloated on a daily basis, and these episodes are happening so often they’re impacting your daily life in a negative way, this is where it is considered too much,” says dietitian Chloe McLeod, director of The FODMAP Challenge and co-owner of Sydney-based Health & Performance Collective.
About one in five Aussies will develop Irritable Bowel Syndrome (IBS), a condition twice as common in women as in men. If you’re someone who is already experiencing the condition, you’ll know it can be stressful, uncomfortable and at times embarrassing. But there is hope — and tweaking your diet is a great place to start.
What is IBS?
IBS is probably the most common cause of bloating, with up to 90 per cent of IBS patients reporting bloating.
Irritable Bowel Syndrome occurs when your bowel’s usual rhythmical waves go into spasms. Aside from bloating, symptoms also include abdominal pain and discomfort, excessive wind, and diarrhoea or constipation (or both of these).
IBS is a functional disorder — meaning it causes changes in your gut function — but it is not associated with ulcers, inflammation, or any abnormal blood tests. This means test like a colonoscopy and X-ray show no abnormalities.
As the symptoms of IBS are common to a number of other gut disorders, the condition is usually diagnosed by a process of elimination, which means that the diagnosis of IBS can often take a long time.
What causes IBS?
The exact cause of IBS is still unknown, but there are many possible triggers.
“High levels of stress, or infection from a parasite or virus [for example, from Bali belly], are two common triggers,” McLeod says. Genetics and an abnormal balance of gut bacteria are also thought to be contributors.
Food also plays a role. People with IBS often discover that certain foods will trigger their symptoms, and are keen to know what they should or should not eat. A group of foods called FODMAPs are the most common dietary trigger — and scientific studies have proven that a low-FODMAP diet can significantly relieve IBS symptoms for many people.
3 things to do if you suspect IBS
Many conditions, such as diverticulitis or coeliac disease can cause similar symptoms, so it’s important to visit your GP, and possibly a gastroenterologist, for a thorough check-up. Importantly, don’t ignore your symptoms and just hope they will go away.
See a specialist dietitian
Cutting out foods without consulting a professional can also complicate a diagnosis. If you suspect food is a culprit, book in to see an Accredited Practising Dietitian (APD), as you might cut out more than you need to, and miss out on valuable nutrients.
Consider your stress levels
Stress can worsen IBS symptoms, so try to reduce stress with activities like a yoga class, a warm bath at the end of the day, or taking time to read a book each night. Try also to get enough sleep and exercise.
The low-FODMAP diet
Don’t let this scientific jargon scare you — FODMAPs are a natural part of many healthy foods. Because they’re not digested well, they move into the large intestine and act as 'food’ for your gut bacteria, which then produce lots of gas.
“People with IBS have more sensitive nerve endings in their digestive system, so this gas can feel very uncomfortable,” says dietitian, Chloe McLeod. The effects of FODMAPs are cumulative — what you eat over a whole day, or a week, counts.
What are FODMAPs?
Put simply, FODMAPs are an acronym for a group of carbohydrates that are poorly absorbed. In other words, they are indigestible sugars that provide food for gut bacteria.
FODMAP stands for:
Fermentable: Rapidly broken down by bacteria in the bowel
Common foods containing FODMAPs
Spring onion (white part)
Bran (from wheat, rye or barley) Wheat & rye (when eaten in large amounts in biscuits, bread, couscous, crackers, pasta, etc)
Soft and fresh (such as ricotta, cottage)
Apple Canned fruit in natural juice
Fructose, high fructose
High total fructose dose
Concentrated fruit sources
Large serves of fruit, dried fruit, or fruit juice
Avocado (more than 1/8)
What is a low-FODMAP diet?
A low-FODMAP diet limits or eliminates foods that contain FODMAPs, and is now internationally recognised as the first line of dietary therapy for IBS. However, a low-FODMAP diet is not forever.
“Unnecessary restrictions and avoidances may make it hard to reach your nutritional needs,” says McLeod. “Plus, many high-FODMAP foods are also high in prebiotics, which provide food for the good bacteria that are found in your gut. Research shows that long-term avoidance of these may affect the health of your bacteria, and your gut."
Rather than an extreme diet overhaul, think of the low-FODMAP diet as a short-term protocol to help you identify your particular IBS triggers.
A strict low-FODMAP diet lasts for two-to-six weeks, to allow gut symptoms to settle. Gradually, the FODMAP groups are then re-introduced one by one and symptoms are monitored, until you know the foods to include and those to limit or cut out.
A low-FODMAP diet can be tricky to maintain without help, so seek the advice of a dietitian who specialises in IBS and gut health. The goal is to have a nutritious, varied diet, minimal symptoms, and as little restriction as possible.
Foods suitable on a low-FODMAP diet
Spring onion (green part only)
Ice cream substitutes
Gluten-free bread, cereal and pasta
100% spelt bread
Oats (less than ½ cup)
Artificial sweeteners not ending in ‘-ol’
Rice malt syrup
Low-FODMAP smart swaps
Try these easy substitutes in the kitchen to help ease bloating.
Swap regualr bread for gluen-free or 100% spelt bread
Swap oats for quinoa
Swap couscous for rice
Swap milk for lactose-free milk
Apple for firm sugar banana
Mango for pineapple
Dried lentils for canned lentils
Onion for chives
Garlic for garlic-infused olive oil
Are onions & garlic off the menu?
Onion is one of the greatest contributors to Irritable Bowel Syndrome symptoms. Even in very small amounts this vegetable can cause discomfort, as the fructans can leach out of the onion into other ingredients during cooking. Garlic also contains fructans, but usually most people can tolerate small amounts. A good way to enjoy the taste of garlic and onion without fructans is to use an infused oil.
Your guide to eating out
Don’t let IBS interfere with your social life. Follow these five tips for eating out on a low-FODMAP diet:
Don’t be afraid to ask the staff questions. That's what they're there for — and they want you to return!
If nothing seems suitable, look for something that can easily be altered, like removing onion or garlic. Most venues are happy to accommodate.
Request simple flavours like lemon juice, olive oil or chilli that you know you'll enjoy and can be easily sourced.
Aim to eat strictly low-FODMAP in the meals leading up to eating out, to help reduce your FODMAP load. You'll be far more relaxed when choosing your meal.
Download the Monash University FODMAP diet app so that during the meal you can check out anything doubtful.
Melissa is an Accredited Practising Dietitian with a love of healthy, delicious food. She is passionate about helping others to lead healthier lives and teaching people to use nutrition to better their health.