So, you are probably struggling with years of bloating and discomfort. Someone probably told you in the past that you might have Irritable Bowel Syndrome (IBS). But, maybe you are not sure whether you actually have this condition or not?

Maybe you are thinking, what tests do I need? Is it expensive? What symptoms does someone with IBS have?

Keep Reading! I will answer all those questions in the next few words.

HOW DO YOU DIAGNOSE IBS?

Unfortunately, there is no formal IBS test that can tell you “YES, you have IBS”. This is probably why most people get so frustrated and they go from one Doctor to the other.

IBS diagnosis is based on two things: symptomatology and through exclusion of other conditions.

WHAT SYMPTOMS SOMEONE WITH IBS HAS?

The most common IBS symptoms are:

• Bloating
• Abdominal Pain
• Alternating bowel habits
• Diarrhoea or/and Constipation
• Abdominal Distention
• Excessive Flatulence

Because these symptoms could happen at any time we need to be able to differentiate them from someone with IBS. That’s why we use the Rome IV Criteria. The criteria are:

Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of the following criteria:

1. Related to defecation
2. Associated with a change in frequency of stool
3. Associated with a change in form (appearance) of stool

In simple terms. If you have been suffering with abdominal pain or discomfort weekly for the last 3 months, alongside any changes in your bowels then you should see a Doctor.

Getting an IBS Diagnosis

Your Doctor will consider your age, medical history, health, symptoms before they decide what tests you should have to exclude other conditions before diagnosing you with IBS.

MOST COMMON IBS TESTS

Coeliac Disease Screen

A simple blood test is needed to measure Total immunological immunoglobin A (IgA) and IgA tissue transglutaminase. If the blood tests come back positive a further camera will be needed to take a biopsy of your small bowel for confirmation of the disease. It is important to note here, that for the Coeliac Screening to be accurate you need to be consuming Gluten in your diet for at least 4 weeks before the test.

Symptoms of Coeliac Disease can be identical to those of IBS, therefore it is essential to rule out this disease.

Stool Sample Test – Faecal Calprotectin

These may be used to look for signs of infection or inflammation. Calprotectin is a protein biomarker that presents in the faeces with inflammation. This can indicate inflammatory bowel diseases (IBD) – Crohn’s Disease & Ulcerative Colitis, but again further testing will be needed to confirm this.

Inflammation & Full Blood Count

Measuring your C-Reactive Protein (CRP) can show signs of inflammation and further testing might be needed then. In addition, a blood test is always useful in checking your general health.

Colonoscopy & Gastroscopy

A colonoscopy is generally not needed for an IBS diagnosis. However, your Doctor will take into consideration your age and symptoms and will decide whether you need one. This however, does not mean that you will have something serious going on.

Summary

Suffering from IBS can be really difficult and can get you into considering anything that you see on the market. If you are concerned that you have IBS please talk to your Doctor. You can discuss with your Doctor your concerns and possible testing to get a proper diagnosis. A formal IBS diagnosis will be given when your symptoms match out those of IBS and once you rule out other possible conditions.

Source: Department of Gastroenterology, Monash University.
This blog and recipes were created and reproduced with permission from Monash University (monashfodmap.com).

What do you do when you feel better following a low FODMAP diet? Re-introduce FODMAPs! While this may sound illogical, it is important for a number of reasons, first and foremost to ensure your diet is minimally restrictive, while still providing adequate symptom control. Read on for a simple guide to the 3 phases of the Monash University Low FODMAP Diet™.

Step 1. Low FODMAP 
This is to be commenced under the supervision of a dietitian for a period of 2-6 weeks. During this phase you would use the Monash University FODMAP Diet App to choose foods with a ‘green’ serving size. This means that you only eat foods in a low FODMAP serve. But remember, a low FODMAP diet is not an elimination diet. Rather, it is a substitution diet, whereby you swap one food for another, e.g. switch your daily apple for an orange, or swap an onion for chives.

Step 2. Reintroduction
This step involves reintroducing foods back into your diet in a methodical way to determine which foods and FODMAPs trigger symptoms and which do not. Each FODMAP subgroup should be reintroduced separately while your background diet remains low in FODMAPs. The reintroduction step is also best completed under the guidance of a dietitian, who will advise you on when to reintroduce; which foods to reintroduce with (e.g. honey to test your tolerance to excess fructose); the amount of the reintroduction food to have, and the order of reintroducing foods. Remember to have a break of a few days between reintroduction of foods to avoid any crossover effects. A dietitian will also help you to interpret your responses. It takes most people around 6 to 8 weeks to complete the reintroduction step.

Step 3. Personalization 
The third step of the diet involves establishing your longer term, personalized FODMAP diet. Once your dietitian has interpreted your food triggers and tolerances, you can begin to reintroduce foods and FODMAPs that were tolerated well and avoiding ONLY the foods that triggered your symptoms. It is important to remember that FODMAP tolerance can change over time, so if there are foods you didn’t tolerate as well, try again in a few months to see if anything has changed. 

We understand there may be a hesitation to reintroduce foods, especially if you are feeling well after following a low FODMAP diet, but there are important reasons why you should complete Step 2 – Reintroduction and expand your diet. To read more about these reasons, take a look at our previous blog posts on the topic. 

• https://www.monashfodmap.com/blog/new-year-goals-to-improve-your-ibs-and/
• https://www.monashfodmap.com/blog/dietary-fibre-series-prebiotic-fibre/

Something that can be an overwhelming and daunting part of following the low FODMAP diet, especially during the strict elimination phase is grocery shopping and selecting suitable products. It can be difficult to decipher what exactly is in a product and whether it is high or low FODMAP and safe for you to eat without triggering a flare. Here are some handy tips that may help take some of the stress out of grocery shopping.

TIP 1: ALWAYS CHECK THE INGREDIENTS

It is super important to make sure you’re reading the ingredients list on all products!! The ingredients list can generally be found on the back or side panel of a product. Ingredients are listed in order from highest volume to lowest volume. This means that although a product may contain an ingredient that is high FODMAP, if it is further down on the ingredients list, it may be in a dose that is safe to eat.

The ingredients list also often contains allergy notice which can be very important!!

TIP 2: BE AWARE OF COMMON HIGH FODMAP INGREDIENTS

The ingredients list can be a confusing place, filled with big and confusing additives and preservatives which are often misunderstood. Knowing which ingredients to look out for will save you time & stress! Here listed are some common ingredients that are known to be high FODMAP. If these ingredients are in the first few ingredients, it’s an indication that the product is most likely high FODMAP and should be avoided.

Following a low FODMAP diet is not always an easy task. We have daily commitments, activities and overall, our lives can be quite busy. The good news for us is that are FODMAP friendly snacks on the market that are nutritious, filling and most importantly, taste great! What more could you want?

If you haven’t got a great amount of time on your hands and wanting convenient, on-the-go, easy to prepare snacks, you’ve come to the right place. Here are a few that I highly recommend you try.

1. Banana smoothie

You can’t go wrong with an easy to whip up smoothie. You simply add an unripe, firm banana, your choice of low FODMAP milk, some oats and if you have a sweet tooth, some maple syrup! Such a quick an easy, minimal ingredient snack option. (Full recipe can be found on the Monash University FODMAP Diet App).

2. Trail mix

Simply start with peanuts and add 10 walnuts or 15g of cranberries or pepitas (these all become high fructan, so you need to pick only one), then add 10 almonds and some shredded coconut. There you have it, a quick and easy on-the-go snack option. Nuts are an energy-dense, nutrient-rich snack, and also help us feel fuller for longer, so win-win!

3. Energy balls

These are super easy to whip up the night before a busy day as you only need a few ingredients. These include oats, cranberries, peanut butter, some maple syrup, quinoa and some dark chocolate chips! The easy part is – all of the ingredients are simply processed together and all you have to do is roll them into bite sized balls! (Full recipe can be found on the Monash University FODMAP Diet App).

4. Cheese & crackers

YES, you can still have your cheese and crackers! Gluten free crisp-breads made from rice/corn paired with some cheddar cheese makes a great on-the-go snack! Just be sure to read your labels with the crisp-breads. Look out for sneaky high FODMAP ingredients like inulin.

5. Low FODMAP snack bars

For my friends in Australia, let me introduce you to Fodbods. They are delicious gut-friendly snack bars made in Australia that are FODMAP friendly! They are also vegan, gluten and dairy free. They come in a range of flavours including choc mint, peanut choc chunk and lemon coconut, just to name a few.

Bottom line

Following a low FODMAP diet may be challenging at times, although there is absolutely no need to go hungry! I hope these snack ideas have inspired you and have allowed you to recognise that there are some quick and easy snacks that you can create/purchase, and that following this kind of diet doesn’t have to be difficult. It is essential that we nourish our bodies to keep our energy levels up, and productivity high, so ensuring that you have some low FODMAP snack ideas up your sleeve, will be of great benefit in the long run.

Reference List:

1. Fodbods-au. (2021). Fodbods – FODMAP Friendly Bars – Natural | Vegan | Gluten Free. https://www.fodbods.com/

2. Monashfodmap.com. (2021). Oat, Cranberry & Choc Chip Energy Balls. https://www.monashfodmap.com/recipe/oat-cranberry-choc-chip-energy-balls/.

3. Monash University. (2012). Monash University FODMAP Diet App.

4. M, L., & L, L. (2016). Nuts and Body Weight – An Overview. Journal Of Nutrition And Health Sciences, 3(1). https://doi.org/10.15744/2393-9060.3.104

For people experiencing IBS, eating out can cause stress, anxiety and feelings of embarrassment. These are completely normal. HOWEVER, you shouldn’t have to feel that way! By using some tricks and tips you can eat out without fear and be present and enjoy the company of loved ones.

1. Be prepared!

Knowing ahead of time what’s on the menu is a great strategy to help get rid of some of the anxiety that builds up before eating out. By scanning the menu and taking note what’s in each dish and what’s friendly for your tummy, you can have an idea of what you’re going to order in advance. This helps you to feel comfortable and confident knowing that you’re able to make an informed decision and won’t feel pressured at the moment and make a choice that leads you worrying about the impending explosion in your belly. Stress is also known to trigger these symptoms in some people so anything that can help lower stress is absolutely a win!

2. Know your triggers

Having an awareness of what specific foods trigger your symptoms is a massive advantage when looking at a menu and making a choice. Knowing your triggers means you can avoid these foods completely or ask them to be excluded from a dish where possible. If you’re still in the beginning stage of a low FODMAP diet for the first time and still working out your triggers, it may be harder to make a safe choice but that’s not to say you can’t, it just means you may need to tread more cautiously and your options may be limited. However, if you let the staff know about your dietary requirements, they’ll most likely be able to find something suitable for you.

3. On the side, please

Sauces, dips, curries and other rich dishes are often hiding onion and garlic, two common triggers for IBS sufferers. By asking for them on the side, you are in control of how much you eat, as they may be safe in smaller quantities. Don’t worry about sounding fussy! It’s a completely reasonable request and a valid concern. Nobody wants the uncomfortable, often painful, symptoms that occur after eating these foods if they can avoid it.

4. Pay attention to quantities

As mentioned above, although certain foods/substances may be triggers for you, they may be safe in when consumed in smaller quantities. Alcohol falls into this category – too much alcohol may increase the ‘leakiness’ of the gut in the short term, which affects the normal movement of the gut and can lead to symptoms, particularly for those with sensitive tummies. Some strategies around alcohol are:

• Be mindful of how many drinks you’re having and limit yourself to just 1 or 2. I know everyone says it, but you can still have fun with only a couple of drinks, especially if you’re around the right people!

• f you’re drinking wine, pour a smaller glass and top it up with soda water. This helps with hydration as well so you’re still getting the taste but not the dehydration, it’s a win-win!

• If you’re concerned about alcohol and want to avoid it completely, have a kombucha or mocktail instead, that way you won’t feel like you’re missing out

5. When in doubt, go back to basics

Although it may seem boring, a piece of protein with steamed veggies or a side salad (dressing on the side) is a great, safe option if nothing on the menu seems suitable.

6. Don’t forget your fibre

Try your best to include something on your plate that feeds your gut bugs. Examples include vegetables, fruit, whole grains, legumes, nuts and seeds. These plant-based foods help nourish our guts and keep them happy, healthy and functioning normally. Fibre also helps us to feel full so ordering a side of one of these can help prevent overeating, which can lead to symptom development.

7. Use your support network

Although it may be embarrassing to talk about at first, let those closest to you know about your IBS and how eating out creates those feelings of dread and anxiety. If they decide on a restaurant or café that doesn’t seem to have any suitable options on their menu for you, let them know and they’re more than likely going to be understanding and accommodating to your needs. If you need more support, ask your dietitian! That’s what they’re there for, after all, to support and guide you in your journey to becoming symptom-free.

If there is one take away from this piece, it is that IBS shouldn’t prevent you from enjoying food and the company of your nearest and dearest. Food is so much more than just what to eat, but it is often a foundation of our social behaviours as humans. We use it to celebrate, commiserate, and catch up with both old and new friends. By using some of these simple tips, you can remove some of the fear associated with eating out and instead use that energy to be completely present and at ease in the company you choose to keep.

Reference List:

Erin Dwyer. Eating out on a low FODMAP diet. 2017. Monash University. Available from: https://www.monashfodmap.com/blog/eating-out-on-low-fodmap-diet/

Dr Megan Rossi. How to keep your gut happy this festive season. 2019. Available from: https://www.theguthealthdoctor.com/all-articles/the-gut-health-doctor-christmas-party-tips-for-looking-after-your-gut?rq=eating%20out

Dr Jane Varney. Eating out tips and tricks. 2020. Monash University. Available from: https://www.monashfodmap.com/blog/eating-out-tips-and-tricks/