Irritable Bowel Syndrome and the low FODMAP diet

It's incredible to think that irritable bowel syndrome (IBS) effects 10-20% of the population worldwide. To be honest, I can believe this as we have seen a year on year increase of referrals to our gastro dietetic clinic for patients newly diagnosed with this debilitating condition.

This functional gastrointestinal disorder is characterised by symptoms of altered bowel habits (for example, constipation and/or diarrhoea), abdominal pain, and bloating without evidence of organic disease. I often see patients in clinic at the end of their tether after years of presenting to their GP with these symptoms over and over without any understanding or answers to all of their questions. These symptoms have often taken over their life, dominating social activities which are driven by locating the nearest toilet, or having painkillers to hand 'just in case'. A thorough GP should be taking a detailed symptom history, listening out for any red flags, and may refer to a consultant for investigations to rule out conditions such as coeliac disease, inflammatory bowel disease to name a few.
Often a long way down the road with investigations all proving 'normal' patients are dismissed, or the 'It's just IBS' diagnosis is rolled out. 

I am lucky at Arrowe Park Hospital that my team have a great relationship with the gastro consultants, working closely with them to help patients who are newly diagnosed. They will often refer to us for the detailed elimination diet therapy called 'The Low FODMAP' diet. This diet removes the highly fermentable oligo-, di- and monosaccharides and polyols (FODMAP)-containing foods which can cause symptoms within this IBS spectrum. The elimination period can be for 4-8 weeks depending upon symptom relief, before reintroducing them systematically to identify any trigger foods. Research into the efficacy of such a dietary approach has shown positive results with patients experiencing improvement in symptom control and quality of life. The combination of working with a healthcare professional and accessing the relevant smartphone app, improves the likelihood of success of completing this elimination diet to identify whether food is in fact the trigger.

However, before we even get to that stage there are a lot of basics to cover to ensure that the patient has at least the foundations right. Pharmacological therapies can be effective, but often patients are keen to explore dietary manipulation either first, or alongside medications such as Mebeverine and peppermint capsules.

I find it rewarding to analyse, discuss and work with patients to improve their dietary approach to help reduce symptoms. Both the basic 'first line' advice, and the more involved dietary therapies such as the Low FODMAP diet are effective, and patient's have experienced success to varying levels depending upon their own medical situation, environment and other aspects.

You can never underestimate the joy from hearing a patient say 'I've got control of my life again'.

I undertook the training to become certified in providing the Low FODMAP diet therapy and found the process detailed and fascinating. I am looking forward to using it in my private practice having found it very useful in my clinic at Arrowe Park.