Why your gut could do with a holiday!
THERE is nothing better than that holiday feeling, as the stresses and strains of your life just seem to ebb away. And for some people, a holiday is just what their gut needs, too. But I don’t mean literally going away — just giving it a brief respite from its usual routine.
This kind of break can really help people with irritable bowel syndrome (IBS), as well as anyone who’s had a stomach bug — when your gut may be more sensitive than usual.
And, just as a fortnight off can change our approach when we are back at our desks, so a ‘gut break’ can help change the behaviour of our digestive tract, reducing symptoms such as bloating, pain and irregular bowel movements.
This idea of resting the gut is the principle behind the low FODMAP diet — a well-established approach to treating IBS, developed back in 2007 by researchers from Monash University in Australia. It may also help with small intestinal bacterial overgrowth (SIBO, where you have more microbes than normal in the small intestine, which leads to bloating, pain and loose poop).
FODMAPs, or Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, are carbohydrates that are generally poorly digested by the upper intestine, finding their way into the large intestine.
here, the trillions of microbes break them down, going into a feeding frenzy — along the way producing beneficial chemicals but also gas, which can irritate the millions of nerve endings.
If you have IBS, or if you’ve had a recent stomach upset, these nerves are often hypersensitive and this gut activity can kick-start cramping pain and symptoms such as bloating.
The undigested carbs also draw fluid into the intestine, leading to loose, or a mixture of hard and loose, poop. This can disrupt the colony of gut microbes, because excess fluid in the gut can affect how fast the food moves through and in turn can lead to more malabsorption of food and more W ITH fermentation by the gut bacteria.
the low FODMAP diet the idea is that you temporarily cut out foods that are high in these carbs, allowing your gut that much-needed break, calming everything down by reducing both the bacteria-produced gas and influx of fluid.
It gives the gut a chance to reset. More specifically, it takes the pressure off those hypersensitive nerve endings, allowing them to settle down.
The diet alleviates symptoms in about 70 per cent of people with IBS, according to various clinical trials, with an improvement in tummy pain, bloating and stool movements often seen within two to four weeks.
I’ve found in my clinic that it can also work for those who’ve recently had a gut infection — the shortterm reduction in gut stimulation can help your gut lining rejuvinate. But, and this is key, you need to then ‘retrain’ your gut to accept these foods, by slowly reintroducing them.
Because that’s the point: you do really want these foods in your diet long term. FODMAPs are by and large healthy foods — they include wholegrains such as barley and rye, beans and pulses such as chickpeas and lentils, and certain fruit and veg such as apples, pears, garlic, cauliflower and onions.
Most of them are prebiotics: in other words they help feed and nourish the microbes in your gut which play such a key role in our health generally.
And a low FODMAP diet needs to be followed with care as its restrictive qualities make it more challenging to get enough of key nutrients such as calcium, and fibre. It can also lead to unwanted weight loss and can worsen constipation (by cutting back on so many fibrous foods).
That’s why British Society of Gastroenterology guidelines recommend that the diet should be undertaken with the support of a FODMAP-trained dietitian.
realistically, that isn’t always possible, which is why I developed the FODMAP-lite approach.
essentially, it restricts a smaller number of foods than the full diet (just the foods highest in these carbs), so it’s easier to still get plenty of fibre and also have a more diverse diet.
In my clinic this ‘lite’ approach seems to be enough to bring about an improvement in most people with mild to moderate IBS (you can find a table of lower FODMAP foods at theguthealthdoctor.com).
When it comes to IBS, with either FODMAP- lite or the standard version, there are three stages: stage one lasts two to six weeks depending on how quickly your symptoms improve, and involves replacing high FODMAP foods with lower alternatives. During stage two you reintroduce the different carb groups one at a time so you can identify which you are most sensitive to and at what quantity.
A food that rates ‘ high’ can be low, depending on how much you eat of it. For example, a cup of pasta is high FODMAP, whereas S HOULD half a cup is considered low.
a food trigger symptoms, then wait a few days and reintroduce it at a half dose. This stage of reintroducing can take several months to complete.
Stage three is the personalisation stage where you reintroduce all food up to your tolerance level over several weeks.
The full three- stage low FODMAP diet might take eight months or more to complete. For those with less severe symptoms, you might want to start with the FODMAP-lite approach which halves the time to complete it.