Tag Archives: bloating

Completed! My low FODMAP Certification from Monash University

I was thrilled to complete this week the specialist certification course on the low FODMAP diet through Monash University. This course provided an in depth coverage of all the scientific evidence, mechanisms, research and implementation techniques on this valuable diet tool for managing gastrointestinal symptoms for diagnosed Irritable Bowel Syndrome. Early research also suggests a role in aiding symptom control in cases of diagnosed Endometriosis and potentially Small Intestinal Bacterial Overgrowth and maternal diet where breastfed infants have Infantile Colic, this exciting research continues.

Coeliac Disease and Non-Coeliac Gluten Sensitivity

Well this is an area of a lot of interest currently and it is important to separate the science from the speculation/internet sensation.

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Many people the world over find report that they have symptoms ranging from bloating, wind and abdominal distension/pain to diarrhoea and altered bowel habit when they consume a diet rich in wheat-based foods. Wheat (and grain relatives),Rye and Barley contain both gluten and fructans which are both hard to digest for some. It is commonly assumed by most folk that it is the gluten that is the problem because they are unaware of fructans and their potential role.  The assumption is made by these individuals that they have a gluten sensitivity.

The symptoms described above are seen in a range of gut disorders including Coeliac Disease, Diverticular disease or Chrohn’s disease as well as Irritable Bowel Syndrome for example. It is tempting for sufferers to start removing wheat from their diet however the exclusion of Coeliac disease is the important step they miss before doing this. The tests for Coeliac disease will only be accurate if wheat remains in the diet and the body reveals it’s reactions to the wheat in screening blood tests and if required,  biopsies. This will show up as abnormal blood antibody levels which will suggest a biopsy is needed and abnormal biopsy histology results can be discovered if they exist. Without the wheat going through the body the reactions won’t be there in either blood or biopsy and a diagnosis can be missed.

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Once these diseases have been excluded It may be that a trial of a low-wheat/rye/barley diet as part of a more more comprehensive low-FODMAP diet may be used to see if symptoms can be resolved.

It was once thought the exclusion of wheat in non-Coeliacs may aid symptom reduction due to the lower level of fructans. There is now suggestion in the science that it may be a reaction to gluten, different to that shown in Coeliac disease, that may worsen some gastointestinal symptoms in non-Coeliacs and this has been given the term non-Coeliac gluten sensitivity(NCGS).

Watch this space as the story unfolds. Well conducted research trials are few and far between but in the last few years a couple have appeared using subjects with self-reported NCGS that have been well designed to ensure all other causes have been accurately excluded.

The BOTTOM LINE- make sure Coeliac disease is accurately excluded before altering you diet.

If Coeliac disease is confirmed after abnormal blood test results and subsequent biopsy there is a very strict dietary protocol to follow to maintain a 100% gluten-free diet, 99 % is not enough removal for this healing of the gut with this condition.

If excluded the other dietary trials can be started in earnest.

Sorting out Chronic Constipation

For those who have felt the effects of constipation for a large part of their lives knowing the type of constipation they have will help find a long-term solution.

There are primary (also called functional constipation) and secondary types of constipation. Primary constipation is due to a problem with the bowel resulting from nerve and muscle dysfunction in the bowel. An example of this is pelvic floor dyssynergia where there , at bowel action time, there is an abnormal increase of pelvic floor muscle activity  rather than the normal decrease necessary for a normal bowel movement. Other types of primary constipation and called normal-transit and slow-transit constipation where nerve and muscle dysfunction causes the changes in the movement of bowel contents.

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Secondary constipation results because of something else happening in the body such as constipation dominant Irritable bowel syndrome or hypothyroidism for example. It can also be due to use of medications to treat medical conditions that have a side-effect that alters bowel habits.

Just to make things difficult there is significant overlap between the sub-types so a mixture of solutions may be needed!

Depending on the type there are different treatment options including:

  • Medications to alter bowel nerve and muscle function
  • Increasing fluid intake
  • Increasing dietary fibre to reach fibre target goals
  • Using some non-fermentable commercial fibre supplementation
  • Non-stimulant laxative use – stool softeners and stool lubricants
  • Stimulant laxatives
  • lowering the intake of FODMAP-rich foods in the diet

Making the changes recommended to you by your Gastroenterologist or Accredited Practising Dietitian day in and day out will give long-term improvements to bowel function and improve quality of life.

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What is Irritable Bowel Syndrome?

Irritable Bowel Syndrome (IBS) is a condition where a set of symptoms, including abdominal bloating and pain, wind and altered bowel movements affect sufferers’ lives. It is a common condition affecting up to 15% of the general population and is called a Functional Gastrointestinal Disorder. This means that the nerves and muscles of the gut may not be working in combination optimally causing digestive upset and bowel issues.

Depending on your symptoms a diagnosis of IBS is best made after other, more serious conditions, are excluded. Some tests organised by your GP or a Gastroenterologists can help to rule out Helicobacter Infection, Coeliac Disease, Diverticular Disease to name a few of the organic gut disorders .

Getting some control back over your bowel symptoms will mean you can spend more time on the fun things in life and less time in the bathroom! This is where a change in some aspects of your diet including some difficult to digest/absorb foods, food volume and timing can help. It is best done in an organised manner to ensure that the minimum number of restrictions results and the maximum amount of comfort.

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Diet for Digestion-the internet version of dietary restrictions-help!

An internet search for a few minutes on the topic of digestive health suggests your diet is to blame for many of your gut symptoms. The list below shows some of the common food and drink items that are to blame, according to ‘Dr Google”. The internet is a wonderful source of information and mis-information and the dietary restrictions list below came from my brief search on this topic.

Excluding coffee, tea, alcohol, fibre, meat, soy, carbohydrate, dairy/lactose, honey, fruit/fructose, wheat, rye, yeast, legumes, onion, garlic, sugar,processed foods, artificial sweeteners are general results.

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Many people with digestive symptoms start omitting one food or group of foods and when symptoms don’t improve they omit another food group and so on until their diet includes a very small range of foods. Eating such a small range of foods makes meals repetitive and not very enjoyable. Nutrient needs will not be met and over time health deteriorates further.

Is there another way to ease digestive distress?

Yes, get an organised diagnosis plan to exclude underlying disorders and take it from there. An Accredited Practising Dietitian(APD) with a digestion interest will help you put this together and work out which dietary restrictions may be required to manage your symptoms and for how long the restrictions should be followed. If you live in Perth come contact me for an appointment or

 

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Accurate Diagnosis

Vector-Entrepreneurship-WomanAccurate Diagnosis of the problem is the opposite to random diet trials which sufferers may be experimenting with.

Diagnosis is essential because just improving symptoms through dietary restriction may just be a band-aid measure. Incomplete investigation can hide serious intestinal or other  problems and these need excluding. Unnecessary restrictive diets also threaten nutritional status and overall health, definitely something we want to avoid.

Diagnosis will usually involve an Accredited Practising Dietitian specialising in digestive issues, your Doctor, and in many cases a referral to a Gastroenterologist (Gastrointestinal Specialist) whose specialist knowledge can determine essential tests and interpret the results.

Putting a finger on the exact digestive issue can be surprisingly difficult in many cases and needs a concerted plan to escape the treadmill and frustration of unstructured trial and error.

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Why is my Digestion Dodgy

As you see from the digestion image there are many parts and processes digestion partsinvolved in digestion between the mouth and the anus. Given the complex nature of digestion it is no surprise that a large percentage of the population experience poor digestion on a regular basis.

Gastrointestinal(GI) disorders occur when one or more parts of the GI tract work poorly and may result in  nausea/ reflux, early fullness, altered intestinal transit time(diarrhoea/constipation), bloating, excess passage of wind, pain and discomfort. Ouch!

There may be an underlying disorder such as Coeliac Disease, Diverticular disease or Chrohn’s disease for example or it may be that the symptoms are not explained by any of these disorders and Irritable Bowel Syndrome is thus diagnosed- a functional GI disorder.

Improving your digestive comfort and quality of life will occur once diagnosis is confirmed and careful investigation of your individual gut response to dietary food components is determined. As an Accredited Practising Dietitian Specialising in Digestion Issues I see the benefit of a targeted plan for diagnosis daily and encourage you to go this path for eventual better control of your symptoms and get back to some of the activities you used to enjoy.

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Fibre and your Bowel

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The fibre content of your diet refers to the part of what you eat that is the carbohydrate fraction of your diet resistant to the digestion and absorption in the small bowel. Some types of fibre are called polysaccharides, oligosaccharides and lignins. The dietary fibre part of our diet promotes actions that are laxative (increasing movement of bowel contents) ,improve our bodies blood glucose response after eating, lower blood cholesterol as well as promoting the action of gut bacteria to make substances that improve bowel health.

Fibre types vary in the degree to which they will be fermented in the large intestine by the action of the bacteria there so some result in a lot of wind production and others less so. Because of this the use if high fibre diets or fibre supplements to treat constipation may cause bloating and pain if the fibre type is a fermentable one such as wheat bran or psyllium. The low FODMAP plant foods and the non-fermentable fibres found in the Sterculia plant (Normafibe supplement) and Methylcellulose (Citrocel) can improve symptoms of constipation more gently.

Those with diarhoea-dominant bowel symptoms may need a total lower fibre intake and some other dietary modifications to slow the transit of gut contents.

Modifying the types of fibre in your diet can assist to control your bowel symptoms and sorting out which diet and supplement best suit your condition can be very helpful.

 

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Bowel Symptom Monitoring

Bowel symptom monitoring ,by keeping a four week daily food and symptom diary, is a great way to keep track of changes in your gut symptoms and identify potential trigger food groups/ food molecules. Use our page ,attached below, or an electronic diary if you prefer.

The bowel symptom/bowel habit section is particularly useful so don’t be shy about getting down to the nitty-gritty there. I find it very helpful if bathroom events are noted in the bottom (no pun intended) row and the feelings of digestive upset noted anywhere on the daily column that they occur so the timing of these around foo and drink consumption is noted.

Tip: a week at a glance diary shows symptom change very clearly. Download a copy and modify it if needed to suit your needs.

Food and Symptom DIARY

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Veggies- the low FODMAP varieties

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Veggies are good for us right? Yes, nutritionally they are one of the best group of foods we can eat in large volumes for good health and reducing our disease risk. This doesn’t mean that all veggies are easy to digest and individuals with symptoms of nausea, bloating, excess wind, abdominal pain, constipation or diarrhoea (big list!) may need to get eat only the most digestible vegetables that have lower levels of the FODMAP’s.

This list includes green beans, potato, carrot, capsicum, asian greens, jap pumpkin, tomatoes  and zucchini. Trialing the removal of other vegetables such as onion and garlic and limiting serve size of broccoli, sweet corn, snow peas and butternut pumpkin are some of the changes used in the test-phase of the low FODMAP diet.

Meals made with low FODMAP ingredients, as shown in the Lunch ideas post can help ease Irritable Bowel Syndrome symptoms and enhance your low FODMAP diet compliance. An Accredited Practising Dietitian with a Digestion specialty can help you put together a menu that will suit your preferences, home and work life so that you can trial this revolutionary diet approach.

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