by Community Dietitian Chloe Hall.
I have always experienced irritable bowel type symptoms. In the past year, my symptoms were exacerbated and I sought the advice of several GPs and had multiple blood tests and an endoscopy (without biopsy) and was told that these were ok, apart from one marker which showed a possible allergy or inflammation.
After having investigations for nine months, I decided to embark on the low FODMAP diet because my symptoms were continuing to get worse and I also requested a referral to the gastroenterologist. I followed the low FODMAP diet for eight weeks before trialling re-introduction and my symptoms were mainly improved.
I found that I could not tolerate even small amounts of wheat in low FODMAP foods, such as soy sauce, and at my gastroenterology appointment I found out that during the year of investigations, I had not been checked for coeliac disease despite a family history of the condition and other auto-immune conditions such as Crohn’s disease. I had also not had a faecal calprotectin test.
Bringing Personal Experience To My Practice
I am now trying to work with the CCG in my area to try and ensure that the appropriate Red Flag blood tests are ruled out in each patient presenting with IBS-type symptoms and increase education for GPs. I had been teaching the low FODMAP diet to patients for the last few years, but I have learnt so much more from undertaking the diet and I wanted to share and also encourage anyone who teaches the diet to trial it for at least a few weeks.
I knew that the low FODMAP diet could be complicated but I was surprised by how much time the diet took to organise. I could no longer just pop into the shops. I love cooking but meals did take longer to prepare, shopping lists longer to write and I also found that thinking about it took over my life for a little while! Luckily my family were very understanding and were just pleased to see me well again and their support was vital.
Recipes And Resources
I found information and recipes online from fellow registered dietitians, all of which were really helpful as was the Food Maestro app for scanning foods. I did find that, overall, there was a lack of online information created by UK dietitians on the low FODMAP diet (with exceptions!) and I think that more UK blogs and websites from the UK profession on this subject would be really helpful for patients.
There are a lot of Facebook groups run by people following the low FODMAP diet but they are self-help groups rather than groups run by dietitians and the right information isn’t always available.
Eating Out
My main passion in life is food and eating out and luckily I did find that this was still possible. I did feel like more of a burden as I had to check the restaurant menu’s before going out and ask my friends to pick restaurants based on my dietary requirements.
I found that picking from the gluten-free menu was the easiest thing to do and then ask for some meals to be adapted. I ate a lot of meat, vegetables and potatoes without sauces. One restaurant was really helpful and made a whole meal for me, that wasn’t on the menu, based on my requirements but we were the only couple in there so I didn’t mind asking; I’m not sure how I would have felt explaining my dietary needs in a packed restaurant!
I also discovered that one of the pizza chains provides gluten-free pizzas and their tomato sauce contains no onion and garlic, so I could just pick a pizza with low FODMAP toppings. So there are some options when dining out, you just have to do your homework.
Reintroduction
Prior to having these issues myself and following the diet I didn’t really understand why patients were never that keen to re-introduce. I always thought that people would be desperate to re-introduce onion and garlic!
When it was coming to the end of the first stage, I found myself wondering if I could just continue on the elimination phase. I did, however, know that FODMAP restriction reduced luminal bifidobacterial and that at present we do not know the long-term effects of this (1 - see references below).
Where I Am Now
I’m now symptom free on a gluten-free diet and have had a positive genetic test for the genes linked to coeliac disease. I may not ever have a full diagnosis and I am, therefore, passionate about ensuring that patients have the appropriate tests if experiencing gastrointestinal symptoms.
My experience has reinforced that gastrointestinal symptoms aren’t necessarily ‘just a bit of IBS’ and that good local IBS pathways and education are vital. I’m now an advisor with the IBS Network and am hoping that with new research emerging on IBS and other gastrointestinal conditions, as a profession, we can continue to increase awareness of gastrointestinal conditions and their treatment.
References:
1. Staudacher, H.M. Lomer, M.C.E., Anderson, J.L., Barrett, J.S., Muir J.G., Irving, P.M., Whelan, K. Fermentable Carbohydrate Restriction Reduces Luminal Bifidobacteria and Gastrointestinal Symptoms in Patients with Irritable Bowel Syndrome. Journal of Nutrition. 2012