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It is just over 12 months ago that I received a welcome call out of the blue from Dietitian, Jocelyn Hunter Clark asking whether I had any space in my new building for her to rent, as the rooms she was using were no longer available. I strongly believe in referring patients on to a dietitian to receive expert, specialised advice about dietary modifications for a whole raft of conditions I see every day and to have Jocelyn at my premises to me would be so convenient for my patients. So Jocelyn has now been at 47 Hampstead Road, Highgate Hill now for over a year and she has been a pleasure to work with. As such I have asked Jocelyn to contribute some blogs on a regular basis to help unravel the mystery surrounding some gastro-intestinal conditions.
Jocelyn is an Accredited Practising Dietitian and Accredited Nutritionist with a Degree in Science and a Post Graduate Diploma in Nutrition and Dietetics. She has over fifteen years’ experience in variety of roles and was a Registered Nurse for 10 years before becoming a dietitian. She has a special interest in gastrointestinal disorders, food intolerance and children’s nutrition. She has a particular interest in Functional Gut Disorders such as irritable bowel syndrome, and regularly attends the Monash University Department of Gastroenterology research seminars.
Before opening her private clinics, Jocelyn was a lecturer at Queensland University of Technology in the School of Public Health.  She has also been a guest lecturer at Griffith University and involved in the supervision and tutoring of Nutrition & Dietetic students completing their Masters degree. Jocelyn is a member of the Dietitians Association of Australia (DAA), is committed to a program of continuing professional development and remains up to date through the Accredited Practising Dietitian program.  She is currently an active member of the professional mentoring program with the DAA.
Her blog today is on IBS and FODMAPS (1).
Irritable bowel syndrome is a common gastrointestinal disorder with symptoms including bloating and distension, erratic bowel habits, abdominal discomfort and excessive wind. There is good scientific evidence for use of diet to manage symptoms but it’s important to get good advice before you start modifying your diet.
The first step is to have a chat to your GP about your symptoms to rule out any possible causes for your symptoms such as Coeliac Disease.
The next step is to consider your diet . Research into food triggers has focussed on the FODMAPs  and it clear that dietary restriction of these foods leads to improvement in symptoms in most people with IBS. FODMAPs do not cause IBS however they often exacerbate the symptoms and so managing FODMAP load in the diet provides an excellent opportunity for reducing symptoms.
So how do FODMAPs aggravate symptoms?
FODMAPs can have a wide range of effects in the gut because they are often incompletely digested.  Foods that are not digested in the small intestine continue on to the large intestine (the colon) where they become food for the good bacteria in your gut. This is considered quite a normal thing to occur and  FODMAPs are considered “prebiotic”, meaning they provide a good food source for the bacteria in the colon which in turn help keep the bowel cells healthy. 
However in individuals with IBS the following may occur

  • FODMAPs are rapidly fermented by gut bacteria and this results in rapid gas production which can contribute to bloating and abdominal discomfort
  • This gas production (methane & hydrogen) can slow the movement through the bowel and contribute to constipation or bowel irregularity
  • Increased water delivery into the bowel (osmotic effect of FODMAPs) may contribute to diarrhoea or erratic bowel habit

If you plan to trial a low FODMAP’s diet it is vital you seek guidance. A specialised gastrointestinal dietitian will provide accurate information and supervise the dietary trial. The diet includes a wide range of healthy foods across all food groups so it is nutritionally sound.  However if you trial this diet without supervision it is highly likely you will be more restrictive with foods than is necessary and this may jeopardise nutritional adequacy. For example, many individual mistakenly exclude gluten even though is unlikely to be a problem unless there is Coeliac Disease. Others will exclude all dairy when they could be including a wide range of lactose free dairy options. Others will make the mistake of limiting all  grains, or excluding fruit and this often means a reduced fibre intake. 
The other concern with an overly restrictive diet or an extended time on the low FOMAP diet is the loss of prebiotic effect. Recent research highlights that a low FODMAP diet causes both a reduction in the  total amount and specific types of bacteria.  For this reason the diet is designed as short-term, supervised trial  followed by a reintroduction of the FODMAPs in a step wise manner to identify tolerance levels.
The good news is that for most individuals large amounts of a certain FODMAP’s may trigger symptoms but smaller amounts may be well tolerated. So it is likely that many individuals will be able to maintain a good level of symptom control with a more liberal diet. The long-term goal of the diet is a healthy eating plan to include as many FODMAPs as  tolerated.  In other words, a healthy diet  with the least restriction necessary for symptom management. And this may mean acceptance of  some of the milder symptoms from time to time in the interests of a broader diet.
Thanks Jocelyn. This will be of great interest and assistance to many patients and health professionals who follow my blog. If you would like to make an appointment with Jocelyn, ring on 0419 673 797.
(1). What are FODMAPs? (Taken from Sue Shepherd’s website Shepherd Works)

FODMAPs are found in the foods we eat. FODMAPs is an acronym for

  • Fermentable
  • Oligosaccharides (eg. Fructans and Galacto-oligosaccharides (GOS))
  • Disaccharides (eg. Lactose)
  • Monosaccharides (eg. excess Fructose)
  • And
  • Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt)