Patients ring to make an appointment saying they wonder if food is involved. Some are fairly sure that some foods are connected to their symptoms, but not always, and excluding those foods has not solved the problems. They may report that if they stay on their usual at-home food they have few symptoms, but if they dine out they often have symptoms afterwards. Others connect symptoms to spice, or what they call “rich food” or to high fat foods. Yet when they reflect if they get symptoms after plain hot chips, or potato crisps, they say those foods are usually tolerated. One said he was in “dire straights” for 12 hours after a herbal treatment. He was also sure onion, mushrooms, capsicum and sausages caused reactions.
They have all had medical gastro investigations with NAD [no abnormality detected] results.
Pain is the primary reason for diet investigation. It is usually described as crampy pain, sometimes “as severe as a monthly pain” or as bad “as if in childbirth”.
Pain may last until a few hours, until a bowel motion is passed, or for up to 24 or 48 hours.
In some bloating is also reported with annoyance at the variation in clothes sizing needed.
Constipation and looseness are sometimes reported but not as the main area of concern. Many report normal bowel frequency. Others have frequent loose motions.
Pain is often accompanied by bowel urgency. This may be a strong pain wave of contraction and relief, though the feeling of recovering after passing the bowel motion may last quite a while.
Some have pain that looks related to recent food, some have pain “all the time”, some have pain come on for no good reason. Some report pain early after the suspect meal, others wake at around 2 am and then cope with pain, and some feel it is, for example, “24 hours after dining out”. Many report pain in the lower abdomen including right down in the anal area.
A Family Sensitivity History shows what food sensitivity symptoms are in family members.
Sometimes they come from families where many members have IBS. Sometimes they have it as a new symptom after years of other food sensitivity symptoms, such as hay fever or migraine, and/or have relations who have, or had, some of the usual food sensitivity symptoms e.g eczema, asthma, rashes or diarrhoea.
Many know they notice smells more than others. They notice what they describe as “off” smells in food held over days in the refrigerator e.g. ham and bacon, cold roasts, ripe broccoli, as well as ripe bananas, and other smells in the environment. See the article “Supersensitivity” which describes how sensitive many food sensitive people and their family members are. You can also note the pages on “Super tasters” and “Super Smellers” in Are You Food Sensitive?
Stories of three patients
I saw three patients who suspected food sensitivity recently. All had had medical investigations. One reported many suspect foods, had a family and personal history of food sensitivity symptoms [nightmares in childhood, restless sleep, fuzzy thinking], and knew he had to juggle food and fluid intake to minimise symptoms. He proved to be sensitive to herbs and spicy foods, cola soft drinks, peppermint, tomato and capsicum.
One had no family history of symptoms, only a couple of suspect foods, could work all day without food, but sounded more like food sensitive patients when he reported being a person who could smell smells that others did not notice, and never ate tomato sauce “I don’t like it and it spoils the taste of other foods served with it!” His symptoms came on at 2am and kept him awake till 4 or 5am. He was sensitive to salicylates, but also to amines in any aged food, even food held in the refrigerator for more than 24 hours.
The third patient, who presented with fatigue as the primary symptom with gastro symptoms over the last 9+ months, recently returned after her elimination diet trial. She reported that her fatigue had not improved much, but that her gut symptoms had completely resolved. “Which ones were these?“ “Bloating, constipation/looseness, tenderness, pain, feels like I need to go but can’t, indigestion, belching, but no heartburn, feel like food sits in my stomach for long periods of time giving a full feeling, and a feeling of incomplete emptying of my gut, and nausea”. Note that this is a picture of what one patient has reported, but each patient has his or her own symptoms.
All rang concerned about distressing symptoms during withdrawal in the first week of the diet trial. Most have discomfort for up to day 14 and some say symptoms do not decrease until into the fourth week. One improved on the 7th day. This patient had already reduced additives and spicy food before learning all the other detail of the low chemical diet.
This is a short picture of IBS patients who are sensitive to additives and natural food chemicals. Each has their own cluster of symptoms, their own suspect foods known to produce reactions, and their own family sensitivity history, meaning that dairy or wheat may have had to be reduced or excluded. They each had their own level of diet strictness, and finally, they all ended up on their own diet with various foods managed to fit into their own lifestyle. Where bloating and wind were important foods containing FODMAPS were also reduced in the diet trial and tested later. Diet can greatly reduce the distressing symptoms in those with IBS. It can be complex but manageable especially with the help of an experienced dietitian, and the books Are you food sensitive? for the detail of the food trial, and Tolerating Troublesome Foods to expand the diet as much as possible over the long term.