When you are diagnosed with IBS you may think that everyone with IBS has similar symptoms, but each person’s pattern of IBS is individual. That individual pattern can give you clues as to the diet direction to take.
Symptoms
Where bloating is present FODMAPS intolerance must be considered. Your bloating may be followed by distressing distension which may increase until pain spasms occur. Bloating really interferes with your life as you need to cope with variation in clothes sizing over a day. Wind is increased. Bowel motions may be normal in frequency, but you may have constipation and it can alternate with diarrhoea.
In food chemical intolerant people the presence of pain is the most upsetting symptom. It is often lower crampy pain which may be annoying through to as severe as a bad monthly pain, or even as bad as labour pains. Pain may come on a few hours after eating, or at 2am and disturb sleep for hours, or not until 24 hours after dining out. It may last until a bowel motion is passed. Some IBS suffers comment that they have a wave of ‘feeling faint’ as the bowel motion is passed. Some may feel ‘knocked flat’ after passing the bowel motion. There is a range in the recovery time. It can be from people who report they can keep working but are aware that they are ‘recovering’ after the bowel contraction. Some need to rest and others have pain that takes time to resolve. Their cramping pain and recovery can sound as if it could be appropriate to call their symptoms “abdominal migraine”.
Bowel urgency is common. This urgency may be so strong that no outing can be considered unless toilets nearby are known. If you are food chemical intolerant you will more often have frequent loose motions and this frequency may be the most bothersome symptom for you. You may pass wind with the frequent bowel motions so you are bothered by the “explosive” happenings. And the wind may be foul smelling so another very bothersome symptom. It is important to emphasize that each IBS person varies in which symptoms are present and how severe they are. Food sensitive people are often supersmellers in that they can notice the “going-off” smell of food in the refrigerator days before others do.
Useful information can be found from within your own family
It is worth hearing about the variety of non-gut symptoms typical of food sensitive people in you or your immediate relatives. These include migraine, chronic headaches, and some less well known ones such as mouth ulcers and car sickness, as well as the usual allergy ones (eczema, hay fever, asthma or rashes). Sometimes your IBS is a new symptom after years of one or two of these other food sensitivity symptoms, or you may come from a family where relations over the generations have some IBS symptoms. The presence of other symptoms also indicates that a positive response to a low chemical elimination diet is increased.
Foods suspected of causing symptoms
You may be sure that some foods cause bloating and wind. Individuals differ widely in those mentioned. Foods often mentioned include the cabbage family of veges, or legumes. You may suspect onion or garlic, or the gluten in wheat. Fruit, especially fruit juice may be added to the list. These are examples of foods containing FODMAPS poorly-absorbed sugars. On the other hand you may know that if you stay on your usual at-home food you have few symptoms, but if you dine out you often have symptoms afterwards. You might connect symptoms to spice, or “rich food”, Asian meals, tomato dishes or particular acidic fruits. You may choose, even crave, foods such as chocolate, mints, some high additive sweets or soft drinks, or one particular favourite sauce.
What diet do you choose?
Because your symptoms are not clearly related to specific foods, or because even if you exclude your most highly suspect foods, or know that sometimes you seem to react to a food and not on other occasions, you do need to get help from someone who knows how to take you through the diet investigation process. If you seem to have symptoms from both of the symptom pictures above it can be even more complicated to manage! You can get help from an accredited practicing dietitian who can take you through the process. Having just the diet sheets may make it look clear but that is not enough. It is good to have guidance about what foods are unlikely to cause reactions so you are not worrying about every food! Where bloating is present the FODMAPS program is the priority. Where cramping pain and bowel urgency are present you can use the low chemical elimination diet. Both diet directions are just the starting point, as the clarification happens with challenges. You may do a combined FODMAPS/Food chemical elimination diet where necessary. The strictness of the diet is dependent on how severe your symptoms are and how motivated this makes you! Your dietitian can provide up-to-date detail on the FODMAPS diet, and the RPAH and Diet Detective Approaches elimination diets and books.
Withdrawal symptoms in the first 7 – 14 days on the diet
If you are food chemical sensitive you will often have symptoms get worse, and have cravings occur, when you begin your diet trial. You may decide to lower the food chemical load slowly over the first week so less severe symptoms are spread over two weeks. You may take three weeks of the diet before symptoms decrease usefully, so it is important to know this. Where bloating is the main symptom this may decrease after one or two weeks.
Challenges
Remember that you do not find out if you react to a food by excluding it from the diet. You find out by excluding all of the “usual suspects” which your dietitian will know, and then testing suspect foods by doing challenges. Challenges or food trials with desired foods you want to try can begin after four weeks and continue until you have a satisfactory range of foods to fit your lifestyle. Your dietitian will guide you through this tricky process. You can use the book Tolerating Troublesome Foods for hints from research on how best to tolerate over 300 foods. Remember that what you get away with may be quite different to what some friend with IBS can manage. It can be a fiddley but knowing what foods cause you most distress is worth any effort, and can mean you can finally understand yourself and your relationship with your food. You may break the diet but you know what is happening, which is great!
This is so me ….. all of it thankyou
Thank you Leanne. We are gradually understanding that IBS is individual. I wish you well in finding out your own best diet. Joan
PS the comment on withdrawal symptoms is particularly interesting, as mine were awful.. partly because they were so unexpected. I was also completely unprepared for the strength of reaction when ‘challenging’ the food after elimination.
Thank you for another great article! Having only recently ‘discovered’ your site, and started reading your books on diet detective etc, it’s good to begin to make sense of the different types of gas/pain. (Had been following a low FODMAP diet with dietician, but could see there was more to my/family food reactions.)
Best wishes
Hi Joan That’s a really helpful blog for many! Thank you. Sally.
Thank you Sally! I have found it useful to ask patients detail of their type of gut symptoms and then ask about them after the diet trial. I hope to write more about the words people use. We have much to learn about the experience of the different parts of the discomfort of IBS for different sufferers.