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Update for Irritable Bowel Syndrome Awareness Month

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It’s Irritable Bowel Syndrome (IBS) Awareness Month once again. I thought I’d give you an update to follow up on my article from last year on the subject. I’ve been living with IBS for several years now. I started having problems when I was a teenager (I’d say around 15). It was an especially stressful time for me. My parents had divorced within the last few years and I was moving five hours from where I lived. Also, with all the changes, my diet had changed a lot. At first, my symptoms weren’t as frequent or severe as they were before I started the low FODMAP diet. Several people had wild theories as to why I was having problems. Even me, I frequently had symptoms when I was washing the dishes (I was washing the dishes every evening at the time), so I thought that hot water activated my digestive system (let’s remember that I was a teenager hihihi)! I mostly had symptoms around dinner at the time. Eventually, I started having some after any meal.

Last year, when I wrote my article, I was in the re-introduction phase of the low Fodmap diet (I describe the diet more in my other article). I have now completed this phase for at least 10 months. I found the foods that are the main cause of my problems. I now know that I am lactose and fructan intolerant. The two ‘bullies’ of my digestive system! I have fewer symptoms now. Often I have them because I ate unusual food and I didn’t have the reflex to look to see if it contains fructan, or when I need to take some ibuprofen or acetaminophen.

Lactose

You might think it’s surprising that I didn’t yet know that I was lactose intolerant since I had symptoms for some time now. Additionally, I had someone close to me who is lactose intolerant and that it affects approximately 44% of Canadians according to a study which was published in the Journal of the Canadian Association of Gastroenterology (Fung et al, 2020). There were several reasons why I never thought I had difficulty with lactose.

To begin with, I had the false belief that being lactose intolerant meant I couldn’t eat anything made with milk. On the other hand, most cheeses are low in lactose. Personally, I have no problem eating a normal portion of it. Also, each person can consume different amounts of lactose before having symptoms of intolerance.

In addition, since I don’t just react to lactose, I had similar symptoms even though I hadn’t consumed any. Besides, for a period of time, I had symptoms so often that sometimes I felt relatively ‘normal’ after consuming lactose (especially ice cream) even though I probably had symptoms from ingesting it later. Typically, symptoms should occur 30 minutes to 2 hours after ingesting the dairy product, but I had symptoms constantly. The low FODMAP diet really helped me sort it all out! I usually have symptoms within 30 minutes of ingesting lactose.

It is also important to note that there are also products that have modified milk ingredients and one would not suspect it. For example, I just recently discovered that certain brands of hot dog sausages contain some. It is therefore very important to read all the ingredients on the packaging when you eat processed foods and to ask for information in restaurants (even if you feel annoying with all your questions)! Personally, I really don’t tolerate modified milk substances, even a small amount gives me a big reaction!

Finally, I now know that even by consuming ‘lactose-free’ products, I can also react to lactose. Many lactose-free products actually have lactose, but it compensates for this by adding lactase which is the enzyme our body should produce to digest lactose. This means that most people who are lactose intolerant will be able to consume them, but not everyone depending on the person’s limitations. Even in my case, the famous Lactaid don’t always seem to do the job in certain situations.

( ! ) Some people who think they are lactose intolerant may instead be intolerant to cow’s milk A1 protein. There are dairy products that contain A2 proteins, which makes milk digestible for people with A1 intolerance. Here in Quebec, there is, among others, the Phylum farm which produces it and which makes very good cheeses!

Sources of fructan

Tests for fructan can be separated into several categories because some people seem not to respond at the same levels to all foods that have it. When I tested it, my nutritionist had me separate the garlic, onion and wheat. There are some people who seem to have problems with garlic and/or onion especially. Unfortunately, for me, I have problems with all of these.

Fructans are also present in many other foods (asparagus, pistachio, mango, etc.) and certain beverages (chamomile tea, black tea, etc.). The limits that we can consume are different for each food and, also, for each person. The low FODMAP diet allows you to find out how much you can consume of each type of food. The goal of the diet is not to completely eliminate foods from one’s diet, but simply to test a small amount and increase until symptoms are present. This allows us to know how much we can eat, while remaining symptom-free. Monash University has produced a super useful application to help guide our choices a little more (and it is possible to put it in French if necessary).

For my part, I seem to react strongly to the presence of garlic and onion, while I have a small margin with wheat. Wheat (bread and dough) was very present in my diet (daily). Garlic and onion also came up quite often (possibly daily too). I am also a big fan of black tea and I used to drink it several times a week (if not every day). So you could say that I was constantly feeding (hihihi!) my symptoms without knowing it.

My fructan-related symptoms usually occur the next day, but since I was consuming at least one fructan-containing source per day… Well, I had symptoms daily! Hence why my intolerance to lactose and fructan was difficult to distinguish. Now, I recognize the symptoms between the two a little more even if they are still quite similar. For example, I tend to get more bloating from fructans because the gas seems to stay in my gut longer since fructans aren’t passed out as quickly as lactose.

What you also need to know is that the limits for the same FODMAP do not add up. For example: if we eat wheat pasta in an acceptable quantity, we must be careful not to eat another food that contains fructan in the same meal. If one eats a food containing fructan during a snack, one may need to avoid it completely at the next meal. For my part, I was advised to wait at least two hours between meals to reset my limit to zero.

It’s also super important to read the ingredients to avoid fructan. Onion or garlic powder are often found in processed foods. Sometimes it is not written directly, because we only have the famous mention of ‘spices’. Also, if you want to avoid lactose with a plant-based alternative, they often contain inulin. Inulin is rich in fructan, so your yogurt may still not be adequate depending on your different intolerances.

( ! ) Gluten intolerance is different, but it is possible to buy certain gluten-free breads or types of pasta and they will be functional for people with fructan intolerance. You just have to look at the types of flour used. Also, in restaurants, it is now often possible to have gluten-free breads (although not always super pleasant in taste or texture).

Psyllium husks

I’m a bit sold on psyllium because as soon as I started taking it without having started the low FODMAP diet, I already saw a certain improvement in the quality of my stools. Now, I still take it every day, adding it in the morning to overnight oatmeal. I see a difference when I don’t take it because I eat other things for breakfast and forget about it. I also tested two different brands and there is one that seems to be more effective for me (Rootalive). So I invite people to do some testing.

Other contributing factors

Even without the presence of FODMAPs, I have certain situations that seem to be determining factors for my symptoms:

  • Fat food;
  • Eating too much in a meal (not just the famous ‘bloating’ normally felt by ordinary people);
  • Alcohol (I drink very little now, and we all agree that it’s not good at all);
  • Medications (like ibuprofen and acetaminophen)… which can be very inconvenient;
  • Significant temperature changes (moving to an air-conditioned space in the summer);
  • Just being too hot (shopping with a winter coat or on very hot summer days);
  • Fatigue (everything is not going well anyway);
  • Too much stress (yes, the damn stress) or anxiety;
  • Your entourage who does not understand your situation (or do not want). This is a cause of very significant stress for your condition. I know I’ve already named stress as a factor, but I want to put that one up front. Having a team to help you and not blame you is a real plus!

Conclusion

In my experience, finding what can help you live better with IBS symptoms is specific to each person and their needs. I have read a lot of articles that heavily preach meditation and hypnosis. Personally, I tried both for a relatively long period of time without improvement. Others prefer to use medication or probiotics. For me, medications were not my preferred choice, as I tend to often have side effects with them. Also, I don’t like the idea of being dependent on a pill to get better and, in this case, I have the choice not to be (let’s leave that for problems that require it). Probiotics seem to do absolutely nothing for me.

I think the important thing is to feel good and not create additional stress for ourselves because of our choices. I was fortunate to have a partner who helped me with my diet (he cooks most of the time) and to consult a nutritionist to guide my choices. It’s not always accessible for everyone and I feel privileged to have been able to do it.

( ! ) In my last article on IBS, I included lots of interesting links for resources about IBS and the low FODMAP diet.

Update for Irritable Bowel Syndrome Awareness Month Read More »

Irritable Bowel Syndrome Awareness Month

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It is currently the end of Irritable Bowel Syndrome (IBS) Awareness Month. I wanted to share on the subject, since I have been living with IBS for several years and it is a health problem that has a lot of influence on my life. In the past, I didn’t really talk about it to people… We don’t talk much about our bowel movement in conversations. Moreover, some people around me were not patient with my condition and made me feel responsible for causing problems as a result of my symptoms (canceling activities, causing delay, not wanting to do certain activities, etc.). Today, I am surrounded by people who are understanding, more respectful of my limits, and who don’t make me feel guilty for feeling bad.

My experience may differ from others, as IBS affects each person differently. There are three types of IBS: constipation-predominant (IBS-C), diarrhea-predominant (IBS-D),  mixed (IBS-M), and undefined (IBS-U). I myself live with IBS-D. When I have symptoms, I need to go to the bathroom quickly and often several times in a row before I feel better. I have discomfort in the abdomen, bloating and sometimes big cramps. Sometimes I have severe hot flashes. Afterwards, I have a big drop in energy that can last between one and two hours (sometimes longer depending on the time of day, e.g. in the evening when I am already tired). Then I’m really hungry!

Changes that didn’t work for me

Over time, I have tried several things to feel better. I tried: medicine to reduce cramps, hypnosis with a psychotherapist, acupuncture, osteopathy, several strains of probiotics, I went to see a nutritionist who put me on a restrictive diet for two weeks when I ate only a few ingredients (the low FODMAP diet was not yet popular), talking about my stress with a psychologist and the Nerva meditative app. I am not the type of person to be closed to suggestions that would make me feel better (except participating in a cult hahaha!). I was, however, unsuccessful.

Changes that have worked for me (found on my own)

When I eat smaller portions and less fat foods, I’m more likely to be well after my meals (when you know how the low FODMAP diet works, that makes a lot of sense for portion size). I stopped drinking alcohol in society several years ago and I even take it very rarely at home. I stopped eating certain foods that seemed to cause me a lot of problems: onions, garlic, leeks, the white of green onions, etc. I avoid consuming carbonated drinks (now I don’t drink them anymore). I rarely eat food from the restaurant if it’s not a takeout order or I eat there at times when I know I have time to feel bad afterwards. Also, I usually share my portions with my partner or my daughter.

The Magic Bag has long since become my best friend any time of the day when I feel my digestive system working a little too hard. I take hot relaxing baths to unwind when I’m feeling ill or tense.

Stress is a contributing factor to the problem, so I avoid taking on too much at once and make sure I have time for myself. I reduced my interactions with people who used to make me feel ‘cheap’ to cancel when I was feeling bad and/or who made me feel bad for not wanting to participate in certain activities that I didn’t feel comfortable doing if I had symptoms.

Some people, who don’t know my daily life, judge me by saying that it’s because I didn’t do enough sport. I was also told funny reasons for my condition, for example: you ate too many grapes so it’s normal that you had diarrhea (I didn’t eat an exaggerated quantity of grapes and some days when I felt bad I hadn’t eaten grapes for several days), or you ate too much cinnamon stick younger, etc. This kind of comment does not help to feel validated in what we live on a daily basis. It’s really important to have allies in your loved ones. As with any health issue, you need people who are on your team, not against you!

Low FODMAP diet

In the last few years, I have heard more and more often about the low FODMAP diet (which stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols which are short chain sugars that are difficult to absorb in the bowel). Despite making its appearance somewhere in the 2000s, the diet was not immediately popularized as a treatment for IBS in Canada. The diet is quite complicated, it requires a lot of changes in the food you eat. It took me a while to start because of that. I made up my mind after a few rather difficult weeks during which I felt quite miserable. Luckily, I have a spouse who had no problem changing their habits to help me feel better. My daughter finds it a little less easy, because we have to try new recipes and modify recipes that we liked a lot, but she is still adapting well. I am currently seeing a nutritionist to help me make decisions and guide me through the diet. She has the Monash specialization. Monash is a university in Australia where they developed the low FODMAP diet.

The diet happens in three phases. The first phase involves eating a low FODMAP diet for two to four weeks depending on how symptoms improve. Consume the acceptable limit or eliminate foods high in FODMAPs (e.g. strawberries limit is 65 grams and celery is 10 grams). Each food has a different permitted limit. To my delight, I myself had quite rapid and quite striking improvements during the first phase. 

I am currently at the end of the second phase which consists of testing the different molecules involved. The molecules that cause me the most symptoms are fructan (e.g. present in foods high in gluten, in certain other foods such as onions and garlic, and in certain fruits), mannitol (e.g. present among mushroom, celery, sweet potato, and cauliflower) and lactose (e.g. present in yogurt, milk, and ice cream, and cream cheese; many cheeses are too low in lactose to react; fun fact some people may not react to the lactose in chocolate milk because of the cocoa). I have no problem with sorbitol (e.g. found in avocados, apples, cherries), fructose (e.g. found in many fruits including berries, grapes, tomatoes, and honey and galacto-oligosaccharides (e.g. found in legumes, soy milk). I also want to see what my limit might be for consuming fructan (I miss wheat pasta). In the long term, the goal of the low FODMAP diet is not to stop eating foods containing the molecules difficult to digest, but simply to find the limit that it is possible to eat without having symptoms and what are the foods that you don’t have to avoid after all.

The third phase of the diet, which I won’t be doing for a while, is to reintroduce foods that are ok for us. Then we can try after a while to reintroduce different foods that were problematic in the past. Some people won’t be able to do this, but some people may be able to eat a larger portion of this food.

Conclusion

For now, I’m super happy because I’m finally having longer periods of feeling good thanks to the low FODMAP diet. Just knowing that I can easily control the symptoms is genuinely nice. Slowly, I learn what I should avoid to feel good. I know that I can attend events and activities without feeling bad if I eat the right thing. I still DO hypervigilance sometimes, because I’m afraid of having a stomach ache, but I imagine that it will get better as I feel good. I find it surprising that I don’t have a stomach ache when I have just eaten.

I plan to test, in the next few days, an antibiotic, Rifaximin prescribed by a last gastroenterologist that I saw recently for a second colonoscopy. Studies of the drug show improvement in symptoms in people with IBS and SIBO (Small intestinal bacterial overgrowth). SIBO is another health condition that causes the same type of symptoms as IBS. SIBO is not often diagnosed where I live (Quebec, Canada) because the test to do so has too many false positives and false negatives.  A meta-analysis from 2017 indicates that between 4% and 78% of people with IBS may also have SIBO.

Resources for the Low FODMAP Diet

Where to find tools or information:

  • You can also look at your local library for diet books on the subject.
  • The pretnumerique.ca [FR] website may have books on the subject that you can rent with your municipal library.
  • The pretnumerique.ca [FR] website with a subscription to the BAnQ (Library and National Archives of Quebec) has books on the subject (I checked). The subscription is free for everyone who lives in the province of Quebec [FR] (to my knowledge). There are plenty of other great resources available too!
  • SOS cuisine offers a low FODMAP diet menu with a subscription. (I haven’t tested it, but I think it might help some people).
  • The blog A Little Bit Yummy has tons of interesting articles on the subject.

Our favorite low FODMAP products:

  • La Merveilleuse Gluten-Free All-Purpose Flour from Angélique (I found mine at Avril [FR])
  • Pasta Le Veneziane (I found mine at Avril [FR])
  • Ketchup de Fody (I found mine at Avril [FR])
  • Garlic-Infused Oil (homemade)
  • Chicken broth (homemade) without onion and garlic
  • Vegetable soup base de Fody (I found mine on Amazon)
  • Low Sodium Organic Beef broth (without onion in it) from Imagine (I found mine at Avril [FR])

Here are several recipe sites:

Our five favorite low-FODMAP recipes:

For more inspiration, you can consult our recipe spreadsheet where we note the recipes that we try and that we like, but be careful not all of them are low in FODMAP.

Disclaimer: I did not receive any money for writing my blog post. I’m only talking about products I’ve paid for or content that’s available for free.

I do not work in the health field, so I cannot advise people on their health problems. Please consult your doctor and/or a nutritionist if you think you have irritable bowel syndrome. These people will be in the best position to advise you!

Irritable Bowel Syndrome Awareness Month Read More »