Update for Irritable Bowel Syndrome Awareness Month

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 »