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For almost 10 years, Matthew Harris learnt to suffer his gurgling, gassy, bloated stomach. It was disagreeable, sure, but not so severe as to actually do anything about it. Then, two years ago, his illtempered gut became something more – much more – when the Melbourne sound engineer/composer found himself staring at blood in the toilet bowl. Now his stomach gripped with a different impulse: fear. Was this the bright-red mark of bowel cancer? Had what was an inconvenience just become life-threatening? Thankfully, tests revealed it hadn’t. But that didn’t mean it wasn’t quality-of-life-threatening. What Harris soon learnt he had – a food intolerance – belies its benignsounding name by making life various degrees of miserable for an estimated one in five Australians. After his initial diagnosis, the 39-year-old did his best to rationalise the problem away. Probably just some dodgy food, he thought. But then almost every day there was
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something new to contend with: stomach pain, constipation, diarrhoea so urgent he’d be almost glued to the toilet. Not easy when you’ve got two young kids. “I’d have to take Imodium if I thought I wasn’t going to be able to cope,” remembers Harris. “When I was having a particularly bad reaction, it felt like my body had been poisoned.” Harris’s case was extreme. But even much lesser levels of food intolerance can erode your quality of life. It could be that you wake up each morning feeling fine, but as the day goes on, you grow bloated, sluggish and irritable. Or you could find yourself regularly terrorising your colleagues and family with hideous flatulence. Sound familiar? Well here’s some good news – you might be able to put a stop to your problems in a matter of weeks, thanks to local research that has identified why millions worldwide are intolerant to certain foods. This homegrown science has so far proved a quick-fix for three out of four people. The catch? It could turn your idea of good nutrition upside down.
When trying to manage a full-blown food intolerance, most people cut out the obvious bad guys – wheat, dairy and processed foods. Instead, they load up on fruit, veg, legumes, grains and, if they’re exercising, very often protein shakes (see “Hidden Dangers”) – the good stuff we’re told to eat in abundance. But what if it’s these very foods that are causing the problem? That’s right, the ingredients you count on as dietary allies could, instead, be your axis of evil. So what are these stomach saboteurs? Sugars. Specifically, a group of sugars called Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols – or FODMAPs for short. Now thought to cause most food intolerances worldwide, they aren’t just lurking in processed foods; they’re in healthy, nutritious staples, too. Dr Sue Shepherd, a dietitian and lecturer in dietetics and human nutrition at Melbourne’s La Trobe University, is the person responsible
for unearthing FODMAPS. In 1999, she began collecting data after seeing an influx of patients who didn’t have coeliac disease – an autoimmune disorder that makes people severely allergic to gluten – but were still experiencing its symptoms. Even when they stopped eating gluten, improvements were often minimal at best. It became obvious there was something else at play. What Shepherd discovered was that intolerant people can’t absorb FODMAPs in their lower intestine. When that happens, these sugars become like a 2am kebab for gut bacteria. Their feeding frenzy releases gas, lots of it, making the bowel swell up and, well, you know what happens next. “Human beings are meant to fart,” says Shepherd. “However, people who are intolerant have a lot more gas being produced, because they’re malabsorbing these FODMAPs.” The result, as Harris discovered, can be bloating, stabbing gutpain, cramps, nausea, diarrhoea, constipation and a bunch of other uncomfortable side-effects otherwise
known as irritable bowel syndrome. Although experts don’t know exactly what causes this, they do know it can be triggered by FODMAP foods. People with IBS have ultra-sensitive nerve endings surrounding their bowel, which become agitated by the effects of FODMAPs when they pass through. When this happens, the bowel starts shouting at the brain that it’s not happy. Unfortunately, your guts end up copping the punishment.
The Gastroenterological Society of Australia estimates that one in five people suffer from IBS, but that’s using the strictest criteria. Anecdotal evidence suggests the real number is much higher. “It’s certainly the most common gastrointestinal disorder by a mile; it would take up half my practice,” says Dr Simon Benstock, gastroenterologist at the Centre for Digestive Diseases in Sydney. He believes that millions more Australians could have it in some form.
You’re not necessarily born with an intolerance. A long course of antibiotics or a bout of gastro, particularly while holidaying in Asia, can introduce new bacteria into your digestive system and upset the balance – potentially for life. Aside from this, many people also experience occasional short bouts of IBS. Stress, anxiety and mild infections all aggravate the bowel. But if this is something you’ve been struggling with for a while, there’s a good chance FODMAPs are to blame. To be on the safe side, first get yourself to a GP to rule out more sinister health issues such as coeliac disease, ulcerative colitis and even cancer, which all produce similar symptoms to IBS. Then, once you’re in the clear, find a dietitian familiar with the low-FODMAP diet. Why the dietitian? Mainly because the number of foods containing FODMAPs can seem overwhelming. You’ll need all the guidance you can get as you start eliminating foods that have long been on your healthy list: everything from stone fruit and honey, to onions, garlic, avocado, broccoli and grains. (You’ll find the full list at shepherdworks.com.au.) Try to navigate these by yourself and you’ll probably cut things out unnecessarily. The best approach is to focus on what you can have, rather than what you can’t, advises dietitian Dr Naras Lapsys, director of The Body Doctor (thebodydoctor.com.au). The low-FODMAP diet isn’t about removing whole food groups from your life; instead, it’s subbing in “safe” foods to replace the ones that give you grief. Often it’s as simple as replacing dairy products with the lactose-free variety, swapping wheat-based cereals, pastas and breads for gluten-free, and sourcing carbs from rice, noodles, potato and corn. All forms of lean protein are safe, so your standard meat and veg can remain on the menu. Apples are high in excess fructose and polyols, so they might be out initially, but bananas, blueberries, oranges and rockmelon are all alternatives. When it comes to your vegetable intake, carrot, cucumber, pumpkin and baby spinach are just a few staples you can still enjoy. “For every food type you normally consume, there’s an alternative,” explains Lapsys, “And in most circumstances you’re going to
Hidden Dangers
Shepherd warns that many popular energy products such as drinks, bars, gels and protein shakes are loaded with FODMAPs. Ingredients you need to check the label for are sorbitol, mannitol, maltitol, xylitol, isomalt and polydextrose. “They are all commonly found in high-protein, low-carb foods and supplements because they’re used as sweeteners,” she explains. Also look out for ructooligosaccharides and inulin, which help lower the product’s GI content. With carbloaded gels and drinks, you need to look out for fructose – especially if they contain more fructose than glucose. Check the order they’re listed on the ingredients panel; they go from most to least. Safe alternatives are glucose, dextrose, maltodextrin and sucrose-sweetened foods.
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LowFODMAP Eating
Dr Naras Lapsys outlines a typical day On the diet for an 85kg guy
Morning snack Three rice cakes with vegemite or golden syrup, plus a long black coffee with some lactose-free milk (or a small dash of normal milk.
Lunch
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Can I ever drink beer or eat pizza again? If, like Harris, you’re int to wheat, garlic and olerant onions, this would sur ely be your greatest reality isn’t quite as fear. The daunting as it sound s. Since intolerances are dif ferent to allergies immune-system rea , which cause an ction and damage you r organs, most peop a cer tain tolerance le have to FODMAP foods. Eve ryone has a threshold much fermentation of how their bowel can hand le. So while you can pro get away with the od bably d Friday-night free-f or-all, do it too regula your symptoms will rly and return with a venge an ce. For Harris, sticking to “safe” foods is eas y enough when he’s cooking, but he admi doing the ts that eating out can be a nightmare. “I’ll meal I think is safe, order a but then it sometime s com onion, which weren’t es loaded with garlic mentioned on the me and nu,” he says. “So som just have to say, ‘I’m etimes I going to eat what I wa nt’ and deal with it.” In fact, taking the oc casional hit of proble m foods isn’t necessar all bad. Exposure to your personal krypto ily nite can allow you to exactly where your work out threshold is. From the re, it’s a case of fine-t your diet to get the uning balance right.
AFTERNOON snack Handful of pecans, walnuts and macadamia nuts, or a boiled egg.
Dinner 250g New York steak/lean backstrap lamb, with baked jacket potato and cucumber/rocket/tomato/pine nut salad with balsamic dressing.
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Corn-/rice-based mountain wrap with lean ham/turkey/ beef/pastrami or chicken, tomatoes, baby spinach leaves and grated carrot; or an easy pub lunch of grilled fish (no breadcrumbs or batter), potato wedges and steamed squash.
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Living on the FODMAP diet
Breakfast Bowl of wheat-free cereal without dried fruit (rice bubbles, gluten-free Swiss muesli, oats) with lactose-free milk (Zymil or rice milk), plus 1-2 pieces of Country Life gluten-free bread and some margarine and peanut butter.
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Harris still doesn’t know what first caused his intolerance, or even recall precisely when it started. What he does know is that, in his thirties, he had to forget everything he knew about food and start again from scratch. “It felt weird cutting out a lot of fruit and veg; it seemed to go against so much of what had been ingrained about eating,” he says. Nevertheless, within the first week Harris could tell the diet was working. “I thought it was going to be impossible to follow,” he admits. “But once I’d done it for a few days, and could see the benefits so quickly, I found it much easier to stick to.” Seeing fast results isn’t unusual. Lapsys says it’s common to notice a measurable difference within the first 3-4 weeks. If most of your symptoms go away in that time, you can then add foods from each FODMAP letter back into your diet one at a time, over several days. This enables you to identify the
specific foods that are causing the domestic disputes in your gut. “Usually, people find they experience discomfort within hours or the next day,” says Lapsys. Harris ultimately found that he can’t digest fructans, the polymers of fructose molecules that hide out in wheat, onions, garlic, asparagus and beetroot. Removing them from his diet not only relieved his angry gut, but helped him shed several kilos thanks to cutting out bread and pasta and loading up on lean protein. Weight loss may be a happy sideeffect for some, but the main aim of the low-FODMAP diet remains tackling food intolerances. Many experts now consider it to be the most effective treatment available, with a study in the Journal of Human Nutrition and Dietetics reporting the diet had a 76 per cent success rate. “It doesn’t mean they’re cured,” Lapsys points out. “But it does mean that as long as they eat properly, they’ll be okay. Someone who used to go to the bathroom eight times a day might now go once. And the pain and bloating just go away.” With no magic cure for IBS, this diet will most likely become an eating plan you follow for life. Start eating too many “bad” foods again and your symptoms will simply come back. It’s something that Harris learnt the hard way. “If I stray from it I suffer,” he says. “But if I stick to it, I definitely feel 100 per cent better.”
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Since 1999, Shepherd has prescribed the low-FODMAP diet to more than 10,000 patients at their wits’ end because medical testing had ruled out allergies, diseases and other inflammatory bowel conditions. But it’s been in recent years that her work has gathered serious momentum – something she partly ascribes to our modern love affair with juice bars. “With everyone drinking so much juice, all of a sudden my business skyrocketed,” she says. While some previously unsuspected foods could be launching a full-scale assault on your bowel, Shepherd doesn’t exonerate FODMAP-packed convenience foods like pizzas, burgers, soft drinks and artificial sweeteners. As a result of our drive-thru culture, most people have some level of intolerance these days, contends Shepherd. But it’s the impact it has on your life that determines whether or not you do something about it. Shepherd tells the story of two recent patients. “The first one was a roof tiler, so he was up there every day farting ’til his heart’s content, but he didn’t care,” she explains. “But when he was home, his wife thought it was horrendous and made him do something about it. Turns out, he had fructose malabsorption.”
The other patient, a pilot, had exactly the same symptoms. But because he was stuck in a cockpit at 9000 metres all day, he couldn’t just let it all out, and ended up with terrible stomach pains. “These are two guys with the same condition: for one it was affecting his quality of life, his ability to work and concentrate. The other really didn’t care,” says Shepherd.
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find it convenient and easy to find that alternative.”
▼ Dessert Sorbet and mixed berries.
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