Irritable bowel syndrome

irritAble bowel SyNdrome: my Story

‘Kate’ is a patient suffering from IBS. Here she tells us about her symptoms and diagnosis and how, with the help of a dietitian, she has taken on the FODMAP diet.

my name is Kate, aged 52 and i am a teacher working full time at an infant school. my husband Dave is also a teacher and our two grown up ‘children’ are now at university. i was diagnosed with irritable bowel syndrome (iBs) a couple of years ago and, at the time, tested to see if i had lactose intolerance and thankfully that was not the case.

I have only seen a dietitian on two separate occasions in my life. My first experience was just after I had completed my training. My mum, who was a nurse, suddenly died and both my dad and I found that a very difficult time. As an only child, I wanted to be with Dad but he insisted that I took my exams and ‘make Mum proud’ and qualify as a teacher. My mum had always insisted that we ate a healthy diet and she was a great follower of highfibre foods. I well remember taking natural bran once or twice a day when I was in my early teenage years! However, after mum died and, whilst revising for my exams, I drank lots of strong coffee, smoked more cigarettes and only ate one meal per day. My weight dropped off me and my shocked dad made me go to see our doctor and immediately who told me that I must go and see a dietitian. She was a ‘Miss Jean Brodie’ in a white coat and I was encouraged and supported by her to revert back to the sensible eating principles. I gained weight and felt the benefit of that.

My second experience with a dietitian occurred after I had been seen by a new doctor at the surgery. I have never been fond of going to the doctor’s and it has only been since the diagnosis of IBS and trying different approaches that I wondered if the FODMAP diet was worth trying. I considered that ‘you are what you eat’ and maybe I was not eating the right foods for me. I had read about the fermentable oligosaccharides, disaccharides, monosaccharides and polyols which make up FODMAP and I had searched the internet, but felt that I needed some support and monitoring to actually give it a go. I am delighted that my second dietitian did not disappoint me and my first appointment was well worth the wait.

My symptoms seemed to have worsened over the years and I felt very bloated and uncomfortable on a daily basis. Sometimes I felt nauseous. My abdomen, to me, seemed to expand as the day progressed and it felt as if there was a process of fermentation going on in my gut. I was always gurgling and bubbling inside! I know it is normal for gas to be produced and we all pass flatus, but for me, it seemed to be getting more frequent, louder and smellier. It became increasingly embarrassing and a slow release was often replaced with a noisy explosion which made me cringe if it happened at school.

Some years ago after watching the film Blazing Saddles, I had excluded beans and onions from my diet as I had noticed that such foods did not suit me. When I was diagnosed with IBS, I was told to avoid eating bread and not to drink fizzy drinks even though I ate little bread and only tended to drink fizzy water. I have always been a lover of fruit, vegetables and wholegrain cereals and tended to eat three meals per day, although often with long gaps between meals. I usually drink at least two litres of fluid per day. I enjoy cooking and entertaining. My weight is steady.

My journey has now started on the FODMAP route. The dietitian increased

table 1: examples of the foods Kate used to eat and what her new plan looks like

meal my diet before FoDmap

pre breakfast tea – no milk no sugar breakfast watermelon and/or prunes Large bowl of mixed cereals such as special K, weetabix and fruit and fibre with lots of milk banana

my new plan

tea – no milk no sugar cantaloupe melon Large bowl of porridge made with half milk half water banana

Lunch

dinner

mid morning, mid afternoon and evening 2 small slices of artisan type bread with cheese, fish or meat tomatoes, beetroot small packet of crisps or savoury biscuits apple or pear and/or cake, or scone water coffee

salmon or chicken or lean meat, or homemade bolognaise/lasagne/meat pie pasta or boiled potato cabbage, asparagus, carrots, courgette and green beans (lots of) Fresh fruit with yoghurt or apple crumble or stewed plums and custard Grapefruit juice and fizzy water decaf coffee wine at weekends coffee (mid-morning), tea (mid-afternoon) and decaf coffee (evening) and water at bedtime cheese, fish or roast meat with mixed salad of lettuce, cucumber, carrot, tomato, celery Rice cakes or oatcakes and spread or a jacket potato, oR butternut soup - homemade with homemade wheat-free bread homemade wheat-free scone or orange water decaf coffee salmon or chicken or lean meat Rice or potato smaller portion of veg such as spinach, carrots, courgette, parsnip, butternut squash ‘allowed’ fruit with yoghurt or wheat-free pudding Grapefruit juice water decaf coffee decaf coffee and allowed fruit (mid-morning) tea and small homemade oat biscuit (midafternoon) and water through the evening

my confidence, as she had told me that when she had attended courses informing her of FODMAP, she had been encouraged to try that approach for several weeks. At first it all seemed overwhelming and after that ‘heart-sink’ moment, when I had the list of ‘foods to avoid’ explained and realised how many I actually ate and often ate lots of, that I knew it was not going to be easy. I felt, though, that it was important to me and I felt reasonably confident that with support I could give it a go. It was to be an initial eight-week exclusion phase before even reintroduction of a food could be considered. I was pleased to see a ‘suitable foods’ list. I must confess to being a cabbage lover. I have eaten two each week for years now and, of course, that was on the ‘avoid’ list, as well as asparagus, mushrooms, beetroot and mangetout, all of which I also ate very regularly. All wheat containing foods are out, but I do like oats and porridge and I often bake gluten-free items for my friend who has coeliac disease. My favourite fruit is black cherry and there is nothing better than a very hard pear - both on the avoid list!

I left my dietetic appointment with a detailed plan which I had put together with guidance from the dietitian, along with an information booklet, a date for a follow-up appointment and an email address and phone number for me to use if I had any queries about my diet. I agreed to keep a symptom dairy. I don’t expect immediate relief, but realistically, I hope to identify culprit foods over time. I also needed time, in fact several weeks, to make sure that I had all the suitable foods at home and a batch baking session undertaken so that it reduced the likelihood that I would end up eating ‘forbidden foods’.

I promised to write this, my story, so it could be shared within the dietetic profession. It is still early days and several weeks before my followup appointment, but my fingers are crossed for a good outcome.