Melbourne dietitian Dr Sue Shepherd.

Melbourne dietitian Dr Sue Shepherd. Photo: Supplied

Recipes from Sue Shepherd's book

Irritable bowel syndrome (IBS) affects one in seven people worldwide, with many more suffering from other food intolerances. The classic symptoms of IBS are abdominal pain, bloating, distension, excess wind and a change in bowel habits (constipation or diarrhoea, or a combination of both), and sufferers of fructose, lactose and wheat intolerances may experience very similar symptoms. 

The first step for anyone with these symptoms should be a visit to the GP. Serious conditions like coeliac disease and inflammatory bowel disease produce symptoms similar to those of IBS and your doctor will run tests to rule those out. This is why self-diagnosing food intolerance is so dangerous: not only are you missing out on key nutrients, perhaps unnecessarily, but you're also failing to get to the root of your problem. Once your doctor has ruled out other conditions and diagnosed IBS,  it's time to talk diet. The low-FODMAP diet is recognised worldwide as the most effective dietary treatment for IBS and food intolerances, and it was created in Australia by Melbourne dietitian Dr Sue Shepherd.

Many green vegetables can be part of the low-FODMAP diet.

Many green vegetables can be part of the low-FODMAP diet. Photo: Supplied

FODMAPs sound complicated, but they are simply a collection of carbohydrates found naturally in some foods, and in some food additives, that the gut struggles to digest. The acronym stands for: Fermentable, Oligosaccharides, Disaccharide (lactose), Monosaccharide (excess fructose) and Polyols (including sorbitol, mannitol, maltiitol and xylitol). Instead of being absorbed in the small intestine, FODMAPs continue on to the large intestine where they are used as a food source by the bacteria that live there, resulting in wind, bloating and other such symptoms. Most of us don't find this to be a problem because our guts are naturally designed to inflate and deflate to cope with excess wind. However, IBS sufferers – who have unusually sensitive pain receptors on their gut wall, in combination with a brain make-up that makes them predisposed to over-interpret messages sent by these receptors – can find the sensation excruciating. 

The best way to minimise these symptoms is to follow the two-step approach of:

•    Eliminating high-FODMAP foods from your diet, in order to give you relief from your symptoms

The Two-Step Low-FODMAP Diet and Recipe Book by Dr Sue Shepherd.

The Two-Step Low-FODMAP Diet and Recipe Book, by Dr Sue Shepherd. Photo: Supplied

•    Gradually reintroducing high-FODMAP foods, in a sensible and measured way, in order to work out your individual triggers.

The Two-Step Low-FODMAP Diet and Recipe Book goes into greater detail about how to follow this process, and it recommends doing so under the guidance of a dietitian, who can help you make any necessary modifications. A one-size-fits-all approach to IBS and food intolerances does not work; how the conditions manifest in each individual can be as unique as a fingerprint, so it's important to work out not only which specific foods irritate you but also the quantity of these foods that you can tolerate, if any. Everyone is different, and the low-FODMAP diet can cater for these differences. 

What's more, it's far less restrictive than many other diets – for example, the strict, lifelong gluten-free diet prescribed to coeliacs – and allows for variation of ingredients to suit individual tastes. While many people initially grieve for the foods they are no longer able to eat, they soon feel the benefits of being symptom-free outweigh any sacrifices. What's more, you can "cheat" on the diet if you need to, since current knowledge holds that no permanent damage is done to the bowels if you splurge once in a while; the worst that will happen is that your symptoms will return. It's your choice: if you are tempted by a high-FODMAP food, you can weigh up the benefit of eating it versus the impact of the symptoms – sometimes you might think the food tempting you is worth it!

Examples of high-FODMAP foods

Fruit: apples, pears, watermelon, peaches, pears, plums, nectarines

Vegetables: artichokes, asparagus, cauliflower, mushrooms, garlic, onions

Milk/milk products: milk, evaporated milk, condensed milk

Grain and starch foods: barley, rye, spelt bread, wheat

Other: cashews, chickpeas, lentils, honey, legumes, soy milk

Examples of low-FODMAP foods 

Fruit: avocadoes, bananas, grapes, limes, pineapple, strawberries

Vegetables: broccoli, capsicum, carrots, cucumber, olives, spinach, tomatoes

Milk/milk products: brie, butter, cheddar, mozzarella, parmesan, rice milk, yoghurt (up to 80g)

Grain and starch foods: corn, gluten-free bread/pasta/biscuits etc, polenta, quinoa, rice 

Other: garlic-infused olive oil, gelatine, meat, fish, eggs, tofu, peanut butter, tea, coffee

* These lists are not exhaustive; for full lists, ask your dietitian or consult The Two-Step Low-FODMAP Diet and Recipe Book by Dr Sue Shepherd.

For more details on Dr Sue Shepherd's dietetics practice, see www.shepherdworks.com.au. The Two-Step Low-FODMAP Diet and Recipe Book by Dr Sue Shepherd (Pan Macmillan, $39.95).