DR MEGAN ROSSI: Why your gut could do with a holiday!

Why your gut could do with a holiday! DR MEGAN ROSSI says that going away and getting out of your routine can really help people with irritable bowel syndrome

There is nothing better than that holiday feeling, as the stresses and strains of your life just seem to ebb away.

And for some people, a holiday is just what their gut needs, too. But I don’t mean literally going away — just giving it a brief respite from its usual routine.

This kind of break can really help people with irritable bowel syndrome (IBS), as well as anyone who’s had a stomach bug — when your gut may be more sensitive than usual.

And, just as a fortnight off can change our approach when we are back at our desks, so a ‘gut break’ can help change the behaviour of our digestive tract, reducing symptoms such as bloating, pain and irregular bowel movements.

This idea of resting the gut is the principle behind the low FODMAP diet — a well-established approach to treating IBS, developed back in 2007 by researchers from Monash University in Australia. It may also help with small intestinal bacterial overgrowth (SIBO, where you have more microbes than normal in the small intestine, which leads to bloating, pain and loose poop).

There is nothing better than that holiday feeling, as the stresses and strains of your life just seem to ebb away. And for some people, a holiday is just what their gut needs, too. But I don’t mean literally going away — just giving it a brief respite from its usual routine 

FODMAPs, or Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, are carbohydrates that are generally poorly digested by the upper intestine, finding their way into the large intestine.

Here, the trillions of microbes break them down, going into a feeding frenzy — along the way producing beneficial chemicals but also gas, which can irritate the millions of nerve endings.

If you have IBS, or if you’ve had a recent stomach upset, these nerves are often hypersensitive and this gut activity can kick-start cramping pain and symptoms such as bloating.

The undigested carbs also draw fluid into the intestine, leading to loose, or a mixture of hard and loose, poop. This can disrupt the colony of gut microbes, because excess fluid in the gut can affect how fast the food moves through and in turn can lead to more malabsorption of food and more fermentation by the gut bacteria.

With the low FODMAP diet the idea is that you temporarily cut out foods that are high in these carbs, allowing your gut that much-needed break, calming everything down by reducing both the bacteria-produced gas and influx of fluid.

It gives the gut a chance to re-set. More specifically, it takes the pressure off those hypersensitive nerve endings, allowing them to settle down.

The diet alleviates symptoms in about 70 per cent of people with IBS, according to various clinical trials, with an improvement in tummy pain, bloating and stool movements often seen within two to four weeks.

I’ve found in my clinic that it can also work for those who’ve recently had a gut infection — the short- term reduction in gut stimulation can help your gut lining rejuvinate. But, and this is key, you need to then ‘retrain’ your gut to accept these foods, by slowly reintroducing them.

If you have IBS, or if you’ve had a recent stomach upset, these nerves are often hypersensitive and this gut activity can kick-start cramping pain and symptoms such as bloating [File photo]

Because that’s the point: you do really want these foods in your diet long term. FODMAPs are by and large healthy foods — they include wholegrains such as barley and rye, beans and pulses such as chickpeas and lentils, and certain fruit and veg such as apples, pears, garlic, cauliflower and onions.

Most of them are prebiotics: in other words they help feed and nourish the microbes in your gut which play such a key role in our health generally.

And a low FODMAP diet needs to be followed with care as its restrictive qualities make it more challenging to get enough of key nutrients such as calcium, and fibre. It can also lead to unwanted weight loss and can worsen constipation (by cutting back on so many fibrous foods).

That’s why British Society of Gastroenterology guidelines recommend that the diet should be undertaken with the support of a FODMAP-trained dietitian.

Realistically, that isn’t always possible, which is why I developed the FODMAP-lite approach.

Essentially, it restricts a smaller number of foods than the full diet (just the foods highest in these carbs), so it’s easier to still get plenty of fibre and also have a more diverse diet.

In my clinic this ‘lite’ approach seems to be enough to bring about an improvement in most people with mild to moderate IBS (you can find a table of lower FODMAP foods at theguthealthdoctor.com).

When it comes to IBS, with either FODMAP-lite or the standard version, there are three stages: stage one lasts two to six weeks depending on how quickly your symptoms improve, and involves replacing high FODMAP foods with lower alternatives.

During stage two you reintroduce the different carb groups one at a time so you can identify which you are most sensitive to and at what quantity.

A food that rates ‘high’ can be low, depending on how much you eat of it. For example, a cup of pasta is high FODMAP, whereas half a cup is considered low.

sHould a food trigger symptoms, then wait a few days and reintroduce it at a half dose. This stage of reintroducing can take several months to complete.

Stage three is the personalisation stage where you reintroduce all food up to your tolerance level over several weeks.

The full three-stage low FODMAP diet might take eight months or more to complete. For those with less severe symptoms, you might want to start with the FODMAP-lite approach which halves the time to complete it.Most of the evidence to date for this diet has been for people with IBS (and I see the greatest long-term success in those who also work on relaxation techniques, such as doing ten minutes of mindfulness a day or yoga).

However, it may also be helpful after a bout of travellers’ diarrhoea or a stomach upset — or if you’re prone to flying-induced gut upset. With traveller’s diarrhoea or a stomach upset I tend to recommend following stage one of the FODMAP-lite approach for up to two weeks.

As for flying, I suggest sticking to lower FODMAP foods for the 24-48 hours before you fly to cut down on bloating caused by changes in pressure in the aircraft — give your gut a mini break to get your holiday to a great start!

Try these: cheesy vegan crackers

Gluten-free, dairy-free but not flavour-free — and they’re low FODMAPs too.

Makes 20

• 35g buckwheat flour
• 25g ground flaxseeds
• 145g mixed seeds (flaxseed, sunflower, pumpkin, sesame)
• 20g poppy seeds
• 2 tbsp nutritional yeast
• Pinch of salt
• Big twist of pepper
• 2 tbsp olive oil

Toppers (optional):

• ½ tsp thyme
• Sea salt flakes

Preheat the oven to 160c fan/350f/gas 4.

Combine the base ingredients, apart from the oil — then slowly pour in the oil and 75ml of hot water and, using your hands, make a wet dough. Leave to rest for ten minutes somewhere warm.

Line an oven tray with baking paper and place the dough in the middle. Put another sheet of oven paper on top of the dough and, using a rolling pin or a glass bottle, spread the dough into a thin layer — the thinner it is, the crispier the cracker.

Remove the top paper and sprinkle the toppers, if using, over the dough and gently press in.

Bake for 25–30 minutes, or until slightly golden. Transfer to a cooling rack and when completely cool break into cracker size of choice.

These will keep in the fridge for two weeks.

Increasing your daily fibre intake by just 8g is linked with an 18 per cent lower risk of heart disease and 15 per cent lower risk of type 2 diabetes. Start your day with a bowl of porridge, mixed seeds and banana, to get your extra 8g in one go! 

AskMegan

In 2016 I was diagnosed with bile acid malabsorption after being told for years I had IBS. I now take medication (colesevelam) and must adhere to a low-fat diet, but have been left with no medical support. As I grow older will I become more — or less — able to control my bowels?

John Frolich.

I am really sorry to hear about your delayed diagnosis. Bile acid malabsorption (BAM) is underdiagnosed, with as many as 30 per cent of those affected told they have ‘diarrhoea-predominant’ IBS (some people have both conditions).

Bile acids, which help break down fat, should be reabsorbed in the small intestine but in some people they end up in the colon, triggering diarrhoea.

Colesevelam is a type of bile acid binder, and these are generally very effective but the dose needs to be adjusted to suit you and your diet, so it’s important to have a review with your doctor (and ideally to see a dietitian who can look at dietary triggers, other than fat; these may include FODMAPs — see above). Other strategies include having smaller, more frequent meals and adding psyllium husk fibre to oats at breakfast.

It’s also important to get your levels of fat-soluble vitamin (A, D, E and K) checked as the medication can affect how your body absorbs these.

Researchers are now looking at hormone therapies to reduce bile acid release and hopefully this will soon help patients such as yourself.

Contact Dr Megan Rossi 

Email [email protected] or write to Good Health, Daily Mail, 2 Derry Street, London W8 5TT — please include contact details. Dr Megan Rossi cannot enter into personal correspondence. Replies should be taken in a general context; always consult your GP with any health worries. 

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