IBS and the FODMAP diet
If you work with IBS clients you may have come across the FODMAP diet but as April is IBS Awareness Month I thought this would be the perfect time to explore what this means and how you might help clients who are following it.
What is FODMAP?
FODMAP stands for Fermentable Oligo-, Di- and Mono-saccharides, And Polyols, which might not be very helpful unless you are a dietician. Essentially the items listed are all short-chain carbohydrates and sugar alcohols which the small intestine finds it difficult to absorb. The result if this is that bacterial action in the digestive system tends to make them ferment, causing increased liquid and gas production in the gut. A recent theory from Melbourne, Australia says that reducing intake of foods which are high in FODMAPs can help IBS sufferers to relieve symptoms of bloating, gut pain, intestinal gas and motility problems like diarrhoea and constipation.
What foods are included or excluded by this diet?
This is the million dollar question, of course, but not an easy one to answer, especially in the space allowed here. In very broad terms, a variety of fruits, vegetables, grains, legumes, sweeteners, dairy foods and lactose-containing foods are high in FODMAPS. Other foods in the same groups are low in FODMAPS.
There are lists and recipes on line (of course), also books and even apps to help you identify low FODMAP foods. But some more reliable than others, but many high FODMAP ingredients are hidden in processed or pre-packaged foods so cutting them all out can be quite a challenge. Added to which your client may have specific food triggers for their IBS which are unrelated to FODMAPs, but still need to be taken into account.
In addition the usual method (based on what my clients tell me) is to hugely restrict the person’s diet and then over several weeks gradually re-introduce low FODMAP foods one by one so their effect can be monitored. This can lead to dietary imbalances, at least in the short term, which might have to be addressed with supplements.
I do appreciate that we all know our own bodies. However, due to the complexities of correctly implementing a healthy low FODMAP diet, the best advice you can give to any client wanting to explore it is to ask their GP for a referral to a dietician, who will help them find their way through the maze of conflicting and sometimes confusing advice.
Is it worth trying?
So far it seems around 70-75% of IBS patients are likely to have an improvement in the severity or frequency of IBS gut-related symptoms by following this diet. Research is still ongoing as larger studies need to be carried out to confirm this initial finding.
It doesn’t help with non gut-related symptoms like headaches which are sometimes associated with IBS, but yes it’s worth exploring for many of those with the condition.
How can hypnotherapists help with this?
Firstly, by raising awareness of the FODMAP diet. Some clients who seek your help with controlling their IBS symptoms may not have come across it, as it’s fairly new in the UK. Ethically we can’t prescribe treatment, of course, but we can encourage our clients to chat about the FODMAP diet to the GP and see if it might be of help to them.
Secondly, I’ve already mentioned that the diet is quite restrictive, especially at first, and some clients find it difficult to stick to. We can use hypnotherapy to help them change their eating and shopping habits, or to boost their confidence, self esteem or motivation – whatever they need to follow it easily and comfortably. These are all areas where you will have plenty of techniques and ideas available (check out the Hypnotherapy Handbook for a start!) which you can adapt to your client’s needs.
Author Debbie Waller is a professional hypnotherapist, specialising in stress, anxiety and related issues. She also offers EMDR which is used for trauma, PTSD, phobias and OCD and owns a multi accredited hypnotherapy school, Yorkshire Hypnotherapy Training. Debbie publishes hypnotherapy-for-ibs.co.uk for those interested in using hypnotherapy to relieve the symptoms of irritable bowel syndrome, and wrote the chapter on IBS and hypnotherapy in The Hypnotherapy Handbook.