We're getting less shy about talking about our bowels these days. That can only be a good thing; in a country with one of the highest rates of bowel cancer, the more we can normalise conversations about the workings of our guts, the better.
But by far the most common gastrointestinal disorder is something less serious but no less worrying for sufferers: IBS, or Irritable Bowel Syndrome.
IBS is what's known as a functional gut disorder. That means there's nothing physically wrong in the gut – nothing doctors can see. It tends to be diagnosed after a process of elimination; serious issues such as cancer, coeliac disease, ulcers and inflammatory bowel disease need to be ruled out, since their symptoms can be similar.
READ MORE: • Salt: The villain in our diets
People with IBS have all sorts of symptoms. Bloating and pain are common, along with constipation, diarrhoea (or a mix of both) nausea and unpredictable bowel habits. Unpredictable is a good way to characterise IBS; some sufferers find themselves quite debilitated by their symptoms and unsure of what to do, what to eat or what to avoid.
Treatments for IBS have ranged in the past from painkillers to antidepressants. In recent years, though, diet has been looked at more closely. In a quest for relief, people look to gluten, dairy, food additives and natural food chemicals as possible causes.
Sometimes avoiding these can be useful. But often, it's not the full answer.
Research has found another food-based culprit a possible cause of IBS symptoms. It's a group of components of foods known as FODMAPs. They're trickier to avoid, but research shows a low-FODMAP diet can provide relief from IBS in up to 75 per cent of cases.
FODMAP is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.
These are different types of carbohydrates, found inside lots of the foods we eat, and in some people they can produce IBS symptoms. Some common problem foods include onions, garlic, chickpeas, baked beans, apples, pears and cashew nuts, but there are lots of others. Dairy and wheat also contain FODMAPs, which may explain why some people have partial relief when they cut these out.
Knowing where to start when investigating FODMAPs as a potential solution for your IBS can be daunting. If you Google "low-FODMAP diet" you'll find lots of lists of foods to be avoided. The problem is, the lists can vary from site to site, as the research and testing of foods emerges. And if you go in without a plan, just avoiding dozens of foods, chances are you won't get to the bottom of the problem.
Dietitians who specialise in IBS guide people through a process when they want to try a low-FODMAP diet. It starts with elimination; this is the one time when you need to avoid all possible FODMAP-containing foods. Then there's a series of challenges, where foods are re-introduced in a particular order, and the monitoring of symptoms.
Ideally by following this process you'll identify the specific FODMAPs that are problematic for you. It's uncommon for people to react badly to all the FODMAPs; you may find you're fine with dairy (containing lactose) but onions (containing fructans) are a no-go, for example. Once you know your problem FODMAPs you'll be able to tailor your diet accordingly.
Experts emphasise the need to keep re-introducing restricted foods regularly, even when you've been eating low-FODMAP for a while. Following a very restricted low-FODMAP diet long-term might not be ideal for overall health, even if it feels like it. Aiming for as wide and varied of a diet as possible is a good goal, to make sure you get the best possible nutrition. And with many FODMAP foods there's a dose-dependent aspect; a little bit of a food might be fine; the problem only arises over a certain level.
There are some resources that are well worth checking out if you've been diagnosed with IBS. One is the Monash University FODMAP Diet app. This is a hugely useful app that lets you look up foods and their FODMAP content, as well as a food diary and general information. The other is healthyfood.com, where there's an evidence-based FODMAPs Toolkit including a guide to the elimination diet, menu plans and recipes.
FODMAPs is a clunky-sounding acronym, but for IBS sufferers it might be a life-changing one.