Niki Bezzant: Learning to control gut instinct

An apple a day keeps the doctor away? Not for some with IBS.

Fodmaps — it's possibly the least catchy acronym in the world (made up from an even less catchy list of classic irritant food types), but it's a very important one for anyone who struggles with bloating, pain and other symptoms associated with Irritable Bowel Syndrome.

IBS is the most common digestive disorder in the world, thought to affect up to 25 per cent of women and slightly fewer men.

That may be a conservative estimate; the IBS and bloating information on the Healthy Food Guide website is consistently among the most popular, suggesting many people are looking for help on this.

IBS is what's known as a functional disorder; that is, there's nothing structural going on in the gut.

In IBS the bowel's normal rhythm is disrupted by spasms that can cause bloating, excess wind, diarrhoea, constipation, cramps and pain.

As these can also be symptoms of more serious conditions, IBS is a diagnosis of elimination; other disorders need to be ruled out first. For a long time treatment was pretty hit and miss, probably because the causes were not well understood.

In recent years, though, the evidence has been growing for a low-Fodmap diet as an effective way to manage IBS.

It has been shown to be effective in 70 per cent of cases or more.

Fodmaps are specific types of fermentable carbohydrates found in many foods. In people who have IBS, these are not well absorbed in the gut. Cutting back or eliminating these foods can eliminate symptoms.

Some of the Fodmap foods people often have trouble with are onions, garlic and leeks; beans, chickpeas and lentils; apples and pears; wheat and rye; lactose in dairy products.

There are lots of others, too, including many fruits and vegetables. In fact when you look at lists of Fodmap foods, it can seem like there's not much left to eat. But that's not really the case.

When managed well, a low-Fodmap diet can be varied and interesting.

Although it can be tempting to stay away from problem foods for good, it's important to re-introduce them for the best chance of getting a well-balanced diet.Following a new diet may be key to maintaining a healthy inside story.

If you want to try the regime, there are a couple of things to remember.

The first is that it's not just a case of consulting the list and cutting out everything on it. There's a protocol to go through so you can identify what the problem food group or groups are for you. It's unlikely you'll have a problem with all of them.

The Fodmap groups are re-introduced one at a time in a series of "challenges", and symptoms are monitored. Dietitians who specialise in gut issues are expert at guiding people through this process.

The second thing to note is that it isn't intended to be a "forever" diet.

Although it can be tempting to stay away from problem foods for good, it's important to re-introduce them for the best chance of getting a well-balanced diet.

Many are dose-dependant, so a little bit of a food may be fine, while larger amounts won't be. Figuring out your thresholds will mean you can get back to as varied a diet as possible and stay bloat-free.

• Niki Bezzant is editor-at-large for Healthy Food Guide. www.healthyfood.co.nz