Irritable Bowel Syndrome, FODMAPs & Huel

Irritable Bowel Syndrome (IBS) is a medical term used to describe a collection of gut symptoms. Symptoms vary from one individual to another and can be worse for some than others. Can Huel help?

IBS is a very common condition affecting around one in five adults. IBS is diagnosed by process of elimination and there is a specific diagnostic criteria for IBS, so if you think you might have it, it’s important that you first go speak to your doctor. Your doctor will complete a few simple tests to rule out any other underlying cause for your symptoms such as coeliac disease. Once these tests are completed, and all is okay, a diagnosis of IBS can be confirmed.

What causes IBS?

The cause of IBS is still not fully understood but is considered a disorder of the gut-brain axis. This means there is a miscommunication between the brain, and the trillions of bacteria living inside the gut, known as the gut microbiota. This miscommunication then causes an over-sensitive intestine, known as visceral hypersensitivity. As a result, this causes an exaggerated response to various things such as fluctuating hormones, food, drinks and some medications. This explains why most people find their symptoms get worse with poor sleep, stress and after eating and drinking.

There is no single cause of IBS, instead there are several factors which can increase your risk of getting it such as:

• Travellers diarrhoea/food poisoning
• Gender (females are more likely to suffer from IBS than males)
• History of anxiety or depression
• Stress
• Genetics

Stress: When the body is under stress, it sends out stress hormones and signals to help you cope. Whilst this does help you cope to a degree, these hormones and signals make your gut a lot more sensitive, especially if there is a prolonged release.

For this reason, if you are experiencing IBS, it is important to consider treatment from two angles. Anything you can do to support yourself in respect of well-being, will help to dampen down the stress response making your gut less sensitive. For example, meditation and yoga have been proven to significantly reduce symptoms of IBS, with one study finding yoga to be as effective as the low FODMAP diet in improving IBS symptoms.^[1]

Dietary factors that influence digestion^[2]

There are some simple steps you can take to help manage your symptoms by addressing your overall diet.

Regular Meals – Eating regularly allows for more equal sized meals throughout the day. Avoid skipping meals as if we miss a meal, we tend to overeat at our next meal and smaller meal sizes may ease symptoms.

Caffeine – Caffeine increases the amount of stomach acid we produce and can increase the rate at which things move through our gut, with coffee being shown to rapidly increase this movement. Caffeine is found mainly in tea, coffee, cola and energy drinks. There are decaf versions of all of these, so look out for them if reducing your caffeine intake. Aim to reduce intake of caffeine-containing drinks to no more than 400mg caffeine per day (three to four cups of coffee), or 200mg if pregnant.

Alcohol – Alcohol can affect the permeability of our gut. When we drink alcohol, our gut becomes ‘leaky’, making it more sensitive to the foods we’re eating. Limit alcohol intake to no more than 14 units per week, with at least two alcohol free days each week. 14 units is the equivalent to 6 x 175ml glasses of wine (13% ABV), 5 x pints of cider/beer (4% ABV) or 14 x 25ml shots of spirits.

Spicy food – Capsaicin, which is the active component in hot peppers and in spicy food, can increase the speed at which things move through our digestive system, and can cause abdominal pain and burning sensations. If you suffer from IBS, reduce your intake of spicy foods.

High fat foods – Fat takes longer to digest, and therefore sits in the small intestine which can cause feelings of fullness, abdominal bloating and abdominal pain. Cut down on rich or fatty foods such as chips, fast foods, pies, battered food, cheese, pizza, creamy sauces and snacks such as crisps, chocolate, cake and biscuits. This also includes takeaways and fast food such as burgers and sausages.

Fluid – It is vital to stay well-hydrated for many reasons one of which is for digestion. Fluid helps dietary fibre work in supporting our gut motility, preventing constipation. Aim to drink 1.5 to 2 litres of fluid per day. This includes water, squash, herbal teas and decaffeinated drinks.

Dietary fibre– It is essential to eat enough fibre in our diets. Fibre is what forms the bulk of our poop, feeds our gut bacteria, and helps with gut motility. It is recommended to aim for 30g fibre every day. To do this, include five portions (1 portion equals 80g) of fruits and vegetables every day, choose wholegrain carbohydrates over white varieties, and include plant-based proteins such as beans, pulses and lentils, as well as nuts and seeds regularly in your diet. Remember, fibre requires fluid to work effectively in the gut! So make sure to hit your 1.5 litre fluid intake each day.

What more can I do?

Give your bowels time to adjust to any dietary changes made. However, if your symptoms persist after following general lifestyle and dietary advice, you may benefit from seeing a specialist dietitian who is trained in delivering a low FODMAP diet. This is a diet low in fermentable carbohydrates also known as Fermentable, Oligo-saccharides, Disaccharides, Monosaccharides, And Polyols.

Many NHS hospitals offer referrals to see a dietitian for the Low FODMAP Diet to support the management of IBS. Alternatively, you may be able to access a local dietitian privately. The Low FODMAP Diet is complex and information available online can be variable and conflicting. A dietitian with the relevant experience will support you to ensure your diet remains nutritionally balanced and manageable for your lifestyle. Clinical trials demonstrate the Low FODMAP Diet can improve symptoms of IBS in up to 70% of people^[3]. The Low FODMAP Diet is a very effective way to manage IBS in addition to getting the above basics right and focusing on your wellbeing.

What are FODMAPs?

Simply put, FODMAPs are short-chain carbohydrates that don’t get digested in the small intestine, so pass through to your large intestine where they are fermented by the trillions of bacteria that live inside your gut, known as the gut microbiota. This fermentation process produces gas and causes water to be drawn into the gut. This is a completely normal and natural process that happens in everyone. However, those with heightened gut sensitivity (i.e. those with IBS), are more sensitive to this gas production. In turn, this can worsen abdominal pain, bloating, wind and diarrhoea, as a consequence.

Where are FODMAPs found?

There are five main types of FODMAPs in the diet:

Fructans – These are short chains of fructose which are poorly absorbed by most people. This means that a lot of what we eat will move straight into the colon and add to the gas build-up. Fructans are found in wheat, rye and barley, as well as in garlic, onions and various fruits and vegetables.

Galacto-oligosaccharides (GOS) – These are chains of the sugar galactose and are poorly absorbed in all people. We do not have the ability to break them down in the small intestine, so they pass to the large intestine, undigested, where they are fermented by our gut bacteria, producing gas, and drawing water into the bowel^[4]. Major sources of GOS include beans and pulses such as chickpeas, and lentils.

Polyols – These FODMAPs are passively absorbed in the digestive system. This means only 20% of what we eat is absorbed into the body^[5]; therefore, the remaining 80% moves through into the colon undigested. Polyols cause a lot of water to be drawn back into the bowel, so often contribute towards diarrhoea and bloating in those with IBS. Polyols are found in some artificial sweeteners, e.g. sorbitol, xylitol and mannitol which are used in sugar-free gum, mints and sweets. They are also naturally occurring and found in various different fruits and vegetables.

Fructose – This is fruit sugar and is actively absorbed in the small intestine when taken in equal measure to glucose. The glucose helps the fructose get out of the digestive tract into the body to be used as energy. When fructose is taken in, in excess of glucose, it cannot be absorbed properly. The fructose that is not absorbed then moves into the colon and behaves like a FODMAP^[6]. Fructose is in all fruit, even low FODMAP fruit, so it is not completely avoided as part of the Low FODMAP Diet. It is recommended to just have one portion (80g) at a time and spread your intake of fruit over the day. Fructose is also found in natural products such as honey and agave nectar.

Lactose – A large percentage of the human population have a reduced ability to digest lactose. This is when we don’t have enough of the enzyme lactase that helps us break down lactose for it to be absorbed in the body. When this breakdown process isn’t happening, the lactose moves through into the colon undigested and behaves like a FODMAP. The prevalence of lactose intolerance varies widely between populations. For instance, lactase deficiency occurs in as few as 5 percent of North Europeans and North Americans of European origin, yet up to 90 percent of Asian, African and Caribbean adult populations are affected^[7]. Lactose avoidance forms part of the Low FODMAP Diet for only some individuals where lactose intolerance is suspected. Lactose is found in dairy products in particular milk and yoghurt. Cheese, butter and cream are actually naturally low in lactose, due to the fact most of the lactose is removed in the process of making them.

The Low FODMAP Diet

The Low FODMAP Diet consists of three stages:

FODMAP restriction: Follow a low FODMAP diet for between four to eight weeks. The exclusion part of the diet involves substituting high FODMAP foods, for low FODMAP alternatives. During this phase of the diet, symptoms often improve and completely subside in some. It can take up to four weeks to really start to notice an improvement, so do give it time.

FODMAP reintroduction: This part of the diet is just as important, if not more important, than the first part. The reintroduction phase is when you learn how each FODMAP interacts with your body. Your dietitian will talk you through how to introduce one FODMAP at a time, systematically, so you can test each FODMAP to understand how they influence your symptoms. Remember, if you eat a problem food and experience symptoms, you will not cause any damage to your gut. There are in fact dangers of following a strict low FODMAP diet long term, and not reintroducing high FODMAP foods where you can, such as decreased gut microbiome diversity which could lead to more problems later down the line^[8]. It is therefore always encouraged to enter the reintroduction stage and under the guidance of a dietitian, find an acceptable balance between the occasional inclusion of moderate and high FODMAP foods (naturally rich in healthy prebiotics) and adequate symptom control.

In the long-term, it is recommended to follow the least restrictive diet necessary.

FODMAP personalisation: Once you have completed the reintroduction stage, you are in the driver’s seat! No longer do your symptoms control you: you control the symptoms. You can then decide how you want to bring FODMAPs back into your diet, dependent on the level of symptom control you require.

By the end of the Low-FODMAP Diet process, you will have learned how to settle symptoms down when you need to, and how FODMAPs affect you personally. With this knowledge and awareness, you can manage symptoms independently long term.

FODMAP Stacking

Some foods contain more than one FODMAP. Whilst on the restriction stage of a low FODMAP diet, some of these foods are suitable to eat but in only small portion sizes. This would be discussed with your dietitian in detail. When following the reintroduction stage of the diet, some of these foods must therefore be reintroduced slowly to gauge your personal tolerance levels.

Everybody has a personal FODMAP tolerance threshold for a total FODMAP load. This threshold is personal to you and can fluctuate depending on factors such as anxiety, stress or a busy and hectic lifestyle. There is also an additive effect for each high FODMAP food so if you have too many too often, you will go over your personal tolerance threshold and you may get symptoms. You may tolerate small amounts of high FODMAP foods occasionally but if you eat too many high FODMAP foods over a short period of time you may get symptoms.

If you know a food gives you symptoms if you eat it every day, but want to include it in your diet, try to have it less frequently, perhaps every three days or once a week. Sometimes including a problem food as part of a meal, rather than on its own, causes fewer symptoms. This can all be discussed with your dietitian in more detail once moving onto the FODMAP personalisation stage.

Huel & FODMAPs

All ingredients listed in Huel Powder v3.0 and Black Edition Huel are low FODMAP and for this reason they can be used alongside the Low FODMAP Diet and as part of your dietary routine if you have IBS. If you have IBS and an extremely busy lifestyle where convenience is a top priority, Huel could form a part of your eating routine to ensure you are achieving a regular meal pattern and optimal nutrition.

However, as tolerance to FODMAPs can vary between individuals, we suggest you introduce Huel Powder into your diet starting with one scoop, increasing the amount every few days.

Please note: Huel Hot & Savoury, Huel Ready-to-drink, Huel Complete Protein and Huel Bars are not low FODMAP.

This article has been written by Kaitlin Colucci (RD, MNutr) Registered Dietitian – Freelance Dietitian Specialising in Gut & Digestive Health

References

1. Schumann, D., Langhorst, J., Dobos, G., Cramer, H. (2018) Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 47(2): 203-211.
2. McKenzie YA, et al. (2016) British Dietetic Association: systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Human Nut & Diet. 29(5): 549-75.
3. O’Keeffe M & Lomer MC. (2017) Who should deliver the Low FODMAP diet and what educational methods are optimal: a review. J Gastroenterol & Hepatol. 32(S1): 23-26.
4. Staudacher HM, et al. (2011) Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Human Nut & Diet. 24(5): 487-95.
5. Beaugerie L, et al. (1990) Digestion and absorption in the human intestine of three sugar alcohols. Gastroenterol. 99: 717-723.
6. Shi, X. et al. (1997) Fructose transport mechanisms in humans. Gastroenterology. 113(4): 1171-9.
7. Storhaug, CS., Fosse, SK., Fadnes, LT. (2017) Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. The Lancet, 2(10): 738-746.
8. Martin, L., van Vuuren, C., Seamark, L. (2015) Long term effectiveness of short chain Fermentable carbohydrate (FODMAP) restriction in patients with irritable bowel syndrome. Gut, 64: A51-A52.