Dietary management of IBS. FODMAP intolerance or food chemical intolerance? How do you decide?

It is often assumed that everyone with IBS has similar symptoms; therefore the management should always be the same. Symptoms and management of IBS is different for each individual.

IBS Symptoms:

FODMAP intolerance should be investigated where bloating is present. In the case of bloating, spasm and abdominal pain may occur following abdominal distension caused from bloating. As a result of bloating wind is increased, you may suffer from constipation, diarrhea or alternate between the two. 

Food chemical intolerance often presents with the most common symptoms being abdominal pain, ranging from abdominal cramping through to severe monthly pain or even as bad a labour pains. Abdominal pain may be initiated a couple hours after eating, the next morning or up to 48 hours after eating. The pain often passes with a bowel motion, although this recovery time varies for each individual. Their cramping pain and recovery can be referred to as “abdominal migraine”.

Bowel urgency is common. This urgency may be so strong that no outing can be considered unless toilets nearby are known. If you are food chemical intolerant you will more often have frequent loose motions and this could be the most inconvenient symptom for you.

It is essential to highlight that IBS symptoms vary not only in presentation but also severity from person to person.

Foods suspected of causing IBS symptoms

Some individuals may already be convinced of potential food sensitivities resulting in symptoms such as bloating and wind.

Most common foods mentioned include cabbage, legumes, onion, garlic, gluten, fruit, and dairy. These are examples of FODMAP foods e.g. poorly absorbed sugars (fructose, fructans, lactose). Instead you may have identified that if you avoid eating out you have few symptoms, but if you dine out you often have symptoms afterwards. In this case you may have connected your symptoms to spice, or “rich food”, Asian meals, tomato dishes or particular acidic fruits. You may desire, foods such as chocolate, mints or high additive soft drinks.

So do you choose low FODMAP or food chemical dietary management?

The best way to tackle this decision is to seek help from a professional such as a dietitian who knows how to take you through the diet investigation process.

As explained above we can see IBS symptoms are not so clearly related to specific foods for every individual.

If you are identifying symptoms from both of the symptom scenarios above your IBS can be even more complicated to manage. An experienced accredited practicing dietitian who can take you through the process.

Food investigations are a very complicated process, guidance about what foods are unlikely to be the cause to your reactions can be helpful before you even begin. If bloating is present the FODMAPS protocol is the priority. In the case of abdominal cramping, distention, pain and bowel urgency the low food chemical elimination diet would be the main focus. Both diet investigations are just the starting point; the clarification of intolerance is with the completion of controlled challenges. It is also possible to complete a combined FODMAPS/Food chemical elimination diet if necessary. A dietitian can provide up-to-date detail on the FODMAPS diet, and the RPAH elimination diet.