As part of my dietetics training, I’ve been taking clinics at the local university’s Student Health. The patients we see in these clinics are completely different to the patients we see in the hospital. The patient referrals we get in the clinic usually fall into one of two categories: weight reduction/ type II diabetes mellitus/ high blood pressure and high cholesterol (yes all in one person!) or possible food intolerance(s)/ IBS-like symptoms. I was definitely the latter type of patient in my first year of university. These patients with IBS-like symptoms are also usually students in their first year of university who are living in a hostel. They are often on a tight budget, have low iron levels, are getting less sleep and are doing less exercise than they were at home, have higher stress levels and don’t like the hostel food. No wonder they come and see us!
Hostel food is generally low in fresh fruit and vegetables, is high in carbohydrates e.g. bread, rice and pasta and is low in good quality red meat. It’s no secret that the Student Health services would be used a lot less if the hostels improved the quality of their food.
When a patient comes to our clinic, our job is to gather as much information as we can from them about their symptoms, lifestyle and usual eating habits so that we can tailor our advice to them as an individual.
However, before launching into low FODMAP advice for someone with IBS-like symptoms e.g. bloating, stomach cramps, constipation/ diarrhoea, we give ‘first-line’ advice, first. This provides the foundation for a healthy lifestyle and in many people, it can solve their symptoms. ‘First-line’ advice targets eating regular meals, managing stress, getting enough sleep and exercise, drinking enough water and eating a balanced diet with lots of fruit and vegetables. Nothing new is it?! The Bristol Stool Chart (see below) even becomes a key part of our assessment – you could say we become pretty comfortable talking about poo!
From this, it is usually pretty easy to work with the patient to make some goals based on where they’re at in terms of the ‘first-line’ advice. Our advice to them can include increasing fibre intake, decreasing coffee intake, exercising more regularly, finding ways to manage stress and eating regular meals that are nutritionally balanced. However, some patients will need IBS and low FODMAP advice on top of the ‘first-line’ treatment. The best way to introduce a patient to a low FODMAP diet is to give them a pictorial sheet with examples of high and low FODMAP fruit and vegetables. Background information on IBS and a low FODMAP diet is also useful as a take-home sheet as it is quite a lot of information to process! We also encourage the patient to download the Monash University App as it has heaps of low FODMAP recipes and information as well as a ‘traffic light’ system for foods based on their FODMAP content.
Do you need to take a probiotic if you have IBS?
Research has shown that probiotics may reduce the severity of IBS symptoms. However, IBS manifests so differently for everyone so probiotics may work for one person but not for the other. If you are going to use probiotics it is important to take them for at least four weeks to see any effect. It is not recommended to take probiotics when you are in the elimination or reintroduction phases of a low FODMAP diet as they can interfere with the results of which high FODMAP foods you react to.
A follow-up appointment will usually be booked for a new IBS patient and they will be given a symptom-food diary to fill-out before their next appointment. This allows us to link their symptoms to a particular food or drink that they had. This is also the best way to remove only those foods that cause symptoms rather than removing all FODMAP-containing foods and unnecessarily restricting someone’s diet.