An apple a day may not keep the doctor away…
Over the past 6 years, there has been exciting research undertaken at Monash University looking at possible dietary triggers for Irritable Bowel Syndrome (IBS). The result of this research is the discovery of a group of dietary sugars which, when ingested by susceptible individuals, causes a range of gastrointestinal symptoms associated with IBS. This group of sugars is called FODMAPs (Fermentable Oligo-saccharides, Di- saccharides, Mono-saccharides and Polyols) and it has changed the face of IBS management around the world.
When you think of IBS, you will often think about adults, but more and more children are now presenting with a history of months and sometimes years of gastrointestinal complaints such as:
- Tummy pain,
- Bloating or visible abdominal distension,
- Excessive wind,
- Diarrhoea +/- associated nappy rash and/or
- Constipation +/- soiling.
The symptoms of IBS are similar to those of other conditions, such as Coeliac Disease, Inflammatory Bowel Diseases (Crohn’s Disease and Ulcerative Colitis) and Bowel Cancer, and as such, it is crucial that these conditions are investigated prior to making any changes to a child’s diet.
The diagnostic test for FODMAP malabsorption is a breath test. The test involves the ingestion of a specific dose of the FODMAP being tested (currently only able to test for Fructose, Lactose and Sorbitol) followed by half hourly breathing into a special bag (for up to three hours) to check the levels of hydrogen or methane produced in the breath. The presence of either of these two gases is indicative of malabsorption of that FODMAP by the gut.
In a nutshell, someone with FODMAP malabsorption is unable to adequately absorb one or more FODMAPs in their small intestine, leaving too much of those FODMAPs to travel further along the digestive system where they are then fermented or broken down by bacteria present in the large intestine, which can results in a range of gut symptoms (as listed earlier).
In young children, the breath test is not always possible due to their inability to blow into the bag adequately to get an accurate reading. As such, in the absence of these results, a process of elimination and challenge under the guidance of an experienced dietitian is required.
When seeing a dietitian for guidance regarding a low FODMAP diet for your child, a comprehensive diet and symptom history will usually be taken to determine the most likely FODMAPs that may be causing your child’s symptoms and guidance regarding the avoidance of those FODMAPS for a STRICT 4 week period will be provided.
Following this 4 week period, and assuming a complete resolution of your child’s symptoms has been achieved, a challenge process will be recommended to pinpoint the exact dietary triggers for your child and to determine their threshold for the problematic FODMAPs. In most cases, the ongoing dietary restrictions are very small when challenges are undertaken in a systematic way.