Irritable bowel syndrome (IBS) is a common gastrointestinal disorder affecting one in five people in the UK. Abdominal pain, cramps, swollen belly, gas, constipation and diarrhoea are some of the main symptoms.
It is a long-term but not life-threatening condition that can interfere with many aspects of daily life.
There is no specific test for IBS, therefore it is diagnosed only after testing for and ruling out all other GI problems. It is not known exactly what causes IBS, and so far there is no cure for it so treatment focuses on controlling symptoms.
IBS has traditionally been managed in many different ways, including dietary intervention, supplements, and medications like anti-cramping and ant-diarrhoea drugs.
The low-FODMAP diet is a fairly new approach to treating IBS and it is proving to be an effective way to manage symptoms.
What are FODMAPs?
FODMAPs stand for "fermentable oligosaccharides, disaccharides, monosaccharides and polyols.
These are sugars that are found naturally in many foods and ordinarily, they play a good role in the body.
If you suffer from IBS, you can be sensitive to them and this causes the unpleasant symptoms that characterise the condition.
High FODMAP groups that are avoided or very restricted on a low-FODMAP diet include:
Why are FODMAPs a problem for IBS?
We are lacking the enzymes that digest FODMAPs, which means they are not absorbed in the small intestine and pass through to the large intestine.
Once FODMAPs reach the large intestine, they get fermented by colonic bacteria. In the fermentation process, bacteria increases fluids and produces gas in the large intestine. This results in symptoms such as gas, pain and diarrhoea.
Eating less of these types of carbohydrates should decrease these symptoms.
The low-FODMAP diet has been around since 2010 and was devised by researchers at Monash University in Australia.
Low-FODMAP diets cut out foods that contain particular types of carbohydrates, notably sugars and fibres. These can lead to digestive problems such as diarrhoea, constipation, gas, bloating and abdominal pain in people with IBS.
There is some evidence that following a low-FODMAP diet can be beneficial for IBS. In one study, 76% of people following a low-FODMAP diet felt they were seeing improvements with their IBS symptoms compared to 54% who were following “conventional” IBS nutrition advice.
FODMAP diets are often challenging to follow as they involve cutting a lot of foods out of your diet. This can put you at risk of having an unbalanced diet if you get it wrong but working with a dietitian can ensure that a low-FODMAP diet still gives you key nutrients without making IBS symptoms worse.
FODMAP elimination diets
A FODMAP elimination diet involves restricting all of the main FODMAPs for a short time and then introducing them back into your diet one by one. Working with a dietitian can help you to reintroduce foods from particular categories in a way that helps you to see exactly which of them are contributing to your IBS symptoms.
You will probably find that one particular group is the one that is causing you problems and that within that, certain foods are more of an issue than others. It’s not usually the case that you will need to avoid everything from the group.
Once you know what the culprits are, you can swap them for low FODMAP choices.
There can be a lot of confusion as to what roles are performed by Nutritionists and Registered Dietitians.
Many people mistakenly believe that they are the same thing but there are some key differences that it is important to know about.
What advice does a Registered Dietitian provide?
A Registered Dietitian is qualified to assess, diagnose and treat dietary problems. They can also provide advice to make appropriate and informed food and lifestyle choices.
Dietitians use the most up-to-date scientific research on diet and disease to guide their advice and this approach will have been a key part of their training.
They will often work with people who have special dietary needs to help to treat conditions such as diabetes, inflammatory bowel disease, eating disorders, food allergies and intolerances and malnutrition, to name but a few. This is often as part of a multi disciplinary team.
They can also help to ensure that changing your diet is done in a safe and healthy way if you are following an exclusion diet or supplementing, for example.
Dietitians also have the authority to provide and administer some medications that are only available on prescription such as pancreatic enzymes. This is done in partnership with trusts and health boards.
Dietitians often work in the NHS but they can also be freelance, run private clinics or work within different sectors such as the food industry, catering, the workplace and sport.
What qualifications does a Registered Dietitian have?
Registered Dietitians are the only nutrition professionals in the UK that are regulated by law.
They are also governed by an ethical code to ensure they are work to extremely high standards.
All dietitians are regulated by the Health and Care Professionals Council (HCPC) and there is no opt out on this.
To qualify as a Dietitian, he or she must have completed an accredited undergraduate degree and/or post graduate diploma or Masters Degree in Nutrition and Dietetics.
They must also do a one year clinical placement within the NHS as part of their training to show that they have clinical and professional competence before registering as a Dietitian.
The minimum qualification for a Dietitian is BSc Hons in Dietetics or a related science degree that includes a postgraduate diploma or higher degree in Dietetics.
To call themselves a Registered Dietitian, he or she needs to be fully qualified and registered with the HCPC.
Registered Dietitians require Continuing Professional Development (CPD) to continue their registration.
What advice does a Nutritionist provide?
A nutritionist can provide advice and information about food, diet and healthy eating.
Nutritionists often work in non clinical settings and can sometimes have roles in the NHS alongside dietitians.
As they don’t have clinical training, nutritionists are not qualified to offer advice on special dietary needs for particular medical conditions. They also do not work with people that have been diagnosed with medical conditions.
What qualifications does a Nutritionist have?
A nutritionist generally completes an undergraduate or graduate degree or diploma in Nutrition or Nutritional Therapy.
Not all degree courses in Nutrition are accredited by the Association for Nutrition but those that meet strict standards of professional education in nutrition will tick this box. After graduating from one of these courses, nutritionists can gain direct entry onto the UKRVN.
Unlike Registered Dietitians, the term “nutritionist” isn’t protected by law and anyone can potentially market themselves as a nutritionist. There is also far less regulation with regards to the advice they provide.
This means that it is crucial to find a nutritionist that is qualified and registered with a professional body such as the Association for Nutrition.
Check too that they are registered with the UK Voluntary Register of Nutritionists (UKVRN). It isn’t a legal requirement to do this but only nutritionists that are registered with UKVRN can class themselves as a Registered Nutritionist.
UKVRN registered nutritionists must take part in Continuing Professional Development (CPD).
What about nutritional therapists?
There are also nutritional therapists, who differ slightly from nutritionists as they work privately and charge for their services.
Nutritional therapy is classed as an alternative therapy. Some nutritional therapists may promote alternative therapies, “nutrition products” or alternative tests such as the York Test, muscle testing or the hair test, which have no scientific basis and may not be approved by the NHS. This can lead to recommendations of detoxification, high doses of supplementation and food avoidance, for example.
As with nutritionists, the term “nutritional therapist” isn’t protected by law. This means that anyone can set themselves up as a nutritional therapist and work with paying clients.
Nutritional therapists aren’t required to complete a degree course (or similar). Training is much more informal than for dietitians or nutritionists and can involve an accredited “Foundation Degree” type qualification that is sufficient for gaining entry for starting a Nutrition degree.
Nutritional therapists are not eligible to register for the HCPC or UKVRN.
A lot of the weight that is gained over the course of the average year goes on over Christmas and it is often hard to shift.
If you can avoid putting on a few extra pounds during the festive seasons, you will probably find it a lot easier to maintain your weight through the rest of the year.
Beating the dreaded Christmas weight gain isn’t as hard as you might think and doesn’t involve a huge amount of sacrifice either.
1. Reframe your approach to Christmas eating
If your usual approach to Christmas eating involves a lot more food than normal, you’re probably used to the idea of your clothes being that bit tighter by January.
To avoid it this time around, look at your general mindset towards Christmas food and drink and decide if it needs to be given an overhaul.
Instead of eating festive food because it’s there, the trick is to be a lot more selective with how you use your calories.
2. In moderation doesn’t have to mean boring
Doing things in moderation doesn’t mean that you have to be miserable over the festive season. You don’t need to ban yourself from the food you enjoy - just don’t overdo it.
Trying to steer clear of fun festive food altogether also makes it more likely that you will find it too hard to keep it up and your good intentions may fall completely by the wayside.
Striking a good balance between healthy and fun can be a much better move.
3. Don’t veer too far away from normal
Indulging to some degree is fine but when you do it for the whole holidays, Christmas weight gain becomes inevitable.
Sticking to your usual eating habits as much as possible gives you a lot more leeway with extra calories than if you abandon them completely for the festive season.
What you do with this extra leeway is up to you once you decide how you will go about Christmas eating. For example, will you mostly eat as normal but allow yourself some time off on certain days over the holidays to eat and drink what you want?
4. Not all Christmas food is bad
Festive or winter foods can be healthy if you make the right choices.
For example, winter soups such as butternut squash are an easy way to be healthy and studies have shown that eating soup as a starter means you will eat fewer calories in the rest of your meal.
And even turkey isn’t just traditional Christmas food; it’s full of zinc and selenium (great for boosting your immunity at this time of year!) and it’s also rich in protein and is a good choice for reducing snacking.
5. Choose healthy festive snacks
Swap calorie laden snacks and treats for healthier alternatives such as roasted chestnuts, satsumas and dates. These are still nicely festive but can also help to reduce Christmas weight gain.
6. Be savvy with your alcohol intake
If you plan to drink over the festive season, be aware that a lot of festive drinks can really pack on extra calories.
It can be a good idea to drink two glasses of a non alcoholic beverage for every alcoholic one that you have.
You may also decide to pick one particular drink that will make up the bulk of your calories and prioritise it, or to predetermine how many alcoholic drinks you will have and stick to that.
7. Watch out for the canapes
Buffet food is a big culprit for Christmas weight gain. It is all too easy to put away up to 1,000 extra calories without feeling like you have really eaten much.
Anything with pastry adds lots of calories, as does cheese straws and spring rolls. Swap them for lower calorie choices such as falafel.
8. Be wary of mindless eating
How many times do you find yourself snacking just for the sake of it as you watch Christmas television? Before you know it, a whole bag of sharing crisps or tin of Quality Street have disappeared, along with a whole host of extra calories.
Research suggests that this kind of multi tasking stops us recognising when we are actually full and makes snacking more likely. This can be avoided with a more mindful approach to eating that helps you to feel fuller.
9. Burn some calories
Want to indulge with less guilty over the holidays? Burning off some of the calories you eat is one of the best ways to avoid Christmas weight gain, especially if you haven’t gone overboard in the first place.
10. Stay on track (even if you're derailed!)
If you are given Christmas foods that don’t fit into your eating plans, keeping them in the house will probably prove too much. Take away the temptation to eat them anyway by removing them completely, either by giving them to other people or donating them to a food bank, for example.