When it comes to talking about digestive troubles we are remarkably shyMore than 40 per cent of people never discussing their symptoms with a doctorThis risks serious conditions being missed, or losing out on helpful treatmentWe ask the experts about embarrassing gut and bowel problemsBy Jo Waters and Angela Epstein for the Daily Mail
Published: 19:52 EDT, 21 August 2017 | Updated: 11:36 EDT, 22 August 2017
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When it comes to digestive troubles we're remarkably shy, with more than 40 per cent of people never discussing their symptoms with a doctor.
But this risks more serious conditions being missed, or losing out on treatment that could help. In the third part of our series, we ask the experts about embarrassing gut and bowel problems . . .
Why you burp - and how to stop it
Burping, or belching, is the term used for expelling wind caused by swallowing air while eating, or by gas generated in the gut during digestion.
It's normal to burp occasionally, but more frequent belching could be down to an underlying condition.
Excess gas, including burping, bloating and flatulence, is a common problem says Dr Ana Wilson, consultant gastroenterologist at St Mark's Hospital, Harrow, often seen in g astroenterology clinics.
For many people, she says, lifestyle changes can help.
'You can reduce burping by taking time to sit and eat and not rushing your food, avoiding fizzy drinks and not talking while eating,' she explains.
Excess gas, including burping, bloating and flatulence, is a common problem
People who suffer from post-nasal drip (where catarrh from the nose and sinuses drains into the throat) may burp frequently because the congested nasal passage means people swallow more air as they breathe through their mouth. Treatment with decongestants can help.
Nicholas Boyle, a consultant upper gastrointestinal surgeon at the Lister Hospital, London, says burping can sometimes be a symptom of small intestinal bacteria overgrowth (SIBO).
This is where colon bacteria migrate into the small intestine and produce high levels of hydrogen and methane gas, and sometimes hydrogen sulphide gas, which are expelled by burping.
SIBO can produce intermittent loose stools, diarrhoea and constipation. It is diagnosed with a breath test which involves drinking two types of sugar — glucose and lactulose — which test for hydrogen and methane gas respectively. SIBO can be treated with antibiotics.
People may burp a lot if they have acid reflux or gastro-oesophageal reflux disease (GORD). The sphincter in the gullet fails to stay closed, so stomach contents splash back up, causing irritation and inflammation (often called heartburn).
Mr Boyle says in these cases, burping is caused by the loose valve at the bottom of the oesophagus, which cannot withstand pressure from the stomach, so gas escapes upwards.< /p>
When it comes to GORD, if lifestyle changes such as cutting down on fatty foods, avoiding tight waistbands, losing weight and raising the head of your bed (which makes it harder for acid to splash back) don't work, the next step is to try over-the-counter remedies.
These include medicines such as Gaviscon or Gastrocote that contain antacids — to neutralise stomach acid — and alginates, which coat the lining of the oesophagus to protect it. But though popular, there isn't much evidence of long-term efficacy.
Are you belching too much?
It's normal to burp three or four times after a meal — it's often a sign you've swallowed too much air, explains consultant gastroenterologist Dr Ana Wilson, a spokeswoman for the Love Your Gut campaign. 'Most people who burp have just swallowed too m uch air by eating and drinking at the same time, rushing their food and eating on the hoof.'
People who are anxious or who have badly fitting false teeth — which cause them to chew in an abnormal way — can also swallow too much air. The timing of burps can also be significant, says upper gastrointestinal surgeon Nicholas Boyle. Burps immediately after meals are more likely to be caused by swallowing air, and those more than half an hour later are more likely to be as a result of an underlying condition.
Mr Boyle says it's important not to self-medicate with over-the-counter remedies for longer than four weeks because one in ten people with GORD also get Barrett's Oesophagus: pre-cancerous changes to the cells that can lead to oesophageal cancer. Oesophageal cancer is rare, but early symptoms are similiar to GORD, so it's important to have a doctor rule ou t anything sinister, he warns.
You could ask your GP for drugs known as proton pump inhibitors (PPIs), such as omeprazole, which block stomach acid being pumped out of the cells that make it. Omeprazole is also available over the counter in a 10mg dose, but higher doses can be had on prescription.
PPIs don't work for between 10 and 40 per cent of people taking the standard dose, according to a review published by the University of Arizona in 2011.
So if this applies to you, go back to your GP and have your dose increased or your prescription extended for another month. Sometimes you may need to be on the drugs at a low dose long-term.
Mr Boyle says: 'Around 1.5 million people in the UK take PPIs and still have reflux symptoms. They may also have side-effects including joint pain, diarrhoea and feeling low.
'Long-te rm use has been associated with malabsorption of magnesium and calcium, gastrointestinal infections, heart disease and dementia.'
Mr Boyle adds that 'these are just associations' — no cause and effect has been proven.
It's normal to burp occasionally, but more frequent belching could be down to an underlying condition
Another option (to be taken separately or as well as a PPI) is a prescription for an H2 blocker, which stops cells in the stomach lining producing histamine, a chemical needed to make stomach acid. These include ranitidine (brand name Zantac) cimetidine (Tagamet) famotidine and nizatidine. Lower-dose versions are available from pharmacies.
You could even try these first; PPIs are generally more effective on heartburn symptoms, but some experts suggest starting with H2 blockers (along with lifestyle changes), as these reduce aci d more gently.
Each year in the UK around 5,000 to 6,000 people with GORD have surgery to repair the sphincter at the bottom of the oesophagus. Mr Boyle believes that thousands more could benefit from newer types of surgery.
It's a fact!
The loudest burp on record registered 109.9 decibels - louder than the average lawnmower or live rock music.
'In the past, one of the reasons large numbers were not referred for surgery included side-effects of the procedure called Nissen fundoplication, where part of the stomach is stitched around the oesophagus to strengthen the oesophageal valve.
'Between 10 and 20 per cent of patients are unable to burp or vomit after surgery. The effectiveness also wears off, with 30 to 40 per cent of people back on PPIs five years after the op.'
A newer type of surgery, available on the NHS, involves a keyhole procedure to insert a band of magnetic beads (LINX) around the lower part of the oesophagus to help the valve resist pressure from the stomach.
'It is usually done under general anaesthetic and takes an hour, but the recovery time is less than a week,' says Mr Boyle.
Those little rumbles - when is it a worry?
Wind
Passing wind is a normal bodily function, albeit an embarrassing one. On average, we pass wind 15 times a day; but up to 40 times a day is considered normal, according to the experts.
Flatus (gas) is a combination of swallowed air — from chewing gum, sucking sweets and eating and drinking at the same time —and gas produced by bacteria in the gut. The main gases are nitrogen, ox ygen, carbon dioxide, hydrogen and methane, which have no odour — the 'rotten egg smell' is caused by hydrogen sulphide.
Excess wind can be caused by diet products such as sugar-free chewing gum, because of the artificial sweeteners; laxatives; fruit juice and foods containing the sugar fructose; and drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) used to treat arthritis.
On average, we pass wind 15 times a day; but up to 40 times a day is considered normal, according to the experts
It can also be a symptom of bowel conditions including irritable bowel syndrome (IBS, see back page), coeliac disease and lactose intolerance.
You can experiment with your diet to cut down on some of the most wind-inducing foods.
According to St Mark's Hospital, a specialist tertiary bowel hospital in Harrow, you should avoid these foods to reduce wind production: beans, peas, lentils and other pulses, bran cereal, cabbage, cauliflower, carrots and broccoli, radishes , eggs, shellfish, milk and milk products, muesli, jacket potato skins, leeks , swedes, parsnips, onions and dried fruits.
Try these
Shreddies Flatulence Pyjamas, £83, from myshreddies.com, look like normal pyjamas but are lined with charcoal to absorb smelly gasses.
Caffeine can also increase bowel movements, possibly because of its stimulating effect on the colon muscles, and produce more wind.
'Your doctors may want to investigate whether your wind is a symptom of IBS, lactose intolerance or coeliac disease if you have other symptoms that suggest this,' says gastroenterologist Professor Ju lian Walters.
'They may also prescribe the anti-spasmodic spasmonal or colpermin [containing peppermint oil] to relieve cramps.'
Rumbling
That embarrassing rumbling, gurgling noise your stomach makes has a medical name — borborygmi. Rest assured it will sound louder to you than anyone else.
It's caused by the movement of gas, food and liquid in the intestines as the muscles propel them down through the gut — called peristalsis.
Until recently it's been considered normal and not a medical condition. But now researchers at the University of Western Australia's Marshall Centre, who invented an acoustic belt that listens to and records gut noises, have found a link between noisy rumblings and some gut diseases.
That embarrassing rumbling, gurgling noise your stomach makes has a medical name — borborygmi
'It may be a sign of incomplete digestion of food and a build-up of gas if accompanied by other symptoms such as bloating, pain and diarrhoea,' says Professor Walters. This may be a symptom of conditions such as lactose intolerance or coeliac disease.
Borborygmi doesn't generally need treatment, but if there are other symptoms such as bloating, pain and diarrhoea, see a doctor.
Tackle that itch...
Known as pruritus ani, a persistent itchy bottom is a symptom of conditions including piles, infection or eczema.
The most common causes are piles and dry skin conditions such as dermatitis, says gastroenterologist Dr Ana Wilson. Other causes include poor hygiene or washing with perfumed soap and not drying properly, eczema and psoriasis , loose faeces due to incontinence, threadworms (see tomorrow) and genital warts.
'It's important to keep the area clean and dry — use E45 cream rather than perfumed soaps and wet wipes rather than loo paper, then dry with toilet paper afterwards,' Dr Wilson advises.
Haemorrhoid creams often contain a local anaesthetic which can block the itching sensation, but try not to use for longer than seven days, as it's possible to become desensitised and itching will return.
Genital warts are caused by the human papilloma virus (HPV) and are the second most common sexually transmitted disease in the UK. They can be treated with creams, including Warticon (podophyllotoxin) and imiquimod or removed by freezing or excision (cutting them away) — all treatments a GP can prescribe.
10 things you didn't know could upset your gut
When it comes to a troublesome tummy, we can be quick to point the finger at well-known culprits such as wheat or dairy products — with some people cutting such foods out entirely.
But eliminating whole food groups from your diet is rarely what doctors advise, unless a specific allergy or auto-immune condition, such as coeliac disease, is diagnosed. And when it comes to irritable bowel syndrome-type symptoms such as bloating, abdominal pain and constipation, there are many less obvious triggers.
Here, we reveal the top gut saboteurs. Some of them may surprise you …
1. Apples
Apples are particularly high in fruit sugar
Yes, of course fruit is part of a healthy diet, but the National Institute for Health and Care Excellence (NICE) has recommended IBS patient s limit fruit to three portions a day.
Apples are a particular problem for two reasons, explains Dr Steven Mann, a consultant gastroenterologist at the Royal Free Hospital in London.
'Some people are fructose-intolerant, which means they don't digest well the sugar in fruit. Apples are particularly high in this fruit sugar.'
Apples also contain sugars known as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (collectively known as Fodmaps), which are poorly absorbed in some people's small intestine and so ferment, triggering symptoms.
A low Fodmap diet is often suggested for people with IBS (see back page). Other fruits that have a high Fodmap content are stone fruits such as apricots and prunes.
2. Mayonnaise
Hormones released in response to the high satur ated fat content in mayonnaise may lead to a delay in the emptying of the stomach and movement of food through the bowel, explains Dr Mann. This can cause uncomfortable feelings of bloating.
3. Branflakes
This is something of a paradox, since we're often told that high-fibre foods such as bran are good for the bowel.
'For those with IBS issues, such as bloating, bran can aggravate the condition,' says Dr Mann. This is because adding a bulking agent in the form of fibre gives the bowel even more work to do, which can make symptoms such as constipation worse. Kevin Whelan, professor of dietetics at Kings College, London, says the fibre story is a complex one.
'In the Eighties and Nineties we were telling IBS patients to eat more fibre, but now we know it's not as simple as that. It depends on what type of fibre it is.'
NICE recommends that people with IBS should be discouraged from eating insoluble fibre (which means it cannot be absorbed by the body), including bran.
Nice says that if more fibre in the diet is needed, it should be soluble fibre (which can be absorbed) such as oats or ispaghula powder (made from the husks of plants and contained in products such as Fybogel).
So try switching that morning bowl of bran cereal for oat-based porridge. Watch out for muesli, though, as it can contain a lot of high-Fodmap dried fruit.
4. Reheated pasta
Reheated carbohydrates, such as pasta and potatoes, contain what's known as resistant starch, which is harder for the gut to break down, says Dr Mann.
That's because once pasta is cooked and cooled, it becomes resistant to the normal enzymes in our gut that break carbohydrates — so the gut effectively has to treat it like fibre, which can worsen IBS symptoms.
Reheated pasta may be worse than cold pasta — research has shown that the starch in cold pasta becomes even more 'resistant' when heated up again.
5. Coffee
The British Dietetic Association recommends drinking no more than two mugs of caffein- ated drinks a day if you suffer from IBS.
The British Dietetic Association recommends drinking no more than two mugs of caffein- ated drinks a day if you suffer from IBS
Consultant gastroenterologist Dr Simon Smale says people with healthy gut function can probably drink more, but those with IBS should aim to keep within recommended limits. 'Obviously tea contains caffeine, too, but coffee is much stronger — especially coffee shop double espressos.
Caff eine can cause problems because it stimulates cell messengers which increase gut motility — so it loosens your bowel movements and can also lead to a feeling of fullness.'
6. Vegan diets
Going meat-free and dairy-free has become a trendy way of boosting your all-round health. But while a diet based entirely on plants might sound very virtuous, it may not be so saintly for your gut.
'Vegans are a very broad church and I would say that more of them eat healthily and probably live longer,' says Dr Smale.
'But vegans with IBS have to be careful not to eat too many beans and grains, fruit and vegetables containing Fodmaps as they can cause bloating, pain and diarrhoea.'
Offending vegetables include onions, garlic, artichokes, mushrooms and cauliflower.
7. Alcohol
'Booze can definitely be a trigger for IBS symptoms as it has an effect on gut motility,' explains Dr Smale. 'Drinking beer, for instance, may result in you having looser stools.'
And while it's obvious that fizzy alcoholic drinks such as lager and Prosecco are more likely to leave you bloated, fizz isn't the only booze factor bothering your gut.
'Spirits with high concentrations of alcohol, such as gin and vodka, can delay gastric emptying which can result in pain or bloating,' adds Dr Smale.
Booze can also trigger IBS symptoms and drinking beer may result in you having looser stools
8. Sugar-free mints
Peppermint oil capsules are a common remedy for IBS — but sugar-free mint sweets can have the opposite effect. These often contain aggravating Fodmaps such as the sweeteners sorbitol a nd mannitol, which can exacerbate IBS; the same is true of sugar-free gum.
Chewing gum can also contribute to wind and burping, as chewing it means you'll take in excess air.
9. Junk food
We all have trillions of bacteria living in our gut and the balance of the different types is an area of great interest when it comes to IBS research.
As well as 'friendly' bacteria, some types in our guts are linked with increased inflammation, according to Tim Spector, professor of genetic epidemiology at King's College London and head of the Great British Gut Project, and this could contribute to IBS.
According to Professor Spector, chemicals known as emulsifiers (which help mix ingredients together in some foods) are especially bad for this — killing off more helpful bacteria strains and allowing the unhealthy ones to flou rish. Some research has suggested a junk-food diet can halve the number of helpful bacteria in the gut in just ten days.
10. Gluten
A well-known trigger of gut problems, gluten is a protein found in wheat, barley and rye (and so is in most bread, cakes, biscuits and pasta).
It used to be thought that gluten caused problems only in people with coeliac disease, but it's more complicated than that.
'There are two types of problem,' explains Dr Smale.
'Some people will develop coeliac disease — an autoimmune disorder where the body produces antibodies to gluten and damages the gut, causing bloating and diarrhoea. This can be diagnosed via a blood test and biopsy, and symptoms subside if the patient avoids gluten.
'But there is another condition — where people have the same sympt oms but test negative for markers in the blood test and gut damage in the biopsies — called non-coeliac gluten sensitivity.
'These patients may respond to a gluten-free diet, but coeliac disease needs to be excluded first.'
How often SHOULD you go to the loo?
What's normal and what's not when it comes to bowel movements?
'Anything from several times a week to three times a day is in the normal range,' says Dr Simon Smale a consultant gastroenterologist at York Hospital NHS Trust and spokesman for the Love Your Gut campaign.
'It's also about whether the stool is easy to pass or you have to strain.'
Severe chronic constipation, less than three bowel movements a week or difficulty passing stools, affects up to two mi llion people in the UK.
For a one-off episode where you have an obvious reason for your constipation, such as a hospital stay or a long-haul flight, it's fine to take an over-the-counter remedy such as senna (a herbal laxative made from pods of the Cassia tree which stimulates the gut), he says. 'But you should not take these long-term. Constipation should be prevented by a healthy diet, drinking plenty of fluids and exercise.'
People who have IBS shouldn't use senna, as they can build up a tolerance and so need to take more and more to get the same effect.
Between 15 and 30 per cent of patients with chronic constipation have a condition called slow transit constipation where their gut doesn't move waste at the normal rate. The advice to eat more fibre may make the problem worse, says Professor Julian Walters, a consultant gastroenterologist at Imperial College Healthcare. � �Bran is a poorly tolerated source of fibre and can make pain and bloating worse in some constipated people.
'So if you find fibre makes things worse, you may need to see a gastroenterologist.'
Red flag: See your doctor if you have unexplained weight loss, a family history of colon or ovarian cancer, rectal bleeding and symptoms that wake you at night. 'I also take more notice if a person over 50 comes to see me with new gut symptoms,' says Dr Smale.
Why you need to talk about your piles...
Piles, or haemorrhoids, are often described as looking similar to a bunch of grapes — they are swollen blood vessels that can hang outside the anus or remain within.
Internal haemorrhoids usually don't cause any pain as there are no nerve fibres in this area. But if the y protrude, they can be itchy and painful and sometimes bleed or ooze mucus.
'You may notice the piles only when you strain to pass a bowel movement,' says consultant gastroenterologist Dr Ana Wilson. 'Most cases will be dealt with by GPs and only about 10 per cent of haemorrhoids need surgery.'
It's important not to be embarrassed about seeking help, says Professor Julian Walters, a consultant gastroenterologist at Imperial College, London.
Step on the gas
Sales of remedies to treat indigestion in the UK total £288 million a year
'People literally die from embarrassment because they dismiss rectal bleeding or blood in their stools as piles or are reluctant to describe their stools to their doctor. B ut we deal with these problems every day,' he says.
'It's important to get any new problems checked out, but there may also be effective treatments available for symptoms that have been persistent.'
You're prone to piles if you are overweight, spend long periods sitting down, suffer a long-term cough or extended vomiting bouts, regularly lift heavy objects or are just getting older.
Lifestyle steps to avoid constipation can help by preventing straining, advises Professor Walters.
'You should also make time for a regular bowel movement so you are not ignoring the urge to pass a stool (the stools are softer then and easier to get out), and your GP may review any drugs that may have constipating effects, such as some antacids, painkillers such as those containing codeine, as well as antidepressants and sedating antihistamines.'
The pain and itching of piles can be relieved by over-the-counter creams containing local anaesthetic and zinc oxide, such as Anusol (£6.29 for 43g), to shrink the haemorrhoid and soothe pain and itching.
Persistent piles
Sometimes piles can become ulcerated or skin tags can develop, making the area difficult to clean. In rare cases, internal haemorrhoids can become engorged and blood clots develop. 'In these cases, you will be referred to a specialist,' says Dr Wilson.
The French connection
The French may love having their drugs via suppository, but we Brits aren't quite so keen, according to consultant colorectal surgeon Amyn Haji.
'The British are very anti-suppositories,' he says. 'Some of my patients would rather have surgery . However, suppositories give effective pain relief for haemorrhoids inside the anal canal. They are a good temporary remedy until you get treatment.'
Germoloids Suppositories (£3.25 for 12) contain a local anaesthetic to numb pain and zinc oxide to soothe itching and shrink piles.
There are up to ten procedures available on the NHS, says Amyn Haji, a consultant colorectal surgeon at King's College Hospital, London and the Whiteley Clinic. These include attaching an elastic band to the haemorrhoid to cut off the blood supply and cause it to drop off. Or there's injection sclerotherapy, where pain-relieving oil is injected into the rectum lining to harden the haemorrhoid so it forms scar tissue.
'Traditional surgery where the haemorrhoid is cut out is most successful, but patients usually need two weeks off work.
'Haemorrhoid artery ligation is less painful — it uses ultrasound to locate the blood vessel supplying the haemorrhoid and stitches it to stop blood flow, but it requires a general anaesthetic and a week's recovery.'
One newer option for internal haemorrhoids is the Rafaelo procedure, where a small probe uses radio frequency heat to shrivel the pile. The procedure is painless, says Mr Haji.
The diet that could banish bloating for good
Sufferers of irritable bowel syndrome (IBS) endure a series of embarrassing gut symptoms including diarrhoea, constipation, bloating, pain in the rectum, needing to pass stools urgently and painful stomach cramps. They may also suffer loud gurgly noises and excessive wind.
'Patients will send me pictures of their bloated tummies at the end of the day — I think they worry that doctors don� �t take them seriously,' says gastroenterologist Dr Ana Wilson. 'A lot of them worry about what is going on and fear it's something serious such as cancer.'
But it is not a straightforward diagnosis.
'IBS is a number of illnesses with no specific cause and no single effective treatment,' explains Alison Reid, chief executive of the IBS Network charity.
'We know that some people develop symptoms after food poisoning (about 10 per cent), or a course of powerful antibiotics, or as a symptom of post-traumatic stress.'
Sufferers of irritable bowel syndrome (IBS) endure a series of embarrassing gut symptoms
It's important to see your GP so that tests can rule out more serious conditions.
These include blood tests for anaemia, white cell counts and C-reactive protein (a marke r for infection or inflammation).
Other tests include an antibody test for coeliac disease, faecal calproctectin (for inflammatory bowel disease) and faecal occult blood (for bowel cancer).
If these are negative, then it's likely the cause is IBS — but there are other conditions.
Gastroenterologist Professor Julian Walters estimates that up to a third of people (at least one million) told they have IBS with diarrhoea as the main symptom actually have a condition called bile acid diarrhoea. 'It can cause up to ten watery stools a day, flatulence, urgency and painful abdominal cramps,' he says.
It's caused when bile acids produced by the liver are not processed properly, so excess bile passes into the colon, stimulating salts and water secretion, and leading to watery diarrhoea.
There is a test for it — the SeH CAT test — where the retention and loss of bile acids is measured over seven days.
A patient swallows a capsule containing bile acid and a tiny amount of radioactive tracer. This allows scans taken a week apart to show how the body is processing the bile acid.
The condition can be treated with medication such as colestyramine, colestipol and colesvelam. 'But too many people are just told that they have IBS and are not offered a test', says Professor Walters. He suggests asking for a test if you have persistent, frequent watery diarrhoea.
Do probiotics really soothe IBS?
Using probiotics — 'friendly' bacteria — to treat IBS is another area of great interest, but do they really work?
A study last year by the University of Copenhagen into genome medicine concluded probiotics made no difference to the gut flora of healthy patients, prompting headlines saying probiotics didn't work after all. But does that mean they won't help IBS?
Professor Kevin Whelan says: 'Probiotics and their role in IBS is an incredibly complex area. It's true that stomach acid does kill off some of the probiotics — that's its job, to stop bacteria passing through — but even if only 1 to 10 per cent of several hundred billion survive, that is still a significant number.'
Professor Whelan says the following products may be effective for IBS:
• Alflorex, (£20 for 30 tablets, from High Street chemists).
• VSL#3, (ten sachets for £14.95, vs13.co.uk). Contains eight probiotic strains.
• Symprov: (£79 for a four-week supply, shop.symprove.com).
A 2 014 UK review of the evidence concluded that gut-directed hypnotherapy had short-term benefits for patients with IBS that had not responded to other treatments.
theibsnetwork.org
IBS-type symptoms can also be caused by small intestinal bacterial overgrowth (SIBO, see cover) and microscopic colitis, a type of severe watery diarrhoea. the latter is caused by changes in inflammatory cells in the colon visible only under a microscope: these reduce the amount of water absorbed from the stool, leading to frequent watery motions.
It can be diagnosed with biopsies taken during a colonoscopy. It can be treated with a drug called Budesonide, a type of steroid, usually for three months, but sometimes it takes a few years to settle the symptoms.
If you do have IBS, there's no one-size-fits-all treatment — it� �s a question of trying different ones until you find something that works for you.
One relatively new idea that may help is the Low Fodmap Diet. Fodmaps are fermentable oligosaccharides, disaccharides, monosaccharides and polyls — short-chained carbohydrates or types of sugar found in a wide range of foods and drinks.
They cause problems because they are poorly absorbed in the small intestine and so enter the colon, where they are fermented by bacteria, causing bloating, wind and diarrhoea.
Most people are able to tolerate Fodmaps — they will still have wind, but not pain as people in IBS have. By avoiding foods high in Fodmaps (and, in susceptible individuals, milk and dairy products as well as bread, which also contains Fodmaps), researchers have shown that diet can improve IBS symptoms in up to 73 per cent of cases.
The six Fodmaps identified as the most likely to cause problems include fructans-oligosaccharides found in wheat, rye, onions, garlic and artichokes; glacto-oligosaccherides found in legumes; lactose found in milk; fructose in honey, apples, pears, watermelon and mango; sorbitol found in apples, pears, stone fruits and sugar-free mints; and mannitol found in mushrooms, cauliflower and sugar-free mints.
Research published last month in the journal Gastroenterology by King's College London, which compared the low Fodmap diet with a normal diet, has shown it's an effective treatment for IBS.
Kevin Whelan, professor of dietetics at King's College London, and the lead researcher, says: 'A lot of the dietary advice given to IBS patients in the past about managing their symptoms through diet has been very hit and miss, and has been pretty much untested.
'Our latest research has shown that following a low Fodmap diet can resolve IBS symptoms in between 50 and 75 per cent of patients. It was particularly successful in helping to resolve flatulence, bloating and abdominal pain symptoms.
Professor Whelan said that in a follow-up study 12 months after patients tried the diet, they gradually reintroduced Fodmap foods and the majority's IBS symptoms did not return.
'We recommend people approach the diet in three stages; removing these foods from their diet, achieving resolution of symptoms and then slowly and systematically reintroducing certain foods one by one,' says Professor Whelan.
But he stresses that because it's a restrictive diet, people with IBS must get advice from a registered dietitian before starting it to ensure they will still get all the nutrients they need.
n What's Up With Your Gut?, by Jo Waters and Professor Julian Walters (Hammersmith Books, £14.99).
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Ten things you didn't know could upset your gut, why you need to talk about piles and the diet that could banish bloating: How to beat health problems no one likes to talk about
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And you can understand,' pursued the lady, 'why her observation of children who have parents who are fond of them, and proud of them - like many here, just now - should make her sorrowful in secret? Neither can we assert that reason has previously inferred this unity from the contingent nature of phenomena.
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