Jackie Love's health took a turn for the worse in the early hours of New Year's Day. After years of fatigue, weight gain and vague digestive issues, the 45-year-old teacher suddenly found herself throwing up.
The nausea continued for months, often with debilitating abdominal pain, but it was when she began having shooting pains in her arm that she began to really worry. Concerned it might be a heart attack, Love rushed to her local doctor.
"I was in tears I was so upset," she says. "I said, 'I don't know what's happening to me … I feel like I have to be hospitalised and I don't know what to do'."
When the doctor suggested Love undergo testing for food intolerances, she just laughed.
"I didn't even associate what I had … with food. There was no concept in my mind about this being a problem with what I was actually eating."
But the doctor turned out to be right. A series of tests showed Love was not adequately absorbing certain types of sugars - including fructose and sorbitol - that are found in foods as common as apples and pears.
The pain in Love's arm, it transpired, was most likely referred pain from her bowel.
This type of food intolerance is common in people with digestive problems, particularly irritable bowel syndrome. IBS affects up to one in five Australians and its symptoms include bloating, diarrhoea and constipation.
Fortunately for Love, there was a solution. A diet developed by a Melbourne dietitian has proved highly effective at managing some of the symptoms she was experiencing.
The low-FODMAP diet was formulated by Dr Sue Shepherd and includes elements of other established diets aimed at dealing with digestive issues such as lactose intolerance. It has undergone extensive testing at Monash University over the past decade and it is now gaining recognition around the world as an effective way to manage irritable bowel syndrome.
The diet limits foods that are high in short-chain carbohydrates and sugar alcohols, such as lactose, fructans and fructose. Milk, for example, is high in lactose; mangoes have excess fructose; and onion and wheat are high in fructans. Two other groups - polyols and galacto-oligosaccharides - are found in high doses in stone fruit and legumes.
The diet helps up to three out of four sufferers to some extent and, unlike those with coeliac disease, patients don't need to cut out the offending foods completely.
"A few FODMAPs are OK," Shepherd says. "It's not like the gluten-free diet, which is about cutting out gluten completely. It's about cutting back FODMAPs until you have the level of symptoms you want."
The exact cause of this sort of intolerance is unknown, but the symptoms often develop after a gut infection and may be worsened by stress, says Monash University's Professor Peter Gibson, one of the FODMAP researchers. Key questions that remain to be answered include whether avoiding certain types of sugars, particularly those that encourage the development of good gut bacteria, can cause other types of digestive problems and why a minority of patients do not respond to the diet.
"We haven't actually got a handle on that at the moment," he says. "It's not been that easy to define who [the diet] will work for and who it won't."
A Sydney dietitian, Liz Beavis, has used the diet with her clients for the past three years.
"Depending on their symptoms, [irritable bowel syndrome] can impact on their work and social life and sleep," she says. "To have improvement on those symptoms where they can sleep without getting up and going to the toilet and know they can get through the workday without popping out to the toilets … can improve life dramatically."
The diet presents some challenges, however. "Obviously it does mean you have to prepare a lot more of your own food and you have to be aware of what you're eating," Beavis says. "That being said, if you can see improvement it's a lot easier to follow, so … there is motivation to continue."
While eating out and travelling is not easy, Love has quickly adapted to her new eating plan and now feels much better.
"It's not a cure but it definitely helps you feel normal," she says.
What are FODMAPs?
The acronym stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. They are a group of short-chain carbohydrates and sugar alcohols that are poorly absorbed in the small intestine.
Where are FODMAPs commonly found?*
- Excess fructose: honey, apples, mangoes, pears, watermelon
- Fructans: beetroot, garlic, onion, leeks, wheat
- Lactose: milk, ice-cream, custard, yoghurt, soft unripened cheeses
- Galacto-oligosaccharides: baked beans, kidney beans, lentils
- Polyols: apples, apricots, pears, plums, prunes, sorbitol
* Not an exhaustive list
(Source: Shepherd Works)