The latest nutrition advice from world experts in IBS and IBD
I’m excited to share cutting-edge evidence about diet and digestive problems from GastroDiet2017, held in the slow food city of Prato.
I’m ‘recovering’ from two full-on days at international research conference GastroDiet, hosted by Monash University in Prato, Italy. I’ve been discussing diet and gastrointestinal health with academics and dieticians from around the world – Singapore to Melbourne, Oslo to London, the best of the best were in the room (and what a beautiful room it is – check out the chandelier). In 2015, the conference conversation was dominated by irritable bowel syndrome (IBS) and the low FODMAP diet. There was plenty of discussion about it this year, but the scope broadened to include inflammatory bowel syndrome (IBD) and so many other digestive topics I can’t wait to share with you. This is the stuff you won’t find on Instagram – it’s real, progressive science that is being written up and ready to publish in high-impact gastro journals. I’m going to give you the low down, and of course a few snapshots of the stunning, fresh ingredients Prato is famous for.
Diet is gaining ground in IBD. While sufferers have tried everything from the Specific Carbohydrate Diet to Paleo, there’s little evidence. The low FODMAP diet may help people with inactive ulcerative colitis manage day-to-day symptoms like bloating and wind; and there’s emerging findings about the power of curcumin, a substance in turmeric. People with Crohn’s or bowel cancer are found to have high numbers of the pathogen E. coli, but a specific kind of fibre in plantains (bananas) and broccoli may stop it from invading gut cells. Data was also presented about a sulfide-reducing diet to reduce inflammation in ulcerative colitis: prioritising pulses, oats and other slow-ferment fibres over meat and processed foods.
It’s not all about food. Exercise may improve functional digestive symptoms, and could keep IBD in remission. Evidence is still unclear, but since physical activity is also shown to reduce bowel cancer risk, why not give it a go? Yoga has positive effects too; however vigorous exercise can induce upper GI symptoms like nausea (not the ‘trots’ as once thought). The most insightful presentations were about the wider impact of digestive problems – on your relationships, work, exercise and how you feel about eating. A study funded by Crohn’s and Colitis UK showed that people with IBD sometimes completely avoid socialising and eating. Doctors are finally recognising that you’re a whole person (why did it take so long?!).
The future lies in your gut bacteria. Your individual gut microbiome might predict your response to dietary changes, but it’s early days for tests and evidence. We do know that methane-producing bacteria are associated with constipation, and may increase risk of IBD. Are foods rich in methanol (like beer, aspartame and pectin in apples) stimulating these bacteria? It’s not yet clear, but they are inflammatory and a biomarker of bacterial imbalance. And as for probiotics? The jury is still out, frustratingly. A new study shows that supplementing probiotics during the low FODMAP diet reduced wind and increased levels of beneficial bifidobacteria. I’m all for trying probiotics, along with lifestyle changes, as an adjunct or alternative – they are generally safe, and there is stronger evidence around post-infectious IBS and diahorrea.
The low FODMAP diet is still on the table, and being served in new ways. 40-60% of people with IBS are thought to have gut hypersensitivity, and histamine elevation may be a contributor. A low FODMAP diet could reduce histamine levels and painful symptoms. Another emerging implicating factor discussed at the conference is sucrose isomaltase deficiency. With similar mechanisms to lactase deficiency, common ingredients like sugar, maple syrup and maltose (found in bread for example) are malabsorbed and instead fermented in the colon, causing pain and diarrhoea. If you’re not responding to a low FODMAP diet, this is something we could consider.
Get creative with food prep and you’ll reap the rewards. Turns out we can reduce FODMAP levels in certain foods just by preparing them differently! Sprout barley and mung beans (soak, drain, wrap in a damp cloth and leave in a cool, dark place; rinse daily for 3-6 days until the sprouts emerge), pickle onions and beetroot; try canned, cooked pulses (just make sure to rinse them first); and choose fermented sourdough bread, particularly spelt. The presentations at the conference about culture and food preferences reminded us all that the low FODMAP diet doesn’t mean no FODMAPs. When I’m working with you, we’ll look at your everyday diet and lifestyle and build your meals around that. Sometimes, a few simple changes are enough to make a significant difference to your symptoms.
Here’s some of Prato’s gorgeous produce. Isn’t it sensational? It’s giant, too! One trip to the Terra di Prato organic food market made me want to eat vegetables all day long. If you want more conference highlights check out my Twitter feed as well as my food diary on Instagram from 2-4 November 2017.