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Irritable Bowel Syndrome - Coggle Diagram
Irritable Bowel Syndrome
IBS
Characterised by chronic or recurrent symptoms, lower abdominal pain, related to bowel movements & some relief of pain after defecation
Non life threatening, does not damage GI lining or cause cancer however, significant impact of QoL
Aetiology unknown - triggers include
Infection
Food intolerance
General diet
Emotional stress
Medication
Diagnosis
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Symptoms
Change in bowel habit
Constipation - IBS C
Alternating - IBS M
Diarrhoea - IBS-D
Unspecified - IBS-U
Sense of incomplete rectal evacuation
Passage of mucous with stool
Abdo bloating/distention
Management - First Line
Limit
Spicy foods
Fatty and rich foods
Caffeine
Eating smaller meals
Alcohol
Check for
Fluid
General healthy eating & regular exercise
Fibre intake
Other considerations
Probiotics
Peppermint oil
Exercise
Medication
Gut directed psychotherapy
Management - Second Line
Low FODMAP diet
Disaccharides
Lactose: milk, yogurt, ice cream, pudding & custard
Monosaccharides
Fructose: honey, agave, watermelon, apples, asparagus & sugar snap peas
Oligosaccharides
Galactans: beans, lentils & chickpeas
Polyols
Sorbitol/mannitol: sugar-free gum, blackberries, apples, pears, peaches, cauliflower, mushrooms & snow peas
Fermentable
Fructans: wheat, rye, garlic, artichokes, inulin & oligosaccharides (fibre)
FODMAPs: short-chain fermentable CHO that are poorly absorbed and cause digestive discomfort in people, found in a variety of food groups
FODMAP restriction,
introduction/personalisation
Reintroduction - 6-10wks
1 FODMAP at a time, 1 food at a time, small amounts over 3 days, BDA, 2016
FODMAP personalisation
Restriction - 4-8wks
High & Low FODMAP Foods
Protein
High - most legumes/pulses, some marinated meats/poultry/seafood, some processed meats
Low - eggs, firm tofu, plain cooked meats/poultry/seafood, tempeh
Breads & Cereals
High - wheat/rye/barely based breads, breakfast cereals, biscuits and snack products
Low - corn flakes, oats, quinoa, quinoa/rice/corn pasta, rice cakes (plain), sourdough spelt bread, wheat/rye/barely free breads
Diary & alt
High - cow's milk, custard, evaporated milk, ice cream, soy milk (made from whole soybeans), sweetened condensed milk, yoghurt
Low - almond milk, brie/camembert, feta, hard cheeses, lactose-free milk, soy milk (made from soy protein)
Sugars & confectionary
High - high fructose corn syrup, honey, sugar-free confectionary
Low - dark chocolate, maple syrup, rice malt
Fruits
High - apples, apple juice, cherries, dried fruit, mango, nectarines, peaches, pears, plums, watermelon
Low - cantaloupe, grapes, kiwi fruit (green), mandarin, orange, pineapple, strawberries
Nuts & seeds
High - cashews, pistachios
Low - macadamias, peanuts, pumpkin seeds
Vegetables
High - artichoke, asparagus, cauliflower, garlic, green peas, mushrooms, onion, sugar snap peas
Low - eggplant, bean(green), bok choy, capsicum, carrot, cucumber, lettuce, potato, tomato, zucchini
Possible P's
Altered GI function related to
suboptimal dietary patterns
suspected food intolerances
Guidelines
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British Dietetic Association (BDA), 2016
Alcohol - asses intake and screen for binge drinking
Spicy Food - if related to symptoms, assess and trial restriction
Fat - if symptoms during or after eating, assess and ensure intake is aligned
Milk and Dairy - restrict in individuals with IBS where sensitivity to milk is suspected OR appropriate trial period of low lactose diet is recommended
FODMAPs - consider low FODMAP diet to improve symptoms for a minimum of 3 to 4 weeks, if no symptom improvement occurs within 4 weeks of strict adherence, then intervention stopped and consider other options
Probiotics - are unlikely to provide substantial benefit