Go with your gut

Geraldine Fitzgerald

From wordy footnotes on your local take-away menu, to the almost mandatory pre-dinner dietary requirements question, talk of food intolerance seems to be everywhere.

Miles of aisles in supermarkets are devoted to ‘free from’ consumables, purporting to cater for real or perceived issues around gluten exclusion. Is it actually a thing?

It certainly is a thing. About 15 per cent of us now suffer from chronic gastrointestinal problems, but despite better understanding of gut health and the microbiome, there’s vast confusion about food intolerance vs food sensitivity; coeliac disease versus Irritable Bowel Syndrome (IBS), and ultimately how close you need to be to the nearest loo.

Gluten has bad press of late, as increasing numbers of people choose to exclude it from their diet to manage an array of gastrointestinal symptoms. Gluten is a general name for the proteins found in certain types of food, such as wheat, barley and rye. It’s also in other types of food, like sweets, sauces and even medicines.

Coeliac disease is an autoimmune disease. About one in every hundred people in Ireland are genetically predisposed to it, although some don’t have symptoms manifesting until adulthood.

Our small intestines have a lining of tiny finger-like projections called villi that help absorb nutrients from the food we eat. When a coeliac ingests gluten, it causes an auto immune response that attacks the villi, damaging them so badly that nutrients can’t be properly absorbed. There are a variety of serious symptoms from weight loss to infertility; anxiety to anaemia; diarrhoea to depression.

Coeliac disease must be medically diagnosed, and that’s done with a blood test. Coeliacs are, in the true sense of the phrase, intolerant to gluten.

Here’s where much of the confusion lies. People who experience issues like bloating, pain and problematic bowel habits that may flare up after eating certain foods, become concerned about being gluten intolerant, whereas they may instead have irritable bowel syndrome or IBS.

It’s increasingly common; affects more women than men and is characterised by an irritation of the digestive tract, while coeliac disease is a distinct immune reaction.

IBS used to be considered a ‘functional’ disorder- a condition with no known cause. Scientific advances and increased understanding of the brain-gut connection led to the current thinking, which is that IBS is a multifaceted problem.

The factors now thought to affect IBS include environment, food sensitivities, previous gastrointestinal infection and abnormal signalling between the gut and the brain.

It can be diagnosed, treated and managed. In many cases a low FODMAP diet is effective – FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. None the wiser?

High FODMAP foods have carbohydrates that can be poorly absorbed in the small intestine and increased water can be drawn into the gut, causing diarrhoea for some. For others, those carbohydrates make their way to the large intestine and get fermented, producing gas and causing bloating, constipation, pain and nausea.

Stress makes symptoms worse, and as people have individualised responses to foods. their diets may need to be adjusted to better manage symptoms. Most importantly, people should avoid unnecessary restrictions to make sure they get a nutritionally adequate diet and maintain the health of the microbiome.

It’s all a bit complicated. People experiencing gastrointestinal issues for more than three months should see a gastroenterologist for evaluation of symptoms, tests and referral to a trained dietician.

There are several conditions that can cause similar symptoms, including endometriosis, bowel cancer and inflammatory bowel disease so it’s best to talk to your doctor.

Going with your gut might be simple, but your actual guts are not.