Health - An apple a day doesn'talways keep the doctor away

Jackie Love's health tooka turn for the worse in the early hours of
New Year's Day. After years of fatigue, weight gain andvague 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 feellike I have to be hospitalised and I
don't know what to do'."
When the doctor suggested Love undergotesting 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, ittranspired, was most likely referred pain
fromher bowel.
This type of food intolerance is common in people with digestive
problems, particularly irritable bowel syndrome. IBS affects up to one
in five Australiansand 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
thesymptoms 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 thatare high in short-chain carbohydrates and
sugaralcohols, such as lactose, fructans and fructose. Milk, for
example, is highin lactose; mangoes haveexcess 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
theoffending 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 tobe 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 theycan get through the workday without popping
out to the toilets … can improve lifedramatically."
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'sa 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 sugaralcohols 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