I’ve been trying the FODMAP diet approach to dealing with this gut problem. It does after all have the benefit of being something I can do truly locally.

Key article:
Barrett Jacqueline S. and Gibson Peter R.: Clinical Ramifications of Malabsorption of Fructose and Other Short-chain Carbohydrates. In [i]Practical Gastroenterology[i] August 2007 pp51-65.[/i][/i]

The FODMAP diet is an approach to targeting functional gut disorders (FGD) by largely eliminating fructose and other poorly absorbed short-chain carbohydrates (Fermentable Oligo- Di- and Mono-saccharides And Polyols = FODMAPs) in the diet. These are fructans lactose (in hypolactasic individuals) polyols and galactans.

FODMAPs are theoretically attractive targets for dietary intervention due to their high osmotic activity and rapid fermentability leading to luminal distension and the potential for subsequent symptom induction in those with less adaptable bowels and/or visceral hypersensitivity.

OK – big long words but reading the article what I have understood it to mean is that FODMAPs are generally poorly absorbed in the small intenstine. They get through to the large intestine and start to ferment rapidly (alcohol and gas). The gut bacteria love it and gorge exploding in numbers. The gut distends and becomes viscerally hypersensitive leading to pain and bloating and symptoms typical of irritable bowel syndrome (IBS) Crohn’s disease and ulcerative colitis.

The key foods to reduce in a FODMAP diet are either very high in FODMAPs or the excess of fructose over glucose is high (equimolar concentrations of glucose can assist efficient fructose absorption to reduce problems). However even where glucose is high enough to balance the fructose don’t overdo the total load.

Small amounts of FODMAPs will not be nearly as much of a problem as bigger amounts. 25g of fructose is a problem for 53% of people 50g for 73% of people. So the aim is to keep it well below 25g.

The idea is to identify foods regularly in our own diet. It is about reducing total load right down not eliminating every spec of FODMAP food.

Here is the list I’ve got:
Fruit: pear figs (also high glucose so is balanced) apple mango lychee (also high glucose so is balanced) nashi star fruit peach mandarin pawpaw watermelon honeydew melon guava star fruit quince papaya apricots cherries plums nectarines grapes persimmon

Dried fruit

Fruit juice canned packing juice orange juice(restrict quantity to 1/3 glass – it has quite a lot of glucose but is not fully balanced)

Dried fruit bars

Fruit pastes and sauces: tomato paste chutney relish plum sauce sweet and sour sauce barbecue sauce (no doubt sweet chilli sauce)

Fruit juice concentrate

Fructose as an added sweetener

High fructose corn syrup or corn syrup solids including: Fruit drinks carbonated drinks pancake syrups catsup jams jellies pickle relish etc. and/or liquid cough remedies and liquid pain relievers etc

Honey

Coconut: milk cream

Fortified wines: sherry port etc

Vegetables: onion leek asparagus artichokes cabbage Brussel sprouts beans

Legumes: baked beans kidney beans lentils black eye peas chickpeas butter beans (no doubt lima beans which I love!)

Wheat or white bread

Wheat pasta noodles

Wheat-based breakfast cereals

Wheat-based cakes cookies crackers

Chicory-based coffee-substitute beverages

Artificial sweeteners: sorbitol mannitol isomalt xylitol

If lactose malabsorption: milk ice-cream yoghurt. (butter & harder cheeses and lactose free cow’s milk ok)

After about a week I’d have to say this hasn’t been a hard diet to be on. I don’t know if I have lactose malabsorption but I bought some lactose free cow’s milk. Have slipped up sometimes but it doesn’t feel desperate. Have eaten mainly bananas as fruit. Gone back to oatmeal porridge & rice.

My gut has been a lot less bloated – it is visibly deflating and softening to press. Much less tender although I did have one bout of pain on bottom left side last night which a trip to the loo ‘fixed’. (Was it the 4! biscuits including some date pillows I ate at lunchtime? – I won’t explain the story of how this happened!) I will definitely continue with this diet. It makes me feel optimistic. I suspect my mood is improving with a reduction in deep internal gut pain. I’m not saying this is a cure but it will change my diet for the long run given how effective it is being and how simple it is to follow so far.