#015 Debra Thomas on The Types Of IBS And Tips to a Successful Low FODMAP Diet

Debra Thomas (BSc RD), a low FODMAP diet specialised dietitian from Wales, in the United Kingdom, talks about different types of IBS and gives useful tips to UK sufferers on how to select suitable low FODMAP products.

In this episode, you’ll learn:

  • How known is the low FODMAP diet in the UK.
  • What are the differences between IBS-D, IBS-C and IBS-M?
  • Is there a reason why some people suffer from one type of IBS rather than another one?
  • Are there more sufferers of one type of IBS, or is it an even percentage?
  • Debra’s suggestions when the low FODMAP diet does not seem to be working.
  • How long should someone stay on the low FODMAP diet?
  • Tips on how to select suitable FODMAP-friendly products in the UK.
  • How to find dietitians in the UK, who are specialised in the low FODMAP diet.


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Can’t listen to this episode right now? Read the transcript below!

LARAH: Welcome to the Low FODMAP Diet and IBS Podcast. My guest today is Debra Thomas. Debra is a registered dietitian, a nutrition consultant and advanced practitioner. She has over 16 years’ experience of advising on a range of therapeutic diets. She’s based in Wales in the UK. Debra helps IBS sufferers to find the most effective treatment for their symptoms. She is certified by King’s College London to deliver tailor-made advice on the Low FODMAP Diet, as an effective treatment for IBS. Debra is also the founder of FODMAP Consultancy and a diet coach, and offers not only one-to-one sessions in consulting rooms in location across South Wales, but also consultancy sessions via Skype. In addition to treat digestive disorders, Debra is also an expert on the treatment of malnutrition and weight management. So here we go. Debra Thomas. Hi, Deb.

DEBRA: Hello. Hi there, Larah. How are you?

LARAH: I’m very good. Thank you so much for accepting to be on my podcast.

DEBRA: Oh, that’s great. It is great to have the opportunity to kind of share the knowledge on IBS. Really thank you.

LARAH: Yeah. I love that. First of all, would you be able to tell the listeners a little bit more about yourself and how did you come across the Low FODMAP Diet?

DEBRA: Okay. Thank you. I studied to become registered dietitian and I’ve worked in the NHS here in the UK, since 1999 in various roles including setting up a cardiac rehab dietetic service and more recently, working as part of the medicine’s management team. My areas of specialism are weight management, but more emphasis on weight gain and IBS as you’ve already said. I’ve always had an interest in IBS and has known many friends who’ve suffered and have many patients referred to me for advice. Before being trained though, I found it was difficult to deliver just basic advice, quite frustrating to just be able to advice on regular eating and adjusting fibre content of the diet, etc. Although these points are really important in managing IBS, there’s such a plethora of research now into the Low FODMAP Diet, which has resulted in NICE, recommending it as an effective treatment for IBS. So those who are not aware of what NICE is here in the UK, NICE stands for the National Institute for Health and Care Excellence. It’s a body that was set up to improve health and social care through evidence-based guidance. King’s College London are the main base trainers for dietitians in the UK for the Low FODMAP Diet and I trained with them in 2014-15. I’ve recently commenced the private practice as you mentioned and specialised in IBS based here in Cardiff, South Wales in the UK.

LARAH: All right! Well, thank you so much that, Deb. You are specialised in exactly what I’ve been needing for the past few years, because I used to be quite a bit overweight and as you are specialised in weight gain and IBS, I would have really liked your input. But then–but now, I already lost 17 kilos so I’m on the right track.

DEBRA: Oh, well done. People do tend to think that, you know, the Low FODMAP Diet is a diet which is going to help them lose weight. And although some of my patients have actually lost weight initially, I think it’s more because they’re actually looking at what they’re eating, rather than the types of foods they’re eating. And I do find after a few weeks of following the Low FODMAP Diet, the weight they initially lost is then regained, but that’s not really what the Low FODMAP Diet is about. It’s about managing IBS rather than weight loss, because there are plenty of dietary regime out there, for weight loss.

LARAH: Yeah, you’re so correct. That’s exactly what happened to me. At the beginning, because I was scared about what I could and couldn’t eat, plus I went to Italy as soon as I was diagnosed with IBS and I was told to follow Low FODMAP Diet and I was given the first instructions, while I was going to Italy for five months to get my daughters to learn Italian. So I got there and all I had, was pretty much what the dietitian gave me, a list of food I could and couldn’t have and then she told me to download the Low FODMAP app from Monash University. So that’s what I had. So to be safe, I would just stick to very basic food. Some meat, little bit of vegetables I could have, sometimes a little bit of fruit, pretty much like in Italy everyone obviously eats pasta, which is the normal pasta, not the gluten-free. So I didn’t have much of that either. So I lost weight which I was quite happy, but then I learned how to make all nice, yummy, Low FODMAP food and low FODMAP treats and cakes, so I put on the weight I lost and more. And then maybe due to my age, due to stressful situations, I just kept on gaining weight more and more and more.

DEBRA: Yes, that’s what I find with my patients really, is that I give them the advice to follow the diet and initially they stick to it rigidly. What happens then is they become a little bit more adventurous and start looking for recipes and then of course the weight tends to go back on again.

LARAH: Yes, very true. As you are from Wales, in the United Kingdom, I’m wondering if the Low FODMAP is quite well-known in the UK, as a treatment for IBS symptoms.

DEBRA: Well, it’s very frustrating actually because it’s not really very well-known and it tends to vary quite widely across the UK. If you look at the King’s College website of trained dietitians, you can see that there are many dietitians around the London area, due to the proximity of the King’s College, then I guess the general public around that region in the UK have better access to FODMAP-trained dietitians. So of course, awareness is raised but in other places, it’s much less well known. In my experience here locally, there’s only a few enlighten GPs, who may have heard about the Low FODMAP Diet and then usually, unfortunately just direct the patients to the internet for advice. As we know, not all the information found on the internet can be relied upon. There’s also a danger, I find, that patients become overwhelmed by the intricacies, if I might phrase it like that, of the Low FODMAP Diet, and either not attempting it then, or just floundering due to the lack of support. This is why the NICE recommendations go on to state that the Low FODMAP Diet is an effective treatment for IBS, as long as it’s delivered by a trained healthcare professional.

LARAH: Thank you, Deb. A great recommendation and I really think that with time, there will be more and more dietitians who will be trained on the Low FODMAP Diet in the world and even in more rural or remote places and not just in the cities. So it might take a while, but eventually, it will become more known and more popular, I would say.

DEBRA: Yes, I think so too. If you look at the King’s College website of the dietitians they’ve trained, they’re quite a large number around the London area and other places across the UK. Many, many travel from other countries even as far away as Singapore to attend the course.

LARAH: Yes, that’s incredible because apart from the Monash University in Australia, the next best place is probably London, so that’s great.

DEBRA: Yes, the King’s College. They actually trained a hundred dietitians at a time. It’s a huge room filled with dietitians.

LARAH: That explains the need that there is for dietitians really.

DEBRA: Yes, definitely. Actually a lot of my private patients are seeking out dietitians, who are trained in the Low FODMAP Diet. And it’s amazing that quite a few of them have actually found their way to the King’s College London website, where all dietitians who’ve attended the course, who obviously gave the permission to have their name on the list, are listed and patients can look for an NHS dietitian across their locality that they live or they can find a private dietitian. Also another good starting point is looking at the freelance dietitians’ website. So what a lot patients would look for, is a freelance dietitian. If they put up into a search engine, it will come up with the British Dietetics Associations, freelance dietitians’ website, which is always a good starting point because you’re having professional advice then that can be relied upon. Of course, all dietitians listed on the freelance dietitians’ website will be registered with the Healthcare Professionals Council, but won’t necessarily be FODMAP trained, but I’m sure they’ll mention that in their information.

LARAH: Thank you so much, Deb. And I will post that link on the show-notes for all the listeners. So any listener in this in the UK would be able to easily find that link to all the dietitians available, through the NHS you said?

DEBRA: Yes. NHS on private dietitians listed on the freelance dietitians’ website.

LARAH: That’s perfect. Thank you. So now there is something that I’ll be interested to find out. And I think it would be really interesting, understanding the differences between the different types of Irritable Bowel Syndrome that people could suffer from. So we hear about IBS-D, IBS-C, IBS-A or IBS-M, one is alternate and one is mixed, I think. Would you be able to explain then to the listeners about this different types of Irritable Bowel Syndrome that people could suffer from, please?

DEBRA: Okay. Thanks, Larah. Well, most people who suffer with IBS tend to have the typical symptoms of bloating, wind, pain and discomfort. But with regards to bowel movements then, they tend to fall into three main groups as you’ve mentioned. There are those with predominantly either diarrhoea, the IBS-D, or constipation, IBS-C, and those who have a little bit of both. And in UK, we refer to that as IBS mixed. In my clinical experience, roughly equal numbers of my patients have mixed in the diarrhoea-type of symptoms, while less have constipation-type symptoms. However, all of these symptoms are difficult to manage and it can be quite debilitating. Sometimes the symptoms can be explained by diet, and irregular meal patterns, lack of fibre in the diet or maybe too much caffeine or fizzy drinks or even medication. For some people, they often take laxatives for constipation which of course, then result them having loose stools and have them running to the nearest bathroom.

So for some people, simple dietary advice will suffice, but for others the problems are more complex and would need to have advice to follow the elimination diet which, of course, is the low FODMAP diet.

LARAH: So, yes. And I also understand the elimination phase of the diet is very, very crucial to determine which are the food that we should avoid individually so that’s really good what you just said. Now, would you know if there has been any research done regarding the percentage of people suffering from one type of IBS-Compared to another type? Or do you think or do you know if they’re all pretty even? So for example, are there more people suffering from IBS-D than IBS-C or is the amount pretty much the same?

DEBRA: Well, stats for IBS in the UK show that prevalence is around about 15% to 20%. I think this is very much in the reporting though because not everybody seeks help. But research to find the prevalence of one type over another, seems to be difficult to find actually, especially in the UK. So I can only kind of offer you some anecdotal evidence really. The patients I’ve seen in my clinic, show higher percentages of IBS-D and IBS-M, roughly around about 42% and 41% respectively. The patients suffering from IBS-C tend to be much lower round about 16%, that’s only in the patients that I actually see in my clinics. Whether the data is directly replicated across the UK would be sort of speculation really, but I’m guessing that it would depend on very much on dietary habits in a particular region and maybe socio-economic groups.

LARAH: That’s interesting to know and if I ever come across any study that talks about these, I will definitely put the link in the show-notes for this episode.

DEBRA: Yeah, that would be great because it would be good to know what the research shows really.

LARAH: For sure, it would be very interesting to know if there are more studies done about it, yeah.

DEBRA: Yeah. Thank you.

LARAH: Do you know or why do you think there are some people that suffer from IBS-D and other suffer from IBS-C? And what does that depend on?

DEBRA: A bit of background that is quite interesting really, so for those who suffer from IBS often experience abnormal and uncoordinated bowel contractions. When it is too fast, they result in diarrhoea, and when it’s too weak or too slow, then often the outcome is constipation. There’s also an osmotic effect that increases and decreases the amount of water retained in the large bowel. So if too much water is lost, stools become hard and large and pellet like and difficult to pass. If too much is retained, then it obviously ends up in loose watery stools with the characteristics of diarrhoea. Diarrhoea can occur on its own, but many people have this alongside bouts of constipation. When you add to this mix, the effect of the billions of bacteria that live in the gut, fermenting the FODMAPs, as they come through and causing the additional symptoms of bloating and wind, and you have the recipe for IBS then.

LARAH: So that makes sense although in my case, I think I consume quite a lot of fibres in my diet and especially in the form of vegetables that I can tolerate. Again, I’m not sure what is the right quantity of fibre I should have and maybe I should have a little bit more fibres.

DEBRA: Yes. Yeah. Well, it’s interesting that a recommendation for fibre for adults in the UK is 18 grams per day. And research shows that for many, that’s very difficult to achieve. I was reading a paper recently that said that they are thinking to increase that to 30 grams per day so if people are not achieving 18 grams, it’s very difficult to even think about how they can achieve 30 grams per day. Of course, another consideration is that we try to remedy the problem by either taking laxatives for the treatment of constipation or for the treatment of diarrhea, anti-diarrheal remedies. So often, for example, a large part stool is passed followed by a looser watery stools so people find they live with alternating constipation and diarrhea. In trying the Low FODMAP Diet, IBS sufferers will be affecting the balance of their gut bacteria, by changes they’ll be making to their diet. This will affect the fermentation process and the osmotic balance resulting in improvements and symptoms for many. This can, on occasions, results in a patient whose original symptoms were IBS-D ending with IBS-C. If this were the case, I might advise then to address their fluid and fibre contents of their diet and try eating more high fibre foods, but of course this would need to be Low FODMAP as well, so maybe Low FODMAP fruits and vegetables. Raspberries are good source of fibre, as is spinach and quite often I direct people to be having things like soluble fibre source of porridge with suitable milled linseed mix. That would be an excellent start of the day and should help with constipation by providing the extra soluble fibre.

LARAH: Thank you, Deb. And I often read that women for some reason seem to be suffering from IBS more than men like this is a percentage. Is this true and what do you think if yes, why do you think this is the case?

DEBRA: In my own experience about 70% of my patients are women and anecdotal evidence for health issues in general suggest that women are a bit more open to speaking about things and maybe therefore more likely to seek help. But as of men, I’ve seen it’s interesting their symptoms don’t really differ that much in the way from their sort of female counterpart, but often when men attend my clinic they either bring a partner or spouse with them or often mention their wife has being nagging them or partner has been nagging them to attend the consultation anyway to seek some help.

LARAH: Yes, it makes sense. I really wonder if the percentage of men suffering from IBS is lower just because men tend not to speak about their conditions with doctors, you know, as much as women do.

DEBRA: I don’t think men speak about issues with other men either, from my experience.

LARAH: That’s very true. I know. We are lucky that at least we can talk even if not with the doctor, we can talk with our friends, with our girlfriends, you know, we can talk about things and get opinions. We are not on our own.

DEBRA: Oh, definitely. It really helps just to share problems and share solutions then, isn’t it?

LARAH: Yes, yeah. That’s true. So what are the main symptoms that your patients who suffer from digestive problems complain about when they first come to see you, obviously they might not all know that they have IBS or maybe they do but which one of them most complaint symptoms?

DEBRA: Well, the research shows that around 96% of IBS sufferers complain of bloating. And from my experience in my clinics, this is very much borne out. Almost all complaints of bloating, most have winds too in both directions, most but not everyone will also have pain and discomfort associated with the bloating on the whole, but almost all will also have the accompanying symptoms of either diarrhea or constipation or the mixed, as we mentioned earlier. Interestingly, when people have complicated the first phase of the Low FODMAP diet, the elimination phase, they’re ready to begin the food challenges but they often comment on other symptoms that have just disappeared, that they haven’t originally associated with their IBS. I mean, they comment on how these have improved as well. So such things as migraine and skin rashes and even insomnia.

LARAH: And that’s amazing. It’s so good that after completing an elimination phase, there are also other issues and symptoms apart from IBS symptoms that they actually improve. It’s a real good thing.

DEBRA: Yes. It’s great to see having a more holistic approach, I suppose.

LARAH: Yes. Oh, that’s good. And talking about your experience with your patients again, do your patients usually already know that they suffer from IBS, when they come to see you?

DEBRA: Well, most of my patients are either referred by their GPs especially in my NHS work. Obviously they’re referred to me, but other patients then are self-referred to me in my private practice. But they usually come along with a diagnosis in my experience. Referral from a GP is very much kind of hit and miss across the country, as we mentioned earlier. This largely depends on the GPs being away, having good working relationships and good respect for dietitians and of course having access to a dietitian who’s FODMAP trained. Patients have often been to a barrage of tests, often an invasive test before actually getting to me to have some advice on the Low FODMAP diet. These investigations would be something like colonoscopy and endoscopies, not something that you’d really choose to go through. Often they’ve suffered for years and in some instances, my patients report having had a lifelong, and then the others complained that they were a whingy baby, that type of thing. But some people have actually had it for decades before it finally reaches a bit of a crisis for it. And then they resolve to do something about it. It seems that from my experience that people just want to take back some control in their lives rather than their symptoms controlling them.

LARAH: Yeah, that sounds about right. That was probably the same for me. There was only so much I could wait for the symptoms to go away by themselves and before realising I really had to investigate those symptoms further and even then it still took a couple of years to get a proper diagnosis, after I actually started to investigate the symptoms. Would you suggest someone to follow a Low FODMAP diet if he or she has not been already diagnosed with IBS by their doctor, but their symptoms sound a lot like IBS?

DEBRA: When a patient is referred to me or is self-referred, I always undertake basic questions and answers in nutritional assessment. Obviously asking them about their IBS symptoms, any previous medical history and of course, a detail of their diet history. It’s very important to eliminate any red flags symptoms such as Inflammatory Bowel Disease, any kinds of bowel or ovarian cancer, especially if there’s a family history of these conditions. Another one that should be eliminated first would be Coeliac disease. So I therefore suggest that they discuss their condition and any possible interventions with their GP first, especially if they have any other risk factors, that would be really important.

Tests that might be done would include a blood test, to check for any infection, a full blood count maybe and of course, the test to exclude Coeliac disease.

Coeliac disease thought to have a prevalence of about 1%. Currently, only about 0.2% are being identified in the GP practices in my locality. The symptoms of Coeliac disease are often similar and are often mistaken for IBS, so before advising on a Low FODMAP Diet, I always recommend to my patients that they have an anti-TTG antibodies test (TTG tests for antibodies for tissue transglutaminase), which is a good marker for Coeliac disease. With red flags excluded then, it’s a good starting point for the patients to consider first their diet in general, and then if necessary, starting to follow a Low FODMAP Diet, in an effort to manage their symptoms.

LARAH: Yes. So it is really important to see your doctor or specialist first to exclude other issues and then if suitable, of course, specialised dietitian to get guidance with the diet.

DEBRA: Yes, definitely. It’s really important to do that.

LARAH: So next, have you ever had any patients, who have not responded successfully to the FODMAP elimination phase and if you had in that case, what else would you have recommended them to try to improve their symptoms?

DEBRA: Well, this is a difficult one. And I always see during my initial consultation with patients give the patients the facts. I think it’s important for them to realise that not everybody responds to the Low FODMAP Diet. So the research shows there are around 75% of IBS sufferers will respond and have a reduction in their symptoms. But of course, this obviously implies that there is 25% who might not respond in the same way. This can be for a variety of reasons and I found that some choose not to follow the diet, after their initial appointment or some are not able to and also cost could be a contributing factor as well. I’ve had some patients though who follow the diet to the absolute letter, but have not shown any measurable improvement and I feel so sorry for these patients having put so much effort in. But for these, I might give it additional advice, for example, to try dairy-free for short period, but unfortunately 80% the Low FODMAP is not going to be the answer. So I advised them to seek alternative treatments. For example, they could try probiotics and hypnotherapy, who has shown benefits for some people and relaxation techniques perhaps something like meditation or yoga might help some sufferers, but it’s unfortunate that it doesn’t work for everyone.

LARAH: Right, hypnotherapy. I am really interested in hearing how hypnotherapy can help IBS symptoms. In fact, I have personally used hypnotherapy before, for like panic attacks and that really helped me a lot with the panic attacks. So I’m just putting out there, if there is a hypnotherapist out there who is specialised in helping IBS sufferers and would like to be on my podcast, please contact me. I’ll be delighted to have you in my podcast and hear about how hypnotherapy can help IBS sufferers. That would be great.

DEBRA: Can I suggest something?

LARAH: Yes, sure.

DEBRA: What I find Larah is that a lot of people are into the misapprehension, a lot of health professionals actually, that the symptoms of IBS are actually all down to stress. But in my experience, I’ve seen over 160 people now in my clinics both in the NHS and privately. What I find is probably just a small handful of people are very stressed and intense and you think, “Well, yes, maybe this is the major contributor to their IBS symptoms.” But for others, it seems to be that the stress is caused by the IBS.

LARAH: So it’s not one causing the other one. It’s the IBS causing the stress.

DEBRA: Yeah, possibly.

LARAH: Yeah, interesting isn’t it? All right. And another question I have for you is: how long should people stay on the low FODMAP diet?

DEBRA: Okay. I think it’s probably timely and an important point to mention is that just to remind your listeners that the Low FODMAP diet isn’t a diet for life. It’s just a means of helping them to identify their trigger foods and therefore manage their symptoms. This is a fact that most people embarking on the diet don’t realise. When someone has identified their trigger food, they may need to determine how much of this food actually causes their symptoms. So having this information put them back in the driving seat. They can make decisions then about choosing the food to eat or not to eat, if it’s one of their trigger foods. But there might be occasions actually when they choose to eat the trigger food in the knowledge that they’ll just manage the symptoms over the next few days. But the Low FODMAP Diet gives them the confidence that once they eliminate that food once again, they’ll go back to their symptomatic relief.

LARAH: Thank you, Deb. So for our listeners in the UK, who are following a Low FODMAP Diet, would you have any tips on how to select suitable FODMAP-friendly products like bread or cereals, sausage, yogurt and that kind of stuff?

DEBRA: It’s quite interesting, Larah that the Low FODMAP Diet is not well-known across the UK as in other countries. We’ve had quite a movement in the last few years towards free-from foods. It’s interesting that people see these free-from foods as being healthier and many people turn to gluten-free foods even though they don’t have Coeliac disease diagnosed. For this reason, the major supermarkets have latch onto this and most now boast a whole aisle of free-from specialities. Although I don’t feel this is a good move ideally for the general population, it is good news for those people who have real dietary concerns. It can still be difficult for IBS sufferers to steer through these options though, as many wheat free products still contain onion and garlic for example. In terms of bread and bread products, flour, biscuits, crackers, etcetera, most supermarkets stock well-known brands. But they also stock their own brands too, so it makes them quite good variety for the consumer. I do find I need to stress with my patients that they need to be following the wheat-free diet, not just a gluten-free diet because it isn’t the same. Some people have difficulty getting their heads around this because obviously I try to explain to them that the gluten part of the grain is the protein, whereas the wheat part is actually the fibre and it’s not the same thing after all.

In terms of staple foods though such as bread and milk, there are many different varieties of them now here in the UK. Many cereals unfortunately are wheat-based so there’s limited variety there, but corn and rice-based cereals will such as cornflakes and rice krispies can be useful as part of a Low FODMAP Diet. I do try and steer my patients towards porridge though, another oat based cereal, because they’re quite good alternatives.

For some reasons, those sources and ready meals have had a steep rise in popularity over recent years here and unfortunately, of course many contain onions and garlic and are not suitable. These rising ready meals and fast food seems to correlate with the declining teaching of basic cooking skills unfortunately, so many younger people are not familiar with cooking from basic ingredients. So this just adds to the burden of dietary change.

low fodmap Golden Polenta Cake recipe

Debra Thomas – Golden Polenta Cake

LARAH: Thank you so much for those tips, Deb. And in terms of the oats for porridge, some people complain that oats for some reason give them symptoms even though oats are Low FODMAP. So they replace it with other things like Quinoa flakes. So that could be also an alternative.

DEBRA: Yes, that would be good. I think the problem with porridge oats is often– not always, but often they mix with milk powder to help them flow more freely. And of course then a lot of people make them with water and that’s because they’re just hydrating the milk powder in the cereal, so that could be a cause of some people symptoms when they’re eating porridge.

LARAH: Okay. Yes, when you buy the pre-packaged porridge and not just the rolled oats by itself let’s say.


LARAH: Good to know. Like for me when I first started the Low FODMAP diet, I was really worried about what I could or couldn’t eat. So I stuck to really basic raw ingredients and it was kind of like a change in my life because again I was used to eat out many times per week but then, you know, with time I have adjusted much better and I feel much better now just having basic ingredients and just cooking from raw ingredients, rather than opening packages of food or opening sauces from a jar. I just make more things from scratch which is healthier.

DEBRA: Well, hopefully when people start cooking from raw ingredients, they actually find that the food tastes nicer, they know exactly what’s going in it and hopefully they find that it’s easier in a way to actually cooking from basic ingredients.

LARAH: I think eventually when you get in a sort of a routine and you know what you’re doing, yes, it’s definitely not bad at all. I think you might need some adjusting, especially if people haven’t been used to cooking before, so it’s a little bit of change of lifestyle.

DEBRA: Yes. What I find as well is that it needs to be practical because so many people are busy, have busy lives and children to collect from school and meals to prepare, work, etcetera but it needs to be practical. So it needs to kind of focus on how you could make changes to your diet, but it needs to be practical too. I often recommend that families perhaps share a Low FODMAP evening meal for example or you could just have the highest FODMAP ingredients at a later point in the cooking process.

LARAH: Well, that’s what I do with my family as well. Most of the time I will cook meals that are low FODMAP for the evening, because anyway they’re having their breakfast that is high FODMAP, whatever they want or their lunch. I can’t be bothered of cooking two different meals all the time, so most of the time, it will be a low FODMAP meal which sometimes is just as simple as don’t  use onion and garlic and use the garlic and onion infused oils or if I make pasta here and there, it will be a gluten-free pasta even though it cost a little bit more, it just saves on electricity and time of having to cook two different pastas. So what about if people are eating out and following a low FODMAP diet, would you have any tips for that at all?

DEBRA: Eating out can be a tricky business. I often advise my patients to eat plainly, so for example a jack of potato, it’s a half a portion of salmon, or white fish but no sauces, no batters, no breadcrumbs. So it can be tricky, but it can be done. Another point I often advise patients is to perhaps contact the restaurants ahead of time to see if they can help with their dietary needs. So, for example, providing a wheat-free gravy or maybe suitable vegetables. If you don’t ask, actually you don’t get. So I often try to encourage my patients to do this so to raise awareness and create a demand.

LARAH: Yeah. Thank you. Thank you for those tips. I have places now that I know I can go and safely eat but yeah, it’s pretty basic food, but nevertheless it’s still good to be able to socialise sometimes and go out.

DEBRA: Eating is such a social thing so we need to be able to continue to do that, but just have an eye on the FODMAP content of food.

LARAH: Yes. And I can’t wait for the day in which not only we’ll have a gluten-free food offered here, but be a low FODMAP food offered here.

DEBRA: Yes. You know, on all UK menues now you should find allergen information due to recent legislation here in the UK. Yes, it would be great to see FODMAPs too.

LARAH: Yes. One day it will happen. I’m pretty sure that will. Thank you so much for all the information you shared with us. As a last question, Deb, how can people find you and contact you?

DEBRA: Okay. Well, as you mentioned earlier, I’m based in Cardiff, in South Wales, in the UK. And I do have consulting rings across the area. But starting point would be my website at www.fodmapconsultancy.com. I’m also on Twitter and my handle is @FODMAPCardiff, and I also got a Facebook page FODMAP Consultancy. And also I do offer a free initial consultation to patients just to help us both decide, the patients and myself, whether the low FODMAP diet is going to help them. So welcome any enquiries. This of course would be followed up by a full consultation.

LARAH: Thank you Deb, and all that will be put on the show-notes, so if you haven’t been able to write it down, just go on the website and just click on the link and that would be the easiest way.

So again, Deb, I thank you so very much for all the information you have shared with us and I really appreciate you being here on the podcast and for your time and I really hope that all the listeners in the UK have also got some more resources now that can help them with their IBS issues and they would be able to find the right specialist for them. So again, all the links will be posted on my website.

DEBRA: Thanks, Larah for giving me the opportunity to raise awareness and give help to people for the treatment of their IBS and that the low FODMAP diet might help them.

LARAH: Yeah, that’s good. Thank you again, Deb.

DEBRA: Oh, that’s great. Welcome, Larah.

Link to Debra’s Website:
Other sites, where Debra is involved:
Links to Debra’s Social Media:


About Larah

I have been suffering from Irritable Bowel Syndrome for many years, but it took a longtime to get a diagnosis, since then I have been following a low FODMAP diet, which has changed my life for the better. This is my story and experience with IBS and the low FODMAP diet.