Dr. Glenda Bishop is a Registered Nutritionist, Wellness Coach, Neuroscientist and Educator, who helps people with Irritable Bowel Syndrome to live ‘A Less Irritable Life’.
In this episode, you’ll learn:
- Who is Glenda Bishop and how did she come across the low FODMAP diet?
- What is Glenda’s Four Step Snack Builder?
- What are some great low FODMAP treats you can have for snacks?
- What things can trigger IBS apart from FODMAPs?
- Should alcohol be avoided, if you’re suffering from IBS?
- Can alcohol be used in cooking if you have IBS?
- Are carbonated beverages an IBS triggers?
- Should coffee be avoided even though it is not high FODMAP?
- Why should IBS sufferers be looking at a personalised solution?
- How important is it to keep track of your FODMAPs throughout the day?
- How much time is generally needed to get IBS under control?
“The more positive you are about your condition and the more accepting you are of what it is and how you can help it, the easier it is to manage your IBS.” –Glenda Bishop
LISTEN OR DOWNLOAD THE LOW FODMAP DIET & IBS PODCAST EPISODE 30 HERE
Can’t listen to this episode right now? Read the transcript below!
My guest, Dr. Glenda Bishop, is a registered nutritionist, a wellness coach, a behavioural neuroscientist, a personal trainer and an educator, who helps people with Irritable Bowel Syndrome (IBS) live a less irritable life. Glenda was diagnosed with IBS twenty five years ago and follows the low FODMAP diet to keep her IBS under control — along with exercise, stress management, and other techniques. Glenda is also the author of the website A Less Irritable Life and works with her clients to create personalised solution, for living a healthy life with IBS.
LARAH: Hi Glenda.
GLENDA: Hi Larah. Thank you so much for inviting me on your podcast. I love listening to it and look forward to it every week, and I hope I can help your listeners as much as your other guests have.
LARAH: Oh, thank you. I’m sure this will be a very interesting episode and I am very grateful that you’re taking the time to be on it. So, let’s start, first of all, by just giving the listeners a little bit of knowledge about yourself and your qualifications. You’ve got a lot of them. And if you can also explain your own digestive issues that you’ve been suffering from for so many years — and when did they all start, and what did you end up doing? And also, how did you come across the low FODMAP diet eventually?
GLENDA: Okay, so a little bit about my qualifications. I’m a registered nutritionist which means I’m certified by the Nutritionist Society of Australia as someone who has both a university degree and extensive experience in nutrition. It’s the highest certification for a nutritionist in Australia, and my degree in nutrition is a Master of Human Nutrition which is a postgraduate level qualification. Before studying nutrition, I studied biomedical sciences which included physiology in biochemistry, and I then went on to specialise in neuroscience. I did a PhD in neuroscience and then I became a university lecturer and researcher where I did most of my work at Monash University. My teaching was mostly in the field of behavioural neuroscience and my research was mostly in the field of nutritional neuroscience. I’ve also got a few extra qualifications as well. I studied fitness and qualified as a personal trainer and fitness instructor. I’m also a Certified Wellness Coach. So, my qualifications are quite diverse, and that means that I can help people with IBS across many health disciplines at the same time. You can probably also tell that my accent is Australian, so I currently live in Melbourne although I originally grow up in Brisbane and I’ve lived in a few places around the world including a short stint over in Ohio in America.
In regards to my digestive issues, it was twenty-five years ago when I was sixteen that I was diagnosed with IBS by my GP. I had quite a range of tests done at the time although the type of tests I had done back then are a bit different to the tests they do these days. I did have an endoscopy. They also did a treatment in case I had an ulcer — a barrier meal and taking antibiotics and having a lactose breath test done — but everything was negative. Unfortunately, back at that time, the general understanding of IBS was that it was all in your head. They didn’t understand it like they do these days, so back then I was told that I needed to worry less and that would help my IBS, and I was also given Buscopan. Unfortunately, neither of those strategies really did much for me, so I lived with that for quite a while and not really getting much resolution from it.
Over the years my IBS has changed a bit. Sometimes it’s been good and not too much of a problem, and other times it’s been pretty bad. Every time it would flare up, I’d get retested, and every time I would always end up with being told, “Oh, it’s just IBS,” which is one of the most frustrating things anyone can tell you, as I’m sure you probably know.
GLENDA: As new tests came out, I would be given those tests, and again, they’d all come back negative. I’ve been tested for celiac disease so many times, for different food allergies as well, and it’s always been clear. So, I’ve lived with my IBS, and at first, I used to hide my symptoms as much as possible, and even the condition. I wouldn’t tell people about it because no one understood. But I don’t blame people for not understanding because back then, not even the doctors understood it, so you couldn’t really expect anyone else to understand it either.
But then, five years ago, my symptoms started getting considerably worse and everything I’d been doing up until then wasn’t really helping anymore, so I started eliminating foods at that point. The first one that we tested that did show an effect was dairy. And so I eliminated dairy, and I did get some improvement, but it was never quite enough. But I still managed to go on with it because again, there was no justification for changing anything at that point. What’s interesting though, is that I’d already heard of FODMAPs back then. I heard of them almost ten years ago, back when I was working at Monash University and I went to a seminar that was given by Sue Shepherd and Peter Gibson, and that was back before FODMAPs really got out into the world. It was the original research studies that they were doing on it. So, I knew about it quite early, but it never seemed to fit what I was experiencing at that time, so I never went down that path at that point. But then, two years ago, my IBS got so bad that my life almost ground to a halt. I had no energy; I was in pain all the time; my bowel movements were completely out of control — and I’m one of the people who has mixed IBS so I was constantly switching between diarrhea and constipation, and lots of bloating and gas. It was a phenomenal nightmare for me. And the doctor was actually quite concerned and did a whole round of tests for almost everything, really, including auto immune conditions. I got tested for celiac disease once more and, hopefully, that’ll be my last test because this time the genetic susceptibility tests came back negative. And I also had lots of other blood tests and scans done to check my abdomen and my pelvis and everything under the sun and, once again, I got that lovely diagnosis of, “It’s just IBS.”
This time, though, the doctor said, “What about fructose malabsorption? Have you ever been tested for that?” and I said, “No, I haven’t.” And that’s when it clicked to me that I should be looking into this. So I didn’t have the breath test done, but instead, I started the full low FODMAP diet because I knew that not all of the FODMAPs could be tested by breath tests, so it made more sense to me to do the entire diet and eliminate everything and see how it went. I got started, and within a week I was improved so much. The difference was just amazing and it kept getting better for me. I got my energy back; I was able to get out and exercise again, and my bloating went down. I actually lost five centimetres of bloating from my waist in the first week. That’s how bad it was at the time and how effective the strategy was for me. But then I did re-introductions which was a total disaster — I reacted to every FODMAP. The only one I could tolerate a little bit was fructose, but polyols, they were shocking. They were my absolute disaster in FODMAPs. However, in the two years since I started the low FODMAP diet my tolerance is improving, and especially with fructose. I can now, would you believe, eat a whole mango without any problems. So, that’s much better, and the other FODMAPs are starting to get better too. But while the FODMAPs have really changed my life, they’re not enough to control my IBS. I still have to watch other things too. I have to exercise on a regular basis. I go for walks and I do gentle exercise like yoga or qigong, which are really helpful for keeping myself calm and settling my body down. I recently started trying to get into running which isn’t doing quite so well with my IBS, but I’m going to persist and see if I can get there. I use stress management and calming mindfulness techniques, and I have to watch what I eat in terms of healthiness and get enough sleep. If I let any of those things go, my IBS can become a bit of a nightmare — so it’s the big picture for me.
LARAH: Thank you, Glenda. That gave us a very good idea of everything. Thank you for clarifying your qualifications and then explaining your journey and your story. I’m sure it will sound very similar to a lot of people, and you had twenty-five years to finally have a little bit of hope that you can manage these symptoms. And, as you said, it is so often true that it’s not just one thing that will help us. It’s not just the diet, or it is not just managing the stress — it’s a combination of all these things. And as you said, yes, exercise is a big part of that. I’ve talk about exercise with my personal trainer, Delina Rahmate — I think it was episode 5 — about how important exercise is for IBS. And then, yes, of course, to manage anxiety, manage stress and the diet so they’re all doing their part to really make you live a better life without having those horrible symptoms all the time.
GLENDA: Yeah, absolutely. Most days my IBS is really well under control. Occasionally I have flare ups because we all do, but I find that by putting everything under the spotlight and making sure I do the whole picture, I get much better control. So, I definitely recommend that people look beyond FODMAPs, but also looking at FODMAPs as well.
LARAH: Yes, I agree with that. And what I found interesting is that you got asked to do the celiac test several times. Does it mean that anyone can become celiac at any point in time?
GLENDA: No, I guess the real reason why I had the test done so many times is because, back when I was first tested for it, the test was still quite new, so in terms of the blood test to look for the antibodies, those tests have been improved over the years, and so every time they would get a new type of antibody test they would test me for that to see whether there was any difference now that the test was better.
LARAH: Okay, now that’s interesting because with intolerances we can become intolerant at any point in time of our lives, I believe, but I guess with celiac, either you are or you’re not.
GLENDA: I mean, there is a genetic susceptibility with celiac disease, and they find that ninety-seven percent of people with celiac disease have got a particular genetic marker, although that genetic marker is actually in around forty percent of the population, so a lot of people can have that marker but not get celiac disease. Something else still has to happen for that to occur, and I don’t think they fully understand yet what causes that to happen, so you may develop that later on in life — but just to have this susceptibility there.
LARAH: Okay, I understand. That makes it much clearer for me. So do you think that you went into the field of nutrition — apart from all your other qualifications and degrees — but do you think you kind of chose the nutrition aspect because of your own struggle with food intolerance?
GLENDA: My interest in nutrition has been there for quite a long time. I was fascinated by how foods could affect medical conditions — making them better or worse — and I used to read books on it as a hobby. It was just one of those things I loved reading about. I’ve always enjoyed cooking as well, so I would often read about nutrition along with that when I was reading about recipes. I also worked in a field called nutritional neuroscience and looking at how components of the food affects brain cells and behaviour. I was not looking at FODMAPs, though. I was looking at metals like iron and zinc, antioxidants, and seeing how that affected the brain. I even did a small amount of work on caffeine and Taurine that you find in energy drinks and how that affects cognitive function. But then I got really interested in the gut-brain axis because of my IBS. The IBS had created anxiety in me as well, so I was really fascinated from that perspective and curious about whether things that I was eating or other things I was doing in my life — like the types of exercise I was doing, or the stress — whether that was affecting what was happening with my IBS or my anxiety. And so I got really interested in that nutrition element to it as well and I started to incorporate that into my neuroscience teaching to teach students about how food affected the brain.
Then I decided, after a while, that I was more interested in the nutrition side than in the neuroscience side, and so I made a career change to go and do my Master of Human Nutrition. But, at that point, I didn’t really have a lot happening with the food intolerances myself. There were suspected things, but never confirmed. And it was only after I’d done my nutrition degree that I started eliminating dairy and then getting into the low FODMAP diet for my IBS. I guess I was quite lucky that I already had a solid training in nutrition before starting a low FODMAP diet because of how complicated it is. I mean, admittedly, we didn’t learn FODMAPs in my nutrition degree — at least when I was studying it — so I did have to learn it myself and do some training courses on it. But, because of that, I’ve gone on to specialising in FODMAPs in my nutrition practice because I want to help other people so that they don’t suffer with their IBS for as long as what I did.
LARAH: Thank you, Glenda. And talking about how you can help other people, could you explain what strategies you used when you have an IBS sufferer coming to you for help?
GLENDA: So, as I’ve already said, everyone’s really different with their IBS and there are so many different types of triggers for it, but that we all react differently. Because of that, everyone needs a different solution. There is no one size fits all when it comes to IBS. The strategies I use will depend on the person; what’s going on with their IBS; how much it’s affecting their quality of life, and then, what they’re able to commit to as well. So if someone’s IBS is only mild, then I don’t always recommend a low FODMAP diet unless they want to try it, but instead, I try to use less restrictive approaches to make some small dietary changes or other lifestyle changes that could help them. But if someone’s IBS is severe enough that it’s impacting on their daily lives, then I find a low FODMAP diet is normally one of the best strategies because even though it is very complicated, it has been shown to be the most promising approach in recent years for IBS because it can help around three quarters of people who have the condition.
But as we’ve already said, FODMAPs aren’t everything with IBS — we have to look at other triggers as well. Gut irritants are a big thing — alcohol, caffeine, the fatty foods and chili — they can all have big effects on people’s digestive symptoms. I also look to see if there are any other obvious food intolerances that could be going on, but I don’t normally do that unless something is jumping out at me as being problematic because again, I don’t want to restrict people even more than what the low FODMAP diet is.
And then, after that, I look at the lifestyle issues. Now sometimes you work through the lifestyle issues at the same time that you’re into the low FODMAP diet. Sometimes it’s better to work through one and do another one later, and sometimes, it’s better to do them all at once. But the lifestyle things could be exercise — just getting them into something gentle. Most people can handle walking, so that’s a really good start for a lot of people, and that can help in a lot of ways to get the gut moving better and to decrease stress levels as well. I might have to help them with some stress management tools, possibly even refer people onto a psychologist if they’ve also got anxiety or depression. And that’s something I just want to make a comment about because anxiety and depression do occur in people with IBS at higher rates than in the general population. And it’s thought that, at least for some people, it’s dealing with the IBS symptoms on a daily basis that creates an anxiety, because you get really afraid of what happens if your symptoms become obvious to people and they become embarrassing — and so that can create a lot of anxiety. And people can also sometimes get a feeling of hopelessness in association with their symptoms, and feeling like there’s nothing else that can be done, and that can trigger depression in some people as well. These mental health conditions are nothing to be ashamed of, but sometimes you do need psychological help. in order to get through them. It can be very valuable for people to do that as well.
I find that sometimes, with women, I need to look at hormonal patterns because some women find that changes in their menstrual cycle can alter their IBS, particularly around the time of their period. Then, there could be other things in their daily routine, how much people sleep, the healthy eating habits, how much water they drink. I also do work with people on the general outlook as well. How they approach IBS, how they approach their restrictions, and helping them to gain a more positive you on what’s going on because the more positive you are about your condition, and the more accepting you are of what it is and how you can help it, the easier it is to manage your IBS.
LARAH: Thank you, Glenda. Yes, there is so much to it and I’m so glad that you’re taking this wide approach of looking at everything in someone’s life, including their lifestyle, that they do their exercise and if they have a stressful issues. I had one of my podcast guests, actually, say that she could not accept a job because of the anxiety that would have created — the embarrassment it would have created, because the toilets were really close to the desks of everyone else. I can relate to that because it was somehow the same for me when I was working in a particular office. I would make sure that it would be empty before I would go in because I knew there would be noises made and unfortunately, I can’t help it. And when you’re that bloated that you’ve got air coming out from every place it can come out, it’s just very embarrassing. I have to say that the more the time passes, the less I feel worried about it. That’s what I want to tell people — that there are so many people suffering what you suffer, so don’t be worried about talking about your condition — especially to your family and friends — because most people will understand.
GLENDA: Oh, I agree with you, absolutely. I think that, at first, when you first start dealing with it, it does seem insanely embarrassing and you just don’t want anyone to know about it. But learning to accept that it is the way it is and that there are going to be times when you might be in a totally embarrassing situation — it just makes it easier and you get more comfortable with it. And, yeah, definitely, talk to people, the people you’re closest to, and hopefully that will take some of the pressure off you as well.
LARAH: Yes, yeah absolutely. Going back to FODMAPs, how can people manage their FODMAP intake throughout their day to make sure they don’t have those IBS symptoms?
GLENDA: Okay, so in terms of FODMAP intake, it’s really important to manage this for two reasons. The first one, obviously, is that if you have a high FODMAP meal, it is likely to cause a reaction in you that’s going to trigger your IBS. The other thing with that is that reactions can sometimes take a while to set in, so when you eat something it might take several hours for you to get a response, or even the next day. So watching what you’re eating in terms of FODMAPs is quite important because it will catch up with you eventually.
The other side of keeping track of your FODMAP intake is that FODMAPs are fermented in the colon and the amount of digested material that accumulates in the colon will be from several meals. And so FODMAPs from, for instance, your breakfast and your lunch are still going to be in your colon by the time you’re eating dinner and then, gradually, that will get in there too, so that fermentation can start to build up over time, so you really want to watch that you don’t get too much going in.
So one of the best ways to start is, at the beginning of the day, always get your breakfast right. If you’re going to start your day well, you’ve got a better chance of keeping your symptoms in control than when you are doing the other things like going to work. Breakfast is probably the easiest meal to control because you’re already in your house and so you can control all the ingredients going into it. It can be a cereal, porridge, eggs on toast, something like Vegemite and tomato on toast — whatever works for you for breakfast. Choose something low FODMAP and get your day started right.
In terms of lunch, this can be more challenging if you work outside of the home, which most people do. When people first start out on a low FODMAP diet, I recommend that any time they’re going to be eating outside their home, if they can take their food with them, that will make their lives a lot easier to control their FODMAP intake. But after you’ve been on the diet for a while you’ll start to get a bit more comfortable and you’ll be able to navigate menus a bit better. Then you can start finding some options in places that are close to your work that have low FODMAP choices and eat out instead of taking your lunch to work every day.
In terms of dinner, of course cooking at home is going to be the easiest option because, again, you’ve got the most control over your FODMAPs. But, of course, there will be times when you want to eat out — going to a restaurant for dinner with friends or family. And if you’re doing that, what I recommend you do is to call ahead to the restaurant to see what it can do for you. These days you can also often find menus from restaurants on their websites. I will often look the restaurant’s website up and then check out what they have to offer, and if there is something that looks like it’s going to be okay, then the restaurant’s probably a good choice, but you can also call them as well and ask for more information. But don’t forget about your snacks during the day as well, because they can tip you over the edge for FODMAPs quite easily. Unfortunately, snacks are something that people often forget about because they’re not a main meal. Snacks are the things we eat in between meals and often, as we’re moving between different tasks, and because of that, people don’t always prepare their snacks very well. I definitely recommend that people get some good ideas for snacks and don’t forget to pack them in your bag during the day so that they have something safe to eat.
LARAH: Yeah, thank you, Glenda. And going back to snacks, I was reading on your website that you also help people to create healthy low FODMAP snacks. So you have like a four step snack builder on your website. Could you please explain what that is and how can that be useful for people?
GLENDA: My snack builder was designed to help people create healthy low FODMAP snacks based on key nutritional needs. I like to see snacks as opportunities to get more nutrition in your day, particularly if you’re missing things in other meals. So, if you don’t eat fruit in your other meals, than snacks are a good time to get some fruit. If you don’t get a lot of calcium because you don’t have a lot of dairy products or dairy alternatives in your main meal, then it’s a good time to get them in a snack.
What we have is have four steps in the snack builder. The first step is choosing a protein, so we want some higher protein foods here. Some good examples are: lactose free yogurt, peanut butter, low FODMAP nuts and seeds, a tin of tuna, boiled eggs — so simple sorts of things like that.
The next step is to choose a fruit or vegetable. Obviously, we want to have low FODMAP options, but there’s a lot that you can choose from in this case, and you’ll probably tend to choose based on what your protein is. So, for instance, you’re having a low FODMAP yoghurt, you’ll probably want to have some fruit with that, whereas if you’re having tin tuna, you might want to have a vegetable with that. Some good examples for fruits would be oranges, bananas, kiwi fruits, strawberries, and in terms of vegetables, you can do vegetable sticks like cucumber, zucchini, you can do green beans, or you could even have cherry tomatoes. Carrots also make excellent vegetables sticks as well, so they are a great thing too. You can actually have a range of different types of vegetables all cut up into sticks, and then you could use them almost like to dip into things to add extra flavour. You could make, for instance, a low FODMAP hummus dip — and that would be a good protein sauce — by using chickpeas. And you can pretty much use any hummus recipe for that, and instead of putting garlic in, all you do is use garlic-infused olive oil and that’ll turn it low FODMAP. So that’s a great way to do it too.
LARAH: Yes, and also to specify for some listeners, they might think that chickpeas are not allowed…small quantities of canned chickpeas are okay.
GLENDA: Yes, absolutely. The Monash University app says that a quarter of a cup of chickpeas is a low FODMAP serve and it’s best if you use canned chickpeas because the canning process removes some of the oligos from the chickpeas, but make sure you always rinse them thoroughly, to remove any excess FODMAPs from the surface.
The third step of the snack builder is the carbohydrates. Now this will depend on how hungry you are, as to whether you have it. You don’t have to have a carbohydrate in every snack, but if you’re hungry, it’s good to add some to help fill you up. Some good examples are low FODMAP toast, particularly, whole grain or high fibre choices better because that’ll give you more fibre, but you can also have things like rice crackers, rice thins, of course making sure they’re plain and don’t have any FODMAPs in them. Or you could even use homemade muffins that you’ve made that are low FODMAP as a nice carbohydrate choice.
The fourth step is optional, and this is if you want a little treat. I wouldn’t recommend that you do this in every single snack that you eat, but, occasionally, it’s quite nice to have it. Some examples here might be a small amount of chocolate, some maple syrup or some jam — something that just adds a bit of sweetness and a bit of, I guess, luxury into your treats. A good example that uses all four of these steps that I personally really enjoy eating is peanut butter on toast with banana. So you’d have low FODMAP toast as your carbohydrate, you would have peanut butter as the protein, banana is the fruit; and the maple syrup is that optional treat that you have. Sometimes I have it with maple syrup, but most of the time I have it without because the bananas are already sweet enough as it is.
Now, as you mentioned before, Larah, I’ve got a blog post on my website about these snacks and the snack builder, so you can go to that on the blog post if you just type in snack ideas into the search bar the blog posts will come up. There’s more information in that and a lot more examples of how you can combine different things to create snacks, along with links to recipes that can be really handy for you as well.
LARAH: Yeah, that’s great. Thank you, Glenda. And I will provide links to the snack ideas and those recipes on the show notes of this episode, so that it will be nice and easy for you.
Alright. You mentioned briefly before about things that can trigger IBS apart from FODMAPs. Now one of these is alcohol. Should alcohol be completely avoided if you are an IBS sufferer or is a small quantity of alcohol allowed? I know that on the Monash University app there’s a small quantity that is allowed, but there is conflicting information as well regarding that. Some people say that you can’t have any of it at all. So if it’s allowed, which ones are okay and which ones are not? And also, if alcohol is used in cooking, is that different?
GLENDA: Okay, so when it comes to alcohol, there are two things we need to consider. The first one is the FODMAPs, and the second side of it is the gut irritant effects of alcohol. So, first of all, let’s look at the FODMAP perspective of it. As far as alcoholic beverages go, we know that rum, low GI wine, and sticky wines are all high FODMAP. On the other hand, we know that beer, gin, vodka and whiskey, and most other wines are low FODMAP. There is a range that is low FODMAP, but there are also other alcoholic beverages that haven’t been tested yet. For instance, we don’t know yet about liqueurs and ciders, and some of the other spirits as well. It’s possible that some will be high FODMAP. For instance, we probably predict that cider that is made from apple juice or pear juice are probably going to be high FODMAP, given that those juices are, but we don’t know for certain yet.
The next thing to consider with alcohol is if you’re going to mix something with it which obviously, is something that a lot of people do with spirits. Fruit juices, dairy-based mixes and soft drinks are the most common things that people would mix with alcohol. But fruit juices are often high FODMAP. We do know that some are okay. Cranberry juice is okay, and you can have a small amount of fresh orange juice. You can also use things like citrus juices, you know, a splash of lemon or lime is a good option. But we do want to be careful of any fruit juices that are high FODMAP. You can, of course, use dairy-based mixes that are lactose-free such as lactose-free milk or lactose-free cream, if you want to — and water and soda water. That will be low FODMAP as well, so you can mix that with your alcohol. At this point in time, soft drinks haven’t been tested in terms of FODMAPs, but if they’ve been made with sugar or sucrose, they should be okay. But if they’ve been made with high fructose corn syrup, then that’s going to be a FODMAP. That will become an issue.
LARAH: So, what about in terms of soda and in term of the gas that’s contained in the soda? Is that okay in small quantities, but maybe not in bigger quantities?
GLENDA: So fizzy drinks can irritate the gut in some people, and one of the problems with carbonated drinks is that when you drink them, you’re obviously taking the gas into your body, and that means it’s then got to come out somewhere. So one of the ways it can come out is by burping. That’s probably the nicest way for it to come out in some ways. Maybe it’s not the politest way, but it comes out, and at least it’s out of your system. But if it remains trapped within your gut then it’s going to have to come out the other end which will come out as flatulence. And while it’s within the gut, it can increase the pressure in there, and that can cause discomfort for some people. So, it really just depends on how you react to the fizziness. Some people do find that staying away from fizzy drinks is a good idea.
LARAH: Yeah, okay. Thank you for that Glenda.
GLENDA: Okay. The other side of alcohol is the gut irritant effects. Alcohol is known to stimulate the digestive system, and so that means that it increases the speed of the content of the gut as it moves through the digestive system. If you’re prone to diarrhea or loose bowel movements, alcohol can trigger that in you and cause you to react in that way when you have it. But that doesn’t mean that people who are prone to constipation get away without any problems either, because alcohol can cause cramping and pain when it stimulates the gut and it can cause contractions or spasms in the bowels, and that can disrupt the formation of bowel movements. We also know that alcohol is quite dehydrating, and together with the disruption of the bowel movement, this can further promote constipation in people who are prone to it. Regardless of which type of IBS you have, you can potentially be susceptible to these gut irritant effects.
Not everybody has problems with alcohol, even if they have IBS. It really depends on you and how you react to it. So, when you asked the question of should we avoid alcohol if we have IBS, It really depends on how you personally react. We do think that most people would benefit from either avoiding it altogether, or drinking less of it, even if the alcohol is low FODMAP. But if you are going to drink it, I would generally suggest that firstly you choose low FODMAP alcoholic beverages and mixes. Secondly, drink the alcohol when you’re eating food because that can help to buffer the gut irritant effect. And then lastly, it’s best if you limit yourself to only one drink or two at the most in a day and that can help to minimise the overall effect that alcohol will have on you.
Now, the other thing you asked about was alcohol in cooking. Alcohol does evaporate during cooking, but it depends on how long the food is cooked for, the heat that’s used, and how much alcohol was added to the dish, as to how much alcohol will be remaining after the cooking process has finished. If you were to add just a splash or two of wine in a casserole which is something that a lot of people do, that probably won’t hurt most people because the long cooking times mean that it will probably evaporate by the time the dish is ready. But, of course, you do have to be careful of any FODMAPs that might be present in alcohol you add to your cooking because FODMAPs don’t evaporate away — only the alcohol — so make sure that it’s low FODMAP to begin with.
LARAH: Yeah, thank you, Glenda. That was a perfect explanation. So there you go. For everyone, if you’re consuming a little bit more alcohol then you should, that may be the reason for your symptoms, so watch out for that as well.
So, another thing is coffee. It seems that some people get affected more than others, and again, not in term of FODMAPs, but probably as gut irritant. Could you just explain a little bit more about coffee as well?
GLENDA: Yeah, absolutely, Larah. It’s pretty much like alcohol, as you said. Coffee is a gut irritant, but again, not everybody is irritated in the same way by coffee. What we do know about it is that caffeine stimulates gastric acid secretion — so that’s the acid from your stomach — and it also stimulates muscle activity in the colon. We also know that coffee itself increases what’s called rectosigmoid motor activity, and what that means is that it creates an urge for a bowel movement. So, essentially, coffee can stimulate a bowel movement in some people and increase gastric acid secretion can also promote reflux in people who are sensitive to that as well. What’s really interesting is that some people who are particularly prone to constipation find that drinking a cup of coffee in the morning is actually a good thing for them because it stimulates a bowel movement and helps to relieve their constipation. This can happen even with decaffeinated coffee, so it’s not only the caffeine, it’s the coffee itself. But if you don’t react to coffee, there’s absolutely nothing wrong with having a couple of cups a day. But if you want to test if you react to it please don’t go cold turkey on drinking coffee. Don’t stop it, if you are drinking several cups a day or you’re going to end up with caffeine withdrawals. Cut back slowly — maybe switch to drinking tea which has less caffeine — and then, if you get away from the coffee for a week or two, have another cup and see how you go and whether it causes a reaction. But as you mentioned too, Larah, coffee is okay from a FODMAP perspective, it’s only when you’re adding milk or flavourings to it that are high in FODMAP that it becomes a problem. As long as you stick with low FODMAP milks and use low FODMAPs sweeteners like sugar then at least that side’s covered and it’s only the gut irritant inside that you have to worry about.
LARAH: Yes, that’s right. And nowadays, there are lots of places that cater to that with either lactose-free milk, rice milk, or almond milk, so there are options there if you still want to have your coffee, if you can handle it. Things are getting much easier for people compared to ten years ago.
GLENDA: Oh absolutely, absolutely. I would add a bit of caution though, to be careful about soy milk because soy milks are quite different when it comes to FODMAPs, and if the soy milk is made from the whole soy beans, that’s high FODMAP, but if it’s made from soy protein isolate, then it’s low FODMAP. When you’re out at a cafe, you can’t always tell what it’s made from, so you may have to ask about the milk to find out what type of soy milk it is, as to whether it will be safe for you.
LARAH: And it’s really going to be more likely made from soybeans because from what I’ve heard from people is that the one made from soy proteins, you can find it, I think, in Australia. It is not the most common soy milk, but in other countries, it seems that it’s even harder to find soy milk made from soy proteins.
GLENDA: Yes, it is. And even in Australia, a lot of the soy milk that’s used in cafes is made from the whole soybean. In some ways, it’s almost better if you can get used to drinking your coffee without milk, or if you can handle milk, then to have the lactose-free milk with it.
LARAH: Yes, lactose-free or rice milk or, I don’t know if people like it, almond milk in coffee could be an option. There are a few alternatives.
GLENDA: Yes, absolutely.
LARAH: Okay. Thank you for that. Could you explain why IBS sufferers should really be looking at a personalised solution?
GLENDA: Okay. Everything we’ve been talking about today has highlighted how different people are in terms of their IBS. The triggers that affect them, and also how they react, is quite different. There is no hard and fast rule when it comes to getting IBS under control. Definitely, please be very wary if you ever see anything saying, “If you do this exactly, it will fix your IBS,” because that’s not how IBS works. There is no guarantee that one person will get a response just because someone else did. You need to work it out for what’s right for your particular situation, and that’s why we need personalised solutions that suit what you are particularly experiencing.
For some people we find that dietary changes will have the biggest effect on their IBS, but then, for other people, stress management or psychological counselling is super important. We also find that there are some people, who don’t actually need to do anything that drastic to get their IBS under control and they can just make some small healthy lifestyle changes and that will help them out quite a bit. But then there are other people, as you said, who have to change across nearly every area of their life. They’re going to have diet, stress management, exercise, healthy eating, and all sorts of other things too. From a personalised perspective, IBS isn’t always the only thing that’s going on in someone’s lives, so sometimes people have also got medications and other conditions that could be influencing their IBS. And not only does it affect their IBS, but it can also affect which solutions are going to be available to them. For instance, if someone has some mobility issues, then exercise isn’t necessarily going to be the easiest thing for them to do. It doesn’t mean they can’t do it — you just have to get a bit more creative on what might work for them.
We also know that, as you said, most people have got several IBS triggers, but very few people are triggered by everything, and because of that you have to work through the different types of triggers to see which ones affect you and which ones don’t. And the reason why this is important is because you don’t want to restrict yourself any more than necessary, but you do want to restrict the things that trigger your IBS. So it’s a real balancing act and it’s a bit hard to get under control. But remember that the aim of fixing your IBS is to improve your quality of life so that you can get back to living the way that you want to. If you restrict everything possible, then your enjoyment of life starts to disappear, so we only want to restrict what you have to.
Working through all the different triggers is quite challenging to do and it can take a long time. You’re not going to figure it out in a few weeks, or even a couple of months. I find that most people need around six months or up to a year and sometimes longer to get a good hold on their IBS, depending on how many triggers they have, so you do need to be prepared for it to take a while. You should definitely seek help if you’re struggling to work it out on your own. Sometimes you’ll need professional help to do that, and that depends on your particular needs; whether you need to be seeing a nutrition professional; whether you need help on general health or on exercise; whether you need help on all of it; that’s just something that will depend on your situation.
LARAH: Yes, thank you, Glenda. And yes, the message is to be patient because things don’t change immediately, even just with the diet. Usually it can take a few weeks. For me, I think I found relief within a week. But anything else — any other underlying problem — don’t give up. Just keep on trying different things and get the help that you need and that you can afford, really.
GLENDA: Yeah, and that’s a good point you made that too, Larah. Even with the low FODMAP diet, some people do get very rapid relief from it, and for other people it can take several weeks until they get that relief coming in. Sometimes you do have to stay away from a trigger for several weeks before you actually realise whether it’s affecting you or not. So you shouldn’t give up after only a few days — or even a week — but persist with it and just see what happens.
LARAH: Yeah. Well, thank you, thank you, that was great information.
GLENDA: My pleasure.
LARAH: Well, thank you so so much, Glenda, for all the information you share with us. You have incredible knowledge. My advice for everyone is to go and visit Glenda’s website and really take advantage of all the information that she has prepared for all of us. Pop into my website and look at the links if you can remember how to get to Glenda’s website and all the links will be there. Is there any other place apart from your website that people can get in touch with you? Any social media?
GLENDA: Yes absolutely. So, I am on Facebook, on Twitter and Instagram and I’m also on Pinterest. But you can find all of those links on my website as well.
LARAH: So, perfect, thank you. Thank you so much, Glenda. I really appreciate your time.
GLENDA: Thanks so much for having me, Larah. I had an absolute blast.
LARAH: Thank you. Goodbye!
LARAH: I hope you have enjoyed this episode with Glenda Bishop. Glenda has a lot of knowledge on IBS also from personal experience as she suffered a lot from those nasty symptoms. Glenda explained how she looks at the needs of each individual person to work out the best possible solution for them.
I send you all my best wishes for a good health and happiness and, until next time, a really warm goodbye. Goodbye!
Links and resources mentioned in this episode