It started with granola. Emma Hatcher recalls eating almost an entire box as a child and doubling up in pain. She had always been aware of having a sensitive gut, but this was unlike anything she’d felt before.
Her stomach problems escalated until she was diagnosed with irritable bowel syndrome (IBS) at the age of 14. The following year, still suffering from cramps, diarrhoea, constipation and bloating, her doctor suggested cutting out wheat, which she did. Next went dairy. Her symptoms improved briefly each time but then edged slowly back.
Increasingly distraught, Hatcher tried desperately to find a solution, changing her mealtimes, portion sizes and experimenting with different food groups.
Nothing seemed to work. So she pushed on, getting a place at Loughborough University to study communications, and then a job as social media manager for a corporate company. But all the while, her condition was making her feel isolated and anxious.
“I felt panicky all the time,” she says today, sipping mint tea in an east London restaurant. “My palms would sweat and my heart would race. I didn’t want to go to work or venture far from home. I’d try to envisage how every day would pan out and was always anxious if i was going out for dinner, or staying at someone else’s house.”
IBS is a chronic condition affecting the large colon and requiring long-term management. It affects one in seven on a daily basis and for many, like Hatcher, can be utterly debilitating. In 2013, it was the largest cause of days off work in Britain, with sufferers staying at home for 22 days of the year.
For Hatcher, things culminated when she had to call in sick from her job after a restaurant meal had kept her up all night. After suffering in silence for years, she finally felt her symptoms had reached a point where they were interfering with her life too much.
But three years on, a very different woman sits before me, contentedly perusing a menu. “My gut is so happy,” says the 23-year-old with genuine enthusiasm.
The solution, when it came, was a low FODMAPdiet.
Developed at Australia’s Monash University, by gastroenterology professor Peter Gibson and dietician Sue Shepherd over the past decade, this is the first evidence-based diet proven to reduce IBS symptoms, with a success rate of up to 75 per cent.
FODMAP stands for fermentable oligosaccharides (wheat, onion, garlic); disaccharides (milk, ice cream); monosaccarides (apples, pears, honey); and polyols (mushrooms, apricots). These are types of carbohydrates and alcohol sugars that are found in everyday foods but poorly absorbed by the small intestine, and that researchers now believe are responsible for the discomfort and bloating associated with IBS.
A low FODMAPdiet provides a three-step plan of action. During the first stage, all foods considered high in FODMAPs are removed from the diet for a six to eight week period to allow the gut to settle. This is a long list including garlic, onion, mangoes, peaches, milk, wheat, barley, rye, asparagus, peas, sweetcorn, beans, cashews and jams, to name a few. The next stage is reintroduction, where small amounts of high FODMAPfoods are slowly brought back into the diet, gradually increasing the amounts to test for tolerance levels.
The final stage is maintenance, where the sufferer learns to avoid the by-now established sensitivity triggers for their gut. It is crucial, and agreed by medical experts, that all parts of the FODMAPdiet must be undertaken under the guidance of a qualified dietician to avoid nutritional deficiencies and maximise the chances of success.
So transformative where the effects of the diet that Hatcher has written The FODMAP Friendly Kitchen, a book containing 100 low FODMAPrecipes. Her mission, through this and her blog She Can’t Eat What?!, is to spread greater awareness about the powers of changing what you consume and to offer food inspiration to people dispirited by the wealth of ingredients that are suddenly off limits.
Hatcher learnt about FODMAPs after being referred to a dietitian by her GP three years ago.
“It was a light bulb moment that there was something out there that could really help,” she says. The feeling of elation was short-lived, however, as she was handed an extensive list of foods to avoid for next two months. Meat and fish were deemed fine, as were most herbs and spices, but most stone fruits, vegetables, nuts, cereals and grains were out. “It was terrifying. I wasn’t sure how I would manage at first,” she says.
But cope she did. The list was pinned to her kitchen cupboard, family and friends were briefed on her new dietary requirements, and she fielded countless questions from baffled waiters in restaurants. “A gluten-free meal with no onion or garlic is a simplistic description of the low FODMAPdiet, but I often find it is the easiest way to explain,” says Hatcher.
Barely two weeks in and she felt transformed.
“I still had stomach ache every now and then, but I felt instantly better. It did take a lot of perseverance to find out my own personal intolerances but it was worth the trial and error. You don’t realise how much your daily life is being affected until you start to feel the improvements. I stopped thinking about when I could next go to the bathroom or whether I was staying at my boyfriends’ house and might be embarrassed by my stomach.”
With help from a dietitian, Hatcher was able to pinpoint sweet potato and avocados as her key IBS triggers but that apples and stone fruits were fine in small quantities. Relaxation techniques such as yoga, stomach massaging and long walks also helped her recovery. Stress can exacerbate IBS symptoms and vice versa, as biochemical reactions caused by feeling anxious and a rise in cortisol levels can impact gut function (a relationship known as the brain-gut axis).
But before we all ditch high FODMAPfood from our fridges, Elaine Allerton, a dietitian at NHS St Richard’s Hospital, Chichester and her two private clinics in Surrey and West Sussex, where she specialises in IBS, has some important advice.
“People should visit a GP or gastroenterologist before starting a low FODMAP diet. It’s important that they are investigated for coeliac disease or other bowel disease, such as Crohn’s or ulcerative cuolitis, or bowel tumours before an IBS diagnosis is given. Always talk to appropriate medical experts, don’t self-diagnose.
“The evidence for low FODMAPs is only relevant to IBS, and there is not yet anything to link it to other conditions.”
Both Allerton and Hatcher empahsise that would-be FODMAP diet followers should not cut out all high FODMAPgroups for longer than eight weeks, a move that could result in nutritional deficiencies if maintained long-term. “This is not about restricting these foods for ever,” adds Hatcher. “The more variations of food you can eat, the happier your gut is likely to be. It’s not a lifelong diet but a foundation you can build on.”
As well as Hatcher’s book, Monash University has developed a FODMAP Friendly App to guide people through the intricacies of the eating regime, while Kings College London has produced a useful booklet that is supplied to dietitians during consultations.
In the meantime, Hatcher hopes her low FODMAP baba ghanoush and nutty chocolate truffles will help those in need. “Just because recipes don’t contain garlic and onion they can still have flavour,” she laughs at my horror on discounting such store cupboard staples. “We need to let IBS sufferers know there is something that can help and they don’t have to suffer in silence.”
The Fodmap Friendly Kitchen Cookbook by Emma Hatcher is published by Hodder & Stoughton (£20). To order your copy for £16.99 plus p&p call0844 871 1514or visit The Telegraph Bookshop.
