We all have some mild abdominal discomfort or a bit of variation in our bowel habits from time to time. But how can you tell when digestive issues are normal and when they're more serious? As an expert on IBS and gut health, here's what I recommend you look out for and why a FODMAP-elimination diet could help resolve your digestive issues:
1. Excess gas.
Healthy people pass gas seven to 22 times a day. Gas is created as our gut microbes ferment the sugars and fibers in our food, and while that might sound scary, fermentation and gas production are perfectly normal. If it's excessive or produced too rapidly for comfort, you may be able to manage it with a special diet, called a FODMAP-elimination diet. FODMAPs are a group of rapidly fermentable sugars and fibers. High-FODMAP foods are eliminated, then reintroduced according to a plan that will allow you to identify the offending foods.
When gas is produced too rapidly, it can make your intestines expand quickly, like blowing up a balloon. Some people experience this as a bloating sensation. If the gas gets trapped and doesn’t pass easily, bloating can be a significant problem. You may even be able to see that your belly has grown measurably bigger. Have you ever said, "I look six months pregnant!" after a meal? Diet-related bloating tends to occur in bouts and ranges from mild to severe. If your bloating is severe or constant, it could be more serious, and I'd recommend asking your doctor about it.
We don’t eat the same thing, the same amount, or at the same time every day—so it’s not realistic to expect your bowels to function like clockwork. Diet-related irregularity isn’t typically anything to worry about, but it could be more serious if you have had a really drastic change in bowel habits.
4. Abdominal pain.
Unfortunately, some people are predisposed to experience many of the relatively normal occurrences described above in an uncomfortable or painful way, part of a condition called irritable bowel syndrome (IBS). Two people might eat the same meal but only one of them has a bout of abdominal pain, bloating, and diarrhea or constipation. Abdominal pain isn’t always related to digestion, and it can have many serious causes. If your pain is severe or unusual for you, see a doctor.
Fecal urgency is when you think you might not make it to the toilet in time. This unpleasant problem can have a big effect on quality of life, especially if you’ve ever had an "accident" or an episode of fecal incontinence. Get this one checked out by your doctor. When digestive issues are accompanied by other signs of trouble—such as bloody stools, fever, or unexplained weight loss—see your doctor promptly.
FODMAP stands for fermentable oligo-, di- and monosaccharides and polyols. FODMAPs include certain natural sugars in foods such as milk, fruit, honey, and high-fructose corn syrup. Other FODMAPs are certain types of fiber in foods such as wheat, rye, onions, garlic, beans, inulin, and chicory root. The FODMAP approach may be right for you if your symptoms have been properly evaluated by your PCP or a gastroenterology specialist, and if a high-fiber diet and a regular meal pattern have failed to help. You may benefit from working with a registered dietitian trained in the delivery of this diet, especially if you have other medical conditions.
Patsy Castos, MS, RDN, LD, is a leading expert in FODMAPs and IBS. A registered dietitian/nutritionist based in Portland, Maine, with a BS in nutrition from Cornell and a master’s in nutrition from Boston University, she completed her internship at Boston’s Beth Israel Hospital and maintains a private practice. She is the author of THE IBS ELIMINATION DIET AND COOKBOOK and also speaks at conferences to other nutritionists and doctors.