Food is among our most fundamental driving forces, alongside sex, companionship, shelter and drink. It can determine our mood, can dominate our thinking and regulate our behaviour. But it is not just hunger that drives us to seek nourishment, it is also stress. When our lives are busy, when the threat of failure and the sheer effort of holding everything together get too much, we turn to food as a reward; we eat not because we are hungry but for solace and comfort. The taste, the texture of food in our mouths and just the very act of eating can calm us down, give us something here and now to think about and do. And if it is accompanied by a glass of wine, the pleasure is so much greater; we want to keep doing it. We are all fundamentally ‘lotus eaters’.
But what if the stress and worry upset your digestion and make your gut so sensitive that the very foods that should calm you down actually causes anxiety and pain? Then like the green-eyed domestic Goddess, your gut can mock the food it feeds on. Like a child with cruel parents, your gut fears the very thing that should give you comfort and the more you reject the thing you love, the more you want it. So you think about food all the time, ‘ruminate’ over it, obsess about what you can eat, worry about whether our next bite is going to give us pain. Food intolerance creates a conflict, both in our mind and our gut.
Diets can so easily nourish an obsession over food by depriving us of so many of the foods that we like and we need to keep us healthy. Just look at the list of foods the guts of people with IBS might be sensitive to; so many fruits and vegetables, wheat, dairy products, some confectionery, fatty foods, even alcohol; all the foods that add balance and variety to our diet and should, in an ideal world, offer comfort and solace. The fact that these diets are endorsed by the very health professional gurus who are trying to help us may seem to make it worse. If you renege on your diet then you feel a failure and are punished with pain.
Dieting is rarely a permanent solution for IBS. Unless it is proven that you have a specific food allergy, you will need to reintroduce the foods you have left out and return to a more balanced regime. But going on a diet offers you the pain free space to relax and think what may be making your gut sensitive in the first place.
Many of you tell us that there was one particular event or situation that triggered your IBS and food sensitivity. Most people find that their food sensitivities can come and go according to what is happening in their lives. Going on holiday can often change things; for some, time out to chill and relax can reduce food sensitivity; for others the unfamiliar surroundings and strange food may provoke anxiety and make things worse.
So many of you write in and tell us how you are adhering to the diet, but you still get symptoms from time to time. Your sensitive gut is connected to your emotional brain and can operate as a distress signal. There’s no shame or stigma in that. Having emotions is part of being human; some may express their emotional tension as anxiety, anger or despair, others may express it in the body as ‘medically unexplained’ headaches, tiredness, backache, muscle pains and, of course, gut symptoms.
So what can you do? First of all lower your expectations. Don’t see going on a strict diet as the cure of your IBS. If you do that, you are probably heading for disappointment. You don’t need to eliminate every morsel of every food that may possibly upset your sensitive gut. Everybody with food intolerance can take a limited amount of the foods that could cause symptoms. So there is no reason that you can’t eat the foods that you like, though you may need to adjust portion sizes. The long term treatment of food intolerance is about finding out which foods are more likely to upset you and then adjusting the amount you eat according to how confident you feel and what may be going on in your life. But there is more than one way to do that. In this issue of Gut Reaction, Dr Miranda Lomer advocates dietary elimination of FODMAPs followed by reintroduction, supervised by a trained IBS dietitian while Dr Joan Ransley demonstrates how it is possible to enjoy eating well using restricted amounts the foods that are likely to upset a sensitive gut.
You may well be able to eat a less restricted diet if you use other activities to take your mind off your fear of eating. And the respite you gain from your diet will enable you to reflect on what situations may make your gut intolerant to food and prompt the necessary changes to either avoid those or deal with them better. Food intolerance is so often about understanding the interaction of food and mood.
Nothing is ever absolute. Rigid rules around eating are not appropriate if you have IBS. Restricting your diet too much can lead to weight loss and nutritional deficiency and sets you up for failure, disappointment and more symptoms. Being good enough will get you through most things in life; your diet, exercise, work, relationships, bringing up children. So understand your food and know yourself. Gain insight into how your limits can change and if you occasionally overdo it, do not persecute yourself. Use it as a learning exercise, adjust, put your IBS back into the background and get on with life.