If you suffer from IBS, you may have come across suggestions to give a low-FODMAP diet a go. But what exactly does it entail? Can it be described as a “diet”? And could it drastically improve your symptoms? We break down the basics.

What is FODMAP?

The abbreviation FODMAP stands for:

• Fermentable,
• Oligosaccharides,
• Disaccharides,
• Monosaccharides, and
• Polyols

These are carbohydrates (sugars) found in many common foods. When poorly absorbed, they cause IBS symptoms. Research has found that limiting FODMAPs in your diet could have a favourable effect on those with IBS. In an Australian study, 75% of IBS patients showed improvements in their symptoms on the low-FODMAP diet.

Why do FODMAPs trigger symptoms of IBS?

According to About IBS, the small FODMAP molecules cause an osmotic effect in the small and large intestine – this means that more fluid is attracted to the bowel, which ultimately causes discomfort and bloating. These FODMAPs also ferment rapidly when the colonic microflora produce gas. When gas increases, this additionally causes discomfort and bloating. It also affects how the muscles in the bowel contract, causing increased peristalsis (movement of the digestive tract), which leads to diarrhoea.

Normal digestive systems also respond to the malabsorption of FODMAPs in food, but in people with IBS, the effect of FODMAPs may be amplified because of the following reasons:

• The muscles of the bowel respond more rapidly, meaning that this could either cause faster or slower movement through the gut, leading to either diarrhoea or constipation.
• The gut of someone with IBS is hypersensitive to any changes and people with IBS may feel abdominal pain much more quickly than someone without IBS, even though the same process occurs.
• The type of bacteria also plays a role – they may produce a larger amount of gas, or there may be an overgrowth of gut bacteria (small intestinal bacterial overgrowth, also referred to as SIBO). 

Why the FODMAP diet doesn’t always work

Criticism of a low-FODMAP diet includes that it could be very limiting and cause over-restriction and a lack of crucial nutrition. However, experts agree that the focus should be on “low” FODMAP and not “no” FODMAP.

According to the Harvard Medical School, someone who suffers from IBS and wants to benefit from a low-FODMAP diet should not restrict all foods on the FODMAP list but should only limit problematic foods in a category.

It is also important to understand that the low-FODMAP diet is a process of elimination based on foods which an individual does not respond well to, and not a list of foods that someone with IBS should avoid as a whole.

“In my practice I find some people are not good candidates for an elimination diet, particularly those at risk for eating disorders, those with little control over their food (such as people living in community situations), and those whose diet history reveals that they are already following an instinctively-determined low-FODMAP diet,” says Patsy Catsos, a registered dietitian.  

High-FODMAP foods include: Onions, garlic, vegetables, such as asparagus, cauliflower, fresh beetroot, mushrooms, fermented foods, such as sauerkraut, a broad variety of legumes, such as kidney beans and black beans, fruits, such as apples, blueberries, pomegranates, avocado and dates, processed meats and refined starch, such as biscuits and cereals, processed condiments, such as tomato sauce, and dairy products, such as cheese and full-fat milk.

Low-FODMAP foods include: Vegetables, such as carrots, bell peppers, aubergine and leafy greens, fruits, such as grapes, papaya, unripe bananas, strawberries and kiwifruit, unprocessed sources of protein, such as lean beef, chicken and seafood, and grain-free, gluten-free breads and cereals. 

*For a comprehensive list of high- and low-FODMAP foods, see this link.

Important to know

Speak to your doctor or a registered dietitian before diagnosing yourself with IBS.

Always have realistic expectations on the low-FODMAP diet – many people with IBS expect to be symptom-free after avoiding all the foods on the list. It doesn’t work like that.

“Learning more about how your body reacts to FODMAPs can empower you to manage your IBS more effectively,” says Catsos. 

You should also be aware of your fibre intake. One mistake that IBS patients often make is to eliminate all sources of fibre – fibre is crucial for the proper functioning of the digestive system.

Ensure that you get plenty of fibre by including fruits, vegetables, grains, legumes, nuts and seeds from the low-FODMAP list. These fibres are fermented slowly and are less likely to lead to more fluid in the gut, according to the International Foundation for Functional Gastrointestinal Disorders (IFFGD).

The solution is to deliberately increase your intake of fibre from low-FODMAP foods: Eat a wide variety of low-FODMAP fruits and vegetables, low-FODMAP grains and legumes, and small servings of low-FODMAP nuts and seeds.

*Disclaimer: The foods mentioned in this article form part of an extremely condensed list – those who wish to follow a low-FODMAP diet should work in conjunction with their doctors and/or nutritionists. 

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Marelize Wilke

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South Africans who menstruate are a step closer to free sanitary pads as government scraps the Value Added Tax (VAT) on sanitary pads from April 2019. 

Finance minister Tito Mboweni made the announcement during his Medium Term Budget Policy Statement (MTBPS) on Wednesday‚ which outlines how government will spend money in the next three years.

Bread and cake flour will also be exempt from VAT. 

The announcement to do away with the VAT on sanitary pads comes after years of activism and campaigns from civil society and ordinary South Africans. 

“It may have taken years to get to this point but the hard work, frustrations and run-arounds made it all worth it. Just to know that millions of people particularly from disadvantaged groups will benefit from this makes all the hard work worth it. Thank you, Minister,” says Sheilan Clarke who was part of Livity Africa’s #FreeToBleed campaign.

Mboweni also announced funds will be allocated to provinces to provide free sanitary pads to poor learners who menstruate.

“We will ensure that female learners in schools have access to sanitary pads.

“Several provinces have already taken the lead in rolling out the provision of free sanitary pads in schools. Funds will be added to the provincial equitable share to enable provinces to progressively further this objective,” he said in his speech. 

According to a 2014 study published in the British Journal of Medicine & Medical Research, the average person who menstruates will use up to 17 000 sanitary pads or tampons in their lifetime.

If a packet of disposable pads typically costs R45.00, one pad is about R2.80. A person could spend close to R48 000 in their lifetime. But zero-rating sanitary pads could equate to a saving of about R5 per packet — or R5000 in a lifetime.  

Zero-rating sanitary pads doesn’t make a difference for those who cannot afford them, says economist Thabi Leoka.

“What is important is not the zero-rating, but that government intend to allocate money for free sanitary pads for school-going learners who make up a large proportion of those who need sanitary pads. ”

In July 2017, the Department of Women in the Presidency hosted a stakeholders meeting where together with civil society and other governmental departments deliberated how the South African government would provide free sanitary pads to poor people who menstruation.

Delegates were presented with the department’s Sanitary Dignity Policy Framework which outlined the proposed roll-out plan for free sanitary pads. 

“We presented the framework to Cabinet in October 2017. Cabinet recommended the policy framework  developed further  that can be implemented and piloted to see how much it would cost government,” says Reshoketswe Tshabalala, the department’s Acting Director General. 

Cabinet selected Mpumalanga, Eastern Cape and KwaZulu Natal and the department will oversee the pilot projects which are earmarked to begin in November.

 “It’s not just about providing sanitary pads. We need to ensure that there adequate disposal facilities, availability of water and proper sanitation to ensure that menstrual health is managed” says the department.

– Health-e

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Pontsho Pilane

In June 2013, the National Director at Legal Resources Centre, Nersan Govender’s life changed when he was diagnosed with breast cancer. 

Speaking to DRUM, the 56-year-old said that there’s a stigma around breast cancer which is that it’s a women’s disease, but in reality, men also have breast tissues and can get breast cancer too.

This is his story:

“It was about five years ago and I discovered a pimple under my left nipple. I had no pain, nothing at all. I was energetic so you wouldn’t tell. That’s the thing about breast cancer even with women, you don’t really know it.

“So, what I discovered was a pimple and I thought it would go away. I went to the chemist and got an ointment, but the pimple never went away. It just started growing and eventually I went to an outpatient health facility and I was told that I have to go have a biopsy done.

“I had a biopsy done and that’s when I discovered I had breast cancer, and that it was spreading rapidly. With breast cancer for men, there are not many survivors simply because they don’t know and they don’t check.

Treatment challenges

“So, I went for the surgery, I went for the radiation, then I went through chemotherapy – it was a difficult time for my family and me. The treatment was for about 10 months. It was very hard — the treatment is actually harder than the cancer itself.

“Sometimes you just want to give up. This is when I discovered support groups. Wings of Hope was a group I discovered and it was still new. They helped me through difficult times and as I started to heal, I joined them as a volunteer.

“Today I head the organisation. I re-positioned it because support is not only about talking about treatment, but it’s about quality of life. 

A new kind of normal

“We try to teach people to have the quality of life and to value every single day, but also try to extend it to the families, because the families need to understand that they add stress when they say you need to be normal, but you can’t be normal. You will be a new normal.

“There were some days where I prayed to die, because during the treatment you’re alive, but you feel dead. I’ve watched some people die in less then a week from chemo. 

“Today I can proudly say that I am a breast cancer survivor. I have two birthdays now — the day I was biologically born and the day I got given a new life.”

This year Nersan celebrates his first remission. He lives by the motto, “Live your life every day.”

Nompilo Gwala and Tholakele Mnganga