Currently viewing the tag: "pain"

Acupuncture has a long history of use to treat many conditions, including pain, depression, fatigue and addictions.  It is known to effect local responses as well as distal changes through neurological and endocrine systems. When used together with heat treatment it can cause multiple biological responses, seen both in animals and humans.  However, the mechanism and biochemical changes responsible for these effects are still unclear.  Chinese concepts refer to the flow of Qi, five element theory and yin and yang. Anatomical studies show that most acupoints located along the meridian lines (also known as channels) are located closely to nerve fibre distribution and blood vessels. Interestingly, there is also an increase in hair follicles and sweat glands at these points.

Nitrous Oxide (NO) is known to play an important physiological role in skin local microcirculation, neurotransmission, immunity and wound healing. It produces relaxation of blood vessels via an increase in NO synthase acitivty, but also utilizes the nitrate-nitrite-NO pathway in the human skin. Studies in rats have also shown that NO content and NO synthase protein levels are in the skin tissue at acupoints and meridian lines. Repeated thermal application also increases immunoreactivity and NO synthase in hamsters. NO also mediates noradrenergic function on skin sympathetic nerve activation, which contributes to low resistance characteristics of acupoints and meridians.

One crossover study conducted on 20 volunteers who underwent a real acupuncture and then non-invasive sham acupuncture in the hand or forearm with 1 week interval between treatments. The blood plasma concentration of NO in the acupunctured arm and hand was significantly increased, which was not observed in the sham acupuncture.

A more recent published study at the Harbor-UCLA Medical Center examined the effect of manual acupuncture and electrical heat to the release of nitric oxide (NO) over the human skin. Participants included 25 volunteers (men and women) aged 18-60 yrs. Participants were randomly asked to undergo manual acupuncture over the pericardium meridian, or heat treatment over the lung meridian. NO was monitored using a Biocapture device with a collecting solution taped to the skin along the meridians. Results found that manual acupuncture and electrical heat cause release of NO from the local skin, which was almost doubled at acupuncture points.

Initial pilot studies also show that the extent of NO production can vary depending on the person’s age and gender due to the differences in sympathetic acitivity, body weight, hormones, sweat rates and skin thickness. There was no noticeable difference between different ethnic groups.

The importance of a rich blood circulation is an evident necessary part of tissue healing, and suggests the rationale for subsequent pain relief or sensitising substances. These studies determined that acupuncture elevates the local level of NO in the treated areas, thus increasing blood flow and warmth. There is vasodilation accompanied neurochemical changes which may further contribute to generation of NO. Thus suggesting that acupuncture treatment using a reinforced technique and the addition of electrical heat will improve local circulation.

Clinical experience has shown that the use of acupuncture for pain relief is an excellent alternative to the use of medicinal pain killers.  However we must not ignore the benefits of increase blood circulation for other conditions, therefore improving the overall body functions.  My own clinical practice regularly incorporates the use heat in the form of direct or indirect moxa or electrical heat. We have always found that the addition of heat enhances the needle effects, thus confirming the above research findings. It should be a treatment choice for those experiencing pain but in particular where there is chronic pain.

 

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Electroacupuncture (EA) may be the answer to improving regulation of blood sugar levels in overweight and obese women. New research published in the FASEB Journal reported that scientists found that a single bout of (EA) activated the sympathetic and partly the parasympatheric nervous system which increased whole-body glucose uptake, an important consideration in the treatment of insulin resistance or prediabetes.

Researchers measured blood sugar levels in 21 women with and without polycystic ovarian syndrome (PCOS) during and after 45min of EA compared to the same number in a control group. PCOS is a common hormonal disorder, but also associated with an increased risk of Type 2 diabetes. The results showed improvement in both groups of women, suggesting a potential benefit for women with PCOS. In a second experiment they also investigated its effects in rats who received autonomic receptor blockers. They found EA caused muscle contractions which in turn activated the autonomic nervous system (responsible for blood sugar regulation), despite the receptor blockers. Previous studies have found that EA in rats1, 2  enhanced insulin sensitivity and lowered blood sugar levels.

EA is believed to be used as far back at the early 1800s, while others attribute it to Japanese scientists trying to improve bone fracture healing in 1940s or  pain control by the Chinese in the 1958.  As with traditional acupuncture in EA needles are inserted in the same way on specific points. Two needles are selected which are then attached to a pair of clips connected to a device that generates continuous electric pulses. The frequency and intensity of the pulses are adjusted according to the condition being treated. In this way several pairs of needles can be simultaneously stimulated for duration up to 30 min. People usually experience a light tingling sensation due to the electrical current.

Advantages of using EA are;

  • The current stimulates a larger area than the needle on its own, thus requiring less precision needling.
  • It can be used without needle insertion, commonly known as TENS (transcutaneous electrical nerve stimulation).

EA is considered to be particularly useful in conditions where there is stagnation or accumulation of Qi. In Chinese medicine Qi is a life energy that flows throughout the body and essential for good health.  Persistent chronic pain is associated with Qi accumulation and the effectiveness of EA has been reported to be particularly useful. This is supported by research evidence that electrical stimulation of acupuncture points activates the release of endorphins, thus lowering blood pressure and heart rate.

Research on EA in stroke has shown positive effects in cognition and quality of life.  When compared to manual acupuncture, EA is more effective in relieving spasticity in stroke. Other conditions that may benefit include; neurological conditions, fibromyalgia, nausea caused by cancer drugs and post operative pain control.

Treatment with (EA) should be avoided in those with a pacemakers as it may disrupt the electrical impulses. For similar reasons, it should not be used over the heart. Careful assessment should be carried out before treating people with a history of seizures and epilepsy.

 

 

It’s not uncommon for the proponents of conventional and of holistic systems of medicine to feel that they inhabit competing camps in the war to alleviate human suffering. In fact, Western and Eastern medicine are essential branches on the great tree of scientific knowledge.  Many of us are working towards the ideal of a continuum of care that provides the very best treatment to all patients. Western medicine has achieved remarkable triumphs.  Vaccination against many infectious diseases has greatly reduced their incidence; science has eradicated smallpox and come close to doing the same for polio.  It has saved millions of children from the scourges that once prevented so many from reaching their fifth birthday.

The specialties of surgery and emergency medicine save countless lives every day.

After decades of clinical practice I still wonder; Where does Western medicine fall short?  In the promotion of lifelong wellness; in the diagnosis and treatment of complex disorders; in the unnecessary or excessive use of pharmaceutical drugs; in safe, effective, ongoing pain management.

We’re certainly making progress in bringing these two branches of medicine closer, for example;  acupuncture has been proven to offer effective pain relief and increasingly accepted in medical pain clinics, and it doesn’t carry the risks associated with drug-based analgesia. Integration of auricular acupuncture in addiction clinics is another measure of its success. There is worldwide recognition of acupuncture for anxiety and stress particularly in cancer treatment, post traumatic stress disorder amongst veterans, and its potential value as anesthesia during surgical procedures.

I have always found that it is necessary to treat the whole person, and not just deal with an immediate crisis or what presents as their most significant symptom. I wanted to share this story (to ensure anonymity names and certain details have been changed).

Ria’s Story-  “Please… I Just Want the Pain to Stop”.

In the hospital waiting room Ria’s stomach churns and twists once again sending shooting pains throughout her body, followed by a cold sweat.  Over the past six months, she’s seen six different doctors; has endured repeated blood tests and other procedures.  No one has been able to offer her a definitive diagnosis. After each visit, she’s sent home with different prescriptions but no effective treatment for the repeated, alternating bouts of diarrhoea and constipation, sometimes nausea too.  Pain medication doesn’t bring any relief.  Her husband Pete feels equally anxious and frustrated.

Visits to six different doctors, blood tests and investigations all have proven to be unhelpful – there is no definitive diagnosis. Each time she is sent home with new meds, pain medication doesn’t work, one tells her that she is stressed and emotionally disturbed and prescribes her antidepressants another says there is some inflammation in her spleen, but nothing else. Ria is desperate, her symptoms are worsening.

Ria is beginning to doubt herself; wondering if it really is “all in her mind.”  She’s afraid to eat because everything just makes her feel worse, and she’s now two sizes smaller.

After yet another round of tests, Ria’s new consultant is also perplexed by her symptoms.  His examination of her shows nothing significant.  He’s ruled out cancer or other serious disease; all her other results are relatively normal. But fortunately for her, this doctor takes the time to listed to her and has a positive view of complementary therapies; he understands that functional disorders often underlie a patient’s stress and anxiety.  He knows that food intolerance is increasingly common and is often very hard to properly pinpoint. He asks her if she would be willing to accept a referral to a holistic physician.  Ria has always had an interest in complementary therapies and gladly agrees. He also gives her advice on juicing and enrolls her on to a mindfulness course.

As a holistic practitioner, I see Ria’s physical and emotional distress to be strongly interrelated, but requiring individual attention, with this in mind I begin acupuncture treatments. Almost immediately, they help to ease her distressed state and bring some relief for her stomach pain.

Over a period of months I guide Ria to make changes to her diet.  Together we develop a plan to identify problem foods. She learns about carbohydrate intolerance and how the FODMAP diet can help.  Ria finds the mindfulness course very effective in relieving her anxiety.  She began to realize her physical and emotional distress began years before the manifestation of painful bowel dysfunction.

Six months after starting treatment, Ria has made great progress.  She knows it will take time to regain the good health she thought was out of her reach, but she is no longer frightened and discouraged.  She is starting to take pleasure in eating again.  She and her husband are now enjoying what they thought might never be possible again–everyday pleasures.

 

From the seemingly innocent to the definitely ominous, additives are everywhere.  Even if you cook or bake everything you consume from scratch, you’re still adding substances to food that aren’t naturally found in the raw ingredients.  And even if you buy products marked “organic” or “all natural,” they are likely to have added preservatives such as tocopherols (vitamin E) or citric acid–found in fruits such as lemons and oranges, and now produced industrially.

We add subtances to food that aren’t naturally found in the raw ingredients.  And even if you buy products marked “organic” or “all natural,” they are likely to have added preservatives such as tocopherols (vitamin E) or citric acid–found in fruits such as lemons and oranges, and now produced industrially.

Rainbow_of_food_natural_food_colors

Additives serve many purposes:

  • Colours  that enhance appearance
  • Preservatives that help protect against food deterioration caused by bacteria.
  • Antioxidants that slow down or stop the oxidative deterioration of foods–what we call rancidity
  • Artificial sweeteners which are lower in calories than sugar–and cheaper to use.
  • Flavour enhancers that improve the taste and aroma of food.
  • Presentation and texture enhancers e.g. thickeners, gelling agents, emulsifiers, emulsifiers.
  • Nutrient additions that increase the nutrient value of foods

The history of food additives is as old as civilization.  Salt, sugar and vinegar were the first preservatives commonly used by cultures around the world, as well as techniques such as smoking and drying.  Chemicals have been developed to accelerate or mimic these processes, or as cheaper alternatives to traditional methods.

Although the chemical additives commonly used in foods must be demonstrated to be safe for human consumption, there are still many concerns about their use:

Allergic Reactions

  • Sulphite and sulphur dioxide (E220-28) have been known to cause allergic reactions. Specifically, asthma sufferers should avoid sulphur dioxide gas due to increased sensitivity, but there are also recorded cases of worsening of asthma after drinking soft drinks containing it. They are mainly found in dried fruits, dessicated coconut, relishes and fruit-based pie fillings.
  • Food colours like tartrazine (E102)can cause mild allergic reactions and some studies show that sunset yellow (E1 10) can cause tumours.
  • Annatto, a natural food colouring found in margarine, cheese, smoked fish and cakes is implicated in allergic reactions and irritable bowel.

Cancer

  • Aspartame (E951) has been linked to various cancers(1,2,3), although studies by US National Cancer Institute and European Food Safety Authority concluded that it did not increase the risk of cancers.
  • Erythrosine is a red food colour. Research has highlighted concerns about its potentialtumour formation and inhibition of the normal functioning of the thyroid.
  • Allura red has been associated with cancer in mice but evidence is not consistent.
  • Nitrites and nitrates (E249-52) may convert in the stomach to potentially carcinogenic nitrosamines.

Hyperactivity

  • Although a definitive link has not yet been established food colours like sunset yellow (E110), quinoline yellow (E104), carmoisine (E122), allura red (E129), tartrazine (E102) and ponceau 4R (E124) have been associated with hyperactivity in some children. These are commonly found in a variety of processed foods, especially in children’s sweets, confectionary, squashes, soft drinks, jams and cakes. Prevalence of hyperactivity is estimated to be about 2.5%.
  • Aspartame has also been linked with changes in behaviour.

Headaches

  • MSG (monosodium glutamate- E621) is a flavour enhancer can cause headaches in some people. Although in a recent review there was no conclusive direct evidence.
  • Aspartame is also linked with causing headaches.

Other

  • Gums (E412, E414) are used to thicken food and improve texture. Theycan give rise to flatulence and abdominal pain.

The Bottom Line

Additives are overused in the processed foods industry, so try to avoid them as much as possible.

  • Always read food labels to be fully aware of what you are buying.
  • Keep processed foods to a minimum, including sweeteners, sweets, lollies, soft drinks and cakes.
  • Be careful of foods that are presented as low-fat, sugar-free as they are likely to be additive-rich and nutrient-poor.
  • Every individual reacts differently to food and additives. It’s possible to be allergic to anything–even the most “natural” subtance.  If you suspect a sensitivity to anything you eat, try a process of elimination to discover the source of the problem, or consult a practitioner trained in nutrition.
  • If your child shows signs of hyperactivity of attention deficit hyperactivity disorder (ADHD) then eliminating some colours from their diet may prove beneficial.

If you have concerns about your own diet or that of a family member, and how it may be affecting health, consider scheduling a consultation with us.

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A pragmatic randomised controlled trial of healing therapy in a gastroenterology outpatient setting

R.T. Lee, T. Kingstone, L. Roberts, S. Edwards, A. Soundy, P.R. Shah, M.S. Haque, S. Singh

Link to Full Article

Abstract     

Introduction

To determine the benefits of healing therapy (spiritual healing) as an adjunct to conventional management in irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).

Methods

200 outpatients with IBS or IBD were randomised to either conventional treatment (control) or conventional plus five sessions of healing therapy (intervention). After 12 weeks controls also had healing therapy. Outcomes used were, the Measure Yourself Medical Outcomes Profile (MYMOP). IBS-QOL, IBDQ, and symptom measures.

Results

There was a significant improvement in the MYMOP score at week 6 (p < 0.001) which was maintained to week 12 (p < 0.001) and 24 (p < 0.001). Improvements in MYMOP were significantly greater in the intervention group at both 6 (p < 0.001) and 12 weeks (p < 0.001) with effect sizes of 0.7 (95% CI: 0.4–1.1) and 0.8 (95% CI: 0.4–1.2). Condition-specific data for IBS showed that most QoL dimensions had a significant minimum 10-point score improvement at 6 and 12 weeks. The overall score improvement was 12.9 units at week 6 (p < 0.001), 12.4 units at week 12 (p < 0.001) and 13.8 units at week 24 (p < 0.001). In IBD there was also similar score improvement, but only up to week 12 were there associations of improved social and bowel functions (p < 0.001, respectively). Between group differences were identified for QoL scores in IBS at both week 6 (p < 0.001) and 12 (p < 0.001) but only for week 12 (p < 0.001) in the IBD group.

Conclusions

The addition of healing therapy to conventional treatment was associated with improvement in symptoms and QoL in IBS, and to a lesser extent in IBD.

 

Artificial sweeteners are non-nutritive, manufactured chemicals with few or no calories. In the UK permitted sweeteners include; aspartame, saccharin, acesulfame potassium (known as acesulfame K), cyclamate and sucralose. We are addicted to the taste of sweetness and the widespread use of sweetener substitutes in food and drink has made our sweet tooth even worse.

Artificial sweetener

Unsurprisingly, sweeteners have been found to be responsible for weight gain rather than weight loss. This is applicable even if Aspartame is taken at levels recommended by the United States FDA (Food and Drug Administration). Research carried out in young hamsters found that those on Aspartame tended to eat more and there was also evidence of damage to brain and liver cells. Other studies carried out in rats have also shown that compared to sugar, sweeteners saccharin and aspartame cause weight gain which is unrelated to caloric intake.

Researchers  have speculated the cause of weight gain to be either reduced energy expenditure or an increase in fluid retention. Breakdown of aspartame produces phenylalanine which is a known inhibitor of a gut enzyme IAP (intestinal alkaline phosphatase). IAP in mice has been shown to prevent metabolic syndrome, a group of symptoms associated with type 2 diabetes, obesity and cardiovascular disease.  In another study aspartame was linked to reduced insulin sensitivity therefore affecting blood sugar regulation.

The act of eating requires a feeling of satiety and satisfaction. A pilot review suggests that sweeteners only offer partial activation of the food reward pathways in the brain. This may also be responsible for the consequent increase in appetite as an attempt to complete the satiety cycle. Such impaired activation has been observed in obese adolescent girls after drinking milkshake.

Intake of artificial sweeteners has a huge contributory effect of our weight gain and obesity problem.  Although not immediately apparent, over the longer term it significantly increases the risk of health problems. Convinced that they are doing the right thing many people choose a diet option. Their aim is to try to lose or maintain their weight but ironically it is causing just the opposite.

The dangers of sweeteners need to be acknowledged by the public health sector and the food industry. Introducing manufactured substances into our body in the form of artificial sweeteners, additives, preservatives and in many other commercial products has a major influence on our body’s chemistry, creating a chemical disaster equivalent to a tsunami. The human body is not made to digest artificial foods that may look and taste similar and nutritionally they can never replace fresh natural foods.

 

 

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Birchfied Big Local recently conducted video interviews of clients and their views on the service.

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A ‘trapped nerve’ describes compression on the nerve, usually due to pressure applied by the surrounding tissue, muscle, tendon or bone. This can present as pain in the neck and shoulder, back, legs, arms and wrists. Common examples include; bulging of the spinal discs and carpel tunnel syndrome. In other less serious causes it can be due to muscle spasm or other mechanical factors.

Nerve compression

The resulting pressure results in inflammation of the nerves giving rise to pain in the area which may radiates to other parts of the body, numbness and tingling, burning sensation and weakness. Once the pressure is relieved the nerve function recovers, but with chronic pain permanent nerve damage can occur.

At the Integrated Health Clinic cases of pain caused by nerve compression are quite common. Most present with severe almost agonising pain. There is limited or very little relief from pain killers, they are unable to sit, lie down or walk without discomfort, unable to adequately perform daily activities, have to take time off work and a good night’s sleep has become a distant memory.  Where the problem is muscular Acupuncture can be used effectively for pain relief, reduce inflammation and easing the muscle spasm.

Acupuncture works by stimulating the ‘Qi’ (vital energy) to flow properly within the impaired qi pathways known as ‘meridians’. Needles help to release neurochemicals such as endorphins which change the way pain is processed in the brain and spinal cord, as well as release of vascular and immunomodulatory factors that reduce inflammation. As a standard the clinic also uses heat treatment some soft tissue manipulation such as massage or cupping to reduce soft tissue constraints, tension and enhance blood flow. Our experience shows that a combined integrative treatment approach greatly enhances the overall outcome.

After suffering from agonising and tearful shoulder pain, a client recently received a combined acupuncture and massage treatment, along with electro-acupuncture which involves the use of electrical needle stimulation. Not only did their pain symptoms and numbness significantly improve but they were pleasantly surprised that their mood was considerably uplifted. Their feedback was…. “I feel so much happier”. This is a welcome and inevitable effect of acupuncture, confirming results from many scientific studies that it benefits not just the physical but also the mental and emotional.

To learn more about how acupuncture or a combined treatment can help you, call or book an appointment.

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If you are struggling with your Irritable Bowel Syndrome symptoms (IBS), don’t give up just yet instead, Take back control !

IBS is a functional disorder athat affects the colon and causes irritable of the lining of the colon. Symptoms can include; diarrhea and/or constipation, bloating, gas and abdominal cramps. Whilst a small proportion of sufferers need to take medication, most people can control it with dietary changes. Studies have shown that avoiding certain foods can help to reduced severity and fewer symptoms, with much improvement in quality of life.

All IBS Is Not The Same

Understanding your IBS is the best way to manage it. Some general tips are;

  • Have regular meal times, chew well and avoid eating in haste to help the process of digestion.
  • Drink at least 8 cups of fluids a day. This can include water, soups, herbal or non-caffeinated drinks.
  • Regular exercise has shown to help reduce symptoms.
  • Reduce stress
  • Benefit can be had from gaining advice on nutritional supplements e.g. multivitamins, essential fatty acids and probiotics to remedy any nutritional deficiencies that may have resulted due to prolonged IBS symptoms.
  • Complementary therapies like acupuncture can help to reduce symptoms and calm the digestive system. It is particularly effective for functional problems. It can also help to reduce stress caused by a busy and demanding lifestyle.

Dietary Changes

  1. Avoid or restrict drinking tea, coffee, alcohol and fizzy drinks.
  2. Avoid artificial sweeteners.
  3. Avoid fatty foods.
  4. Start to keep a food diary and when symptoms occur. This will help to identify problem foods.
  5. Avoid or limit foods that may worsen symptoms.
  6. If you have persistent or frequent bloating, a low FODMAP diet can help. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. Essentially these are carbohydrate, but specifically FODMAPS are certain types of carbohydrates that are not easily broken down and so have difficulty being absorbed by the gut. Left undigested in the gut they quickly start to ferment to release gases resulting in bloating. Low FODMAP diet essentially involves restricting your intake of high FODMAP foods e.g. some fruits and vegetables, animal milk, wheat products and beans. There is a danger of eliminating too many foods, potentially impacting on general health. Thus seeking guidance from a knowledgeable professional will ensure that you maintain a healthy balanced diet. You can read more about the low FODMAP diet here.

Give Foods Another Chance

When you are actively experiencing IBS symptoms it can seem like you react to almost everything that you eat. Often people may have eliminated food that they are able to eat if their colon is not in a reactive state. Thus, after a minimum of 3-4 weeks of food avoidance or limitation, the colon will have rested and calmed down. At this time you can start to can bring back foods one at a time at a rate of one item per week. You might be pleased to discover that you’re only sensitive to one or two FODMAP carbs, not all of them e.g. wheat is a problem but dairy is OK.

Creating Your Own Personalised Diet

The aim is to find out what foods or other factors (e.g. stress) trigger your IBS symptoms. In this way you can create your own personal diet which gives you all the nutrients you need but only includes the foods that you can handle.

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What are FODMAPs?

FODMAPs are short chain carbohydrates and sugar alcohols naturally occurring in foods or as an additive.  As a group they are known as FODMAPs (Fermentable Oliogosaccharides, Disaccharides, Monosaccharides and Polyols). Not all carbohydrates are considered FODMAPs and the content level also varies.

Collectively they have three common properties:

  1. Incomplete digestion and absorption. They can be classified into two groups;
    • Those that are partly absorbed FODMAPs (fructose, lactose polyols)
    • Those which are not absorbed in anyone (fructans and galactooligosaccharides)
  2. Osmotically active action drawing in water into the large bowel.
  3. Rapidly fermented by bacteria due to their short chain molecular structure.

FODMAP image
Low FODMAP diets are scientifically proven and was first pioneered in Melboune, Australia for the management of IBS. However, in the UK it is still a relatively new concept. The effectiveness of FODMAP diets is variable. In people with IBS it is around 70%. All FODMAPs have a role in symptom development, but the dietary amount varies across the different genetic, ethnic and dietary groups. For example people who can digest lactose, dairy products are not a problem. Fructans and fructose are most common in North American, Western and European diets. Furthermore, we have to consider that the rate of absorption of fructose in the small intestine is widely variable and consequently the effects experienced by different people will also vary.

How do FODMAPs affect the bowel?

Luminal distension is considered to be the common physiological cause of many functional gut disorders. It induces symptoms of pain, bloating and abdominal distension. This evidence comes from Barostat and gas infusion research studies. FODMAP food that has not been digested passes through the small intestine to the colon where they are fermented by the bacteria resulting in the release of gas causing bloating, wind and pain. Due to their osmotic nature water enters the colon resulting in loose motions and diarrhoea. Research has shown that in individuals with sensitive bowel function (e.g. IBS) FODMAPs tend to react more readily.

What can I do to find out what if FODMAPs affect me?

If you have gastrointestinal symptoms, diarrhoea, constipation, gas, bloating and/or cramping then you are more likely to be sensitive to the effects of FODMAPs. Reduce your intake of high FODMAP foods for 4-8 weeks and observe whether your symptoms improve. If they do then you can start to reintroduce some of the higher FODMAP food one at a time to see if your symptoms recur. You can track your symptoms in a diary or use a symptom tracker app.  The lists below will also be helpful.

  1. Low FODMAP shopping list (Kate Scarlata, 2014) PDF
  2. Low FODMAP food list (SIG, 2016) PDF 

Resources:

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