Most of the millions of people who are jumping on the gluten-free bandwagon don’t have celiac disease, the condition triggered by a severe allergic reaction to gluten. Some of these people may have gone gluten-free believing that this protein found in wheat is the cause of their irritable bowel syndrome (IBS).
But avoiding gluten may be in vain for IBS sufferers, because a growing body of evidence suggests that fructose and a collection of other of hard-to-digest carbohydrates known as FODMAPS could be the cause for their gastrointestinal distress.
FODMAPS and IBS
Credit for establishing the link between FODMAPS and IBS goes to Sue Shephard, a dietitian and researcher in Melbourne, Australia who sought a nutrition-based treatment for celiac disease. She developed an experimental diet that eliminated foods often not absorbed in the small intestine that cause cramps, bloating and diarrhea once they reach the colon.
As part of her PhD thesis at Monash University, she tested her diet on 25 people with irritable bowel syndrome for 22 weeks and found that at least 70 percent were relieved of their symptoms. The foods eliminated from the diet included a long list of popular staples such as apples, pears, onions, beans, milk, fruit juices and sodas.
The offending nutrients are a group of carbohydrates including fermentable oligosaccharides, disaccharides, monosaccharides and polyols. To simply that mouthful, Shepherd and her colleagues coined the term “FODMAPs.”
Drugs vs diet
Shepherd began teaching FODMAP avoidance in 1997. Her thesis study was published in the journal Gastroenterology in 2009. In 2012 Bloomberg reported that she employed 13 dietitians in a practice treating nearly 4,000 people a year. Yet in the U.S. mainstream medicine largely ignores the influence of diet on IBS.
American patients are often advised to take fiber supplements or over-the-counter anti-diarrheal medications. Doctors write prescriptions for antibiotics, antispasmodics and even antidepressants. In severe cases of IBS, a powerful drug called Lotronex could be prescribed, but only after the patient signs a statement acknowledging risks that include serious or fatal side effects.
The low-FODMAP diet
According to the digestive Health foundation in Melbourne, a day on the low-FODMAP diet could include a poached egg with spinach plus a banana for breakfast, a ham and salad sandwich on gluten-free bread for lunch, and grilled chicken, baked potato and sauteed spinach and capsicum, seasoned with the green onion, salt, pepper, olive oil and pine nuts. Safe snacks include with blueberries, or peanut butter on a celery stick.
Ask a pro
Developing a low-FODMAP diet suitable to your individual needs is a process of elimination and careful re-introduction that requires expert help. If you think a dietary intervention could be the answer to your IBS, a dietitian who is up to speed with Shepherd’s approach can help you learn what foods to avoid—and most importantly what you can eat to stay healthy.
New York Times
U.S. News & World Report