IBS, FODMAPs and the Paleo Diet

You know there is something changing when a large, well-respected media outlet, like the Wall Street Journal, prints an article about health that focuses only on diet as a means to a cure rather than pharmaceuticals. That is what happened earlier this week when the Journal published an article about IBS (irritable bowel syndrome) and FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols). These are high carbohydrate foods which include dairy products, some fruits and vegetables, wheat, rye, corn syrup and artificial sweeteners. These foods cause IBS symptoms of gas, bloating, constipation or diarrhea for many people. Could it be that finally, there are those within the medical community, who are not looking to push pills to solve every ill?  Are we starting to see a reversion to Hippocrates’ idea of “let food be thy medicine and medicine be thy food”? Can it be that a Paleo diet solution for IBS isn’t far behind?

Dr Sue Shepherd, a dietician of Victoria, Australia, developed the low FODMAP diet in 2001. She has proven, through her research, that limiting dietary FODMAPs is an effective treatment for people with symptoms of IBS. The idea for this way of treating IBS is catching on in other parts of the world.  It is still relatively unknown in the U.S., but a presentation on FODMAPs drew a highly interested audience at the American College of Gastroenterology conference in Washington. Word is also spreading among IBS patient groups.

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The theory is that many people who have IBS have difficulty absorbing certain types of carbohydrates in their small intestines.  Since the food is not properly broken down, when these large molecules travel to the colon, they are attacked by bacteria and cause bloating, gas, diarrhea or constipation.

It’s been known for a long time that foods like dairy products, some fruits and vegetables, wheat, rye, corn syrup and artificial sweeteners cause stomach upset. In regards to lactose, a sugar found in milk, it is estimated that about 15% of Americans lack the necessary enzyme to digest it.  Now there is a growing awareness that the same applies to foods with high concentrations of fructose. Three other types of sugars have been found to cause absorption and fermentation problems in some people, such as fructans which are found in wheat and rye, galactans which are present in legumes and polyols, which are found in some fruits and fake sweeteners like sorbitol and mannitol. For a fuller list of foods allowed and foods to avoid, click here and here.

It is in fact probable, that people who do not have celiac disease but still have trouble digesting wheat products may actually be sensitive to the fructans in wheat rather than the gluten, which is protein component.

How does the FODMAPS diet work?

Elimination is the way this plan works. All problematic foods which contain FODMAPS are eliminated, then reintroduced slowly to determine if there is a sensitivity. From the IBS Diet plan website:

During your elimination trial, it is recommended that you eliminate all FODMAPs either significantly or entirely. Most patients will begin to feel significantly better within a few hours and a few days, but will take up to two weeks to feel fully healthy. A minority of patients have reported that it took up to three months to fully recover. After recovery, you can begin to gradually reintroduce foods using the steps outlined at the end of this article.

Many IBS sufferers with generally mild symptoms will find that a general reduction of fructose intake alone significantly relieves them of their symptoms. Other individuals will find that they must significantly reduce their intake of all FODMAPs to experience relief. You may find over time that eating certain FODMAPs does not bother you.

Finally, it should be noted that fructose – the ubiquitous simple sugar – is often allowed in “safe foods” if the food also contains a glucose-to-fructose ratio greater than one. This is because research shows that ingesting glucose at the same time as fructose (and in the same quantities as fructose) eases fructose absorption.

IBS, FODMAPs and the Paleo Diet

While this information may be news to some in the medical community at large, this is old news to followers of the Paleo diet.  Many of us have been through the elimination process, on our own, trying to figure out exactly what was making us sick to our stomachs. Some of us have done exactly what the FODMAPs diet prescribes, eliminate the offending foods and then reintroduced to see if we are effected by it.

But any move in the medical establishment that encourages diet change for health improvement rather than drug prescriptions is a change for the better. Perhaps the FODMAPs diet is another sign of a trend that truly embraces Hippocrates’ idea of  “let food be thy medicine and medicine be thy food”.

What do you think? Are we seeing a move away from prescription drugs toward food based health? Please join in the conversation by leaving your comments below.


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4 Responses to IBS, FODMAPs and the Paleo Diet

  1. Dr Peter Thatcher November 16, 2011 at 3:35 pm

    I have long thought that diet is a major factor in the management of IBS symptoms. We know that up to 70% of sufferers will gain benefit from an IBS diet. I don’t think there is too much new here. We have long know that lactose, gluten, some fruits and nuts can cause issues as well as high fibre substances, particularly in IBS-D and IBS-A.

    There isn’t a 100% correct diet for any one individual and diets have to be tailored to individual conditions and circumstances. The FODMAP’s clearly are an issue, but not necessarily for everyone. Food diaries are important to help determine which foods are helpful and which ones to avoid.

    To say that the medical community is behind everyone and just pill pushers is a little stereotypic and naive. I think medics with interest in IBS would be quite offended by these comments.

    • Lila Solnick November 16, 2011 at 9:19 pm

      Hi Dr. Thatcher,

      I agree that there isn’t a one size fits all diet. That is plain, when you consider what some people eat without problems. In the Paleo community, for example, there are people who have no ill effects from dairy and consume any type easily (even though it’s not a Paleo food), and others that cannot tolerate it at all. But there seem to be some foods that very few, if any people can tolerate well, such as grains, specifically wheat. The evidence is fairly clear that our health, as a species, deteriorated once we started to consume more wheat.

      As far as the medical community is concerned, I speak as I find. The allopathic doctors that I’ve encountered seemed totally uninterested in looking into the root causes of various ills that I’ve had. They were all ready to prescribe medications. And unfortunately I did take some of these prescriptions with poor results and long term side effects. Perhaps my view is biased, I will agree, but I’ve heard little to change my opinion of the conventionally trained doctor, unless said doctor entered the holistic realm. In the end it has been alternative medicine that I’ve used to remedy the problems I’ve had. A combination of dietary changes, supplementation, homeopathy and other therapies have brought healing to most issues, but the side-effect of one particular drug.still linger and will take time and money to remedy. I am deeply sorry if I’ve offended any doctors who think beyond pharmaceuticals and do look at diet and other causes for illness. These ARE the type of doctors we need. Healers in the truest sense and personally I welcome them!

      Thank you so much for visiting and commenting.

  2. Dr Peter Thatcher November 17, 2011 at 1:26 pm

    Thank you Lila

    I understand your experiences reflect your view on the medical community and it is disappointing that you have had these negative experiences which is to the shame of the medical community. Equally, if you need a real opinion then you need to seek the advice of a specialist in this area and not really on a generalist.

    Thanks for your comments.

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