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.
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.