FODMAPs and Gastroenterology
Why does this diet actually help?
This three-part blog series is based largely on an article published in December 2012 in Practical Gastroenterology, “A FODMAP Diet Update: Craze or Credible?” Series editor: Carol Rees Parrish, M.S., R.D. Article authors: J. Reggie Thomas, DO, Banner Good Samaritan Medical Center. Rakesh Nanda, MD, FACP, FACG, Phoenix VA Health Care System. Lin H. Shu, MS, RD, Phoenix VA Health Care System, Phoenix, AZ.
That journal is published for people who read at the MD or PhD level. This blog series is an attempt-to-translate for the rest of us!
Part Three: Testing the Low-FODMAP Diet
After reading the last two blog posts on CCF, you now know more than you really wanted to know about the different kinds of sugars that are in your foods. What about the medical evidence behind the low-FODMAP diet?
Early IBS researchers focused mostly on fructose and lactose, and they helped many IBS sufferers. Then in 2006, Dr. Shepherd’s ground-breaking study showed that restricting ALL FODMAPs “led to sustained improvement in all gut symptoms in 77% of 62 patients with IBS and fructose malabsorption.” That is an enormous percentage! In 2008, further study was conducted (the researchers call it “double-blinded, randomized, quadruple arm, placebo-controlled rechallenge trials,” if that impresses you! It impressed my gastroenterologist).
The double-blinded etc. study was even MORE encouraging. 77% of patients who consumed the FODMAPs fructose and fructans, and 79% who consumed a mixture of fructose, fructans, and glucose, “reported their symptoms were not adequately controlled” … but only 14% of people who consumed glucose only! Glucose, a non-FODMAP sugar, did not seem to be causing IBS symptoms in most people.
The picture just kept getting clearer.
[Please note: We are not talking about people whose diagnoses included celiac, Crohns, or other severe intestinal issues—that’s why it is vital to go to your doctor FIRST and make sure you aren’t suffering from one of those very different illnesses. IBS has traditionally been a “diagnosis of exclusion,” meaning they couldn’t find anything else wrong with us.]
A 2010 study confirmed that FODMAPs sometimes create discomfort by increasing gas production—like blowing up your insides as a balloon. And a 2011 study of 82 patients showed statistically significant results for limiting FODMAPs. In that study, it decreased “bloating, abdominal pain, and flatulence.”
So the authors of this medical-journal article ask, “How should the FODMAP diet be used?” and they answer, “with a dietician’s assistance.” They suggest getting a referral from your physician, and then hopefully getting 1) hydrogen breath testing, which can show exactly which sugars you aren’t tolerating, 2) dietitian referral (Yes, the article spells “dietician/dietitian” both ways—who but a compulsive copy editor is likely to notice?), 3) complete FODMAP restriction for 6 weeks—cutting ALL of them out of your diet, to give your symptoms a chance to go away, and then 4) a “slow controlled reintroduction of FODMAPs to determine the level that will be tolerated.”
I like #4. It gives me hope. It means that I might not have to go without all these sugars for the rest of my life. But even if I do, I believe it’s worth it to feel this much better. I don’t know how I stopped making some of those transporter molecules (Part One), if that’s what happened. I do know I used to be able to eat all those foods, though I always had some gas/bloating issues. But things got much worse after a stressful time in my life. Maybe you had a similar experience.
Summing up, the authors of this respected-scientific-journal article write, “The FODMAP diet may once have been a craze, but now with an increasing body of evidence behind it, is definitely a credible and valuable tool in the management of patients with FGID.”
Print that paragraph—and the title & date of this journal article—take it all to your doctor, and get started!