This article has been making the rounds online and we wanted to take a moment to review. The argument is that people who have Irritable Bowel Syndrome (IBS) are simply having trouble digesting certain carbohydrates.

The challenge is that the idea behind this hypothesis are close to correct. The down side is that the diet probably restricts a lot of foods that any given specific individual IBS patient doesn't need to avoid. They are removing many of the common food allergens, but in a shotgun fashion. So it's not surprising that people are getting better.

Another challenge is that people don't really know exactly why they feel better, so when they cheat they don't know why the consequences differ from one food to the next. And when it doesn't work, which these shotgun approaches often won't, then they don't understand that either. And of course it's not nearly as effective as they claim. Those claims are always overstated. If we took every study that said that 75% of IBS sufferers improved, then we'd have over a 1000% success rate!

Excerpt from WSJ.com:

As many as 20% of adults at some point suffer from a painful digestive disorder that is difficult to diagnose and has no cure. Treatment is hit or miss, and many sufferers never seek help because they find the symptoms hard to discuss.

Irritable bowel syndrome (IBS) has long baffled gastro-intestinal experts. Some think it is caused by imbalances in gut bacteria; others point to psychological stress. Now, a small but growing contingent of specialists is focusing on food intolerances as a possible culprit—and a new dietary approach, called the low-Fodmaps diet, is gaining attention around the world.

Irritable Bowel Syndrome, a painful gas-and-bloating condition, plagues 10 to 15% of adults at some point and has long divided GI experts. As Melinda Beck on Lunch Break explains, a growing contingent of specialists are focusing on diet as a culprit.

The theory is that many people with IBS have trouble absorbing certain carbohydrates in their small intestines. Large molecules of those foods travel to the colon, where they are attacked by bacteria and ferment, creating the telltale IBS symptoms of gas, bloating, constipation or diarrhea.

A long list of foods—including dairy products, some fruits and vegetables, wheat, rye, corn syrup and artificial sweeteners—can potentially create such problems in susceptible people. Collectively, they're known as Fodmaps, an acronym that for stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.

In people who have bacterial deficiencies (not enough of the good bacteria we all need - often due to antibiotics, infections or other factors) it is possible that they are not producing enough of the enzymes needed to break down the carbohydrates the FODMaps diet is tying to avoid.

In these cases the diet helps, but the patient would be far better served by having their underlying bacterial imbalance fixed - then they wouldn't need to avoid any of these foods because they would be able to digest them normally. But there is another factor - food allergy. It is no coincidence that the FODMaps diet is both relatively successful and avoids the most common allergenic foods.

There are many good studies showing that IBS patients often have immune system reactions in which immunoglobulin to foods can cause a person to have all the symptoms of IBS. The most common allergenic foods being dairy, soy, and gluten grains (including non-gluten parts of these grains).

The most worthwhile quote in the entire article: "We've been missing the boat in not recognizing the role of foods in functional GI disorders," Dr. Chey says. "We'll see much more attention to this in the next few years."

The IBS Treatment Center hasn't been missing the boat. We have been helping patients from all over the world identify their food allergies and intolerances for 6 years.

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More one size fits most solutions - this time it is the FODMaps diet. The argument is that people have trouble digesting carbs.

But there is plenty of evidence that many people are allergic to some of the foods eliminated in this diet. That point, plus the evidence that many people have allergic reactions to gluten is likely a better explanation as to why.

The cited theory, (that people with IBS have difficulty absorbing certain carbohydrates) doesn't explain the dairy part of the diet at all.

Diet May Provide IBS Relief

Eating guidelines called the low-Fodmaps diet are gaining attention as a way to relieve irritable bowel syndrome. The diet calls for eliminating certain foods, including dairy products, wheat, rye, corn syrup, fruits, artificial sweeteners and vegetables, on the theory that people with IBS have difficulty absorbing certain carbohydrates.

A key quote from a recent Wall Street Journal article sums up the misconception:

"Eventually, many IBS sufferers find they can tolerate many foods on the list as long as they keep the total amount of Fodmaps under a certain level."

"It's not like having celiac disease, where people can't ever eat gluten," says Sue Shepherd, a dietician in Victoria, Australia, who developed the diet in 2001 mainly for patients with lactose or fructose intolerance, but found it worked well with IBS sufferers as well."

Our response: That's because celiacs "can't" eat gluten. Remember, the vast majority of people with celiac disease are asymptomatic.

The article continues...


"GI doctors can also rule out more serious causes of symptoms, such as celiac disease, inflammatory bowel disease or colon cancer."

"We've been missing the boat in not recognizing the role of foods in functional GI disorders," Dr. Chey says. "We'll see much more attention to this in the next few years."

Agreed!
In the same 'Digestive Health Brief', there was this about gluten free:

People who respond to gluten-free diet may not all be celiacs. People with gastrointestinal issues who feel better after going gluten-free do not necessarily have celiac disease, says Washington, D.C.-area gastroenterologist Dr. Robynne Chutkan, who adds the popularity of the diet is more of a trend than anything else.

A blood test and biopsy are used to diagnose celiac disease, and a food challenge can show gluten intolerance, but using a gluten-free diet to lose weight may not be a good idea.

Your thoughts?
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