Understanding Irritable Bowel Syndrome/Disease

(An interesting piece of information, I wrote this short article in 2005! on maternity leave! I am republishing from my archive...

I wrote this shortly after researchers at Monash University, Australia discovered that there are a group of short chain carbohydrates (commonly found in foods) that are either poorly absorbed in the intestines or impossible to absorb altogether. Lots of research and studies have since been undertaken, I will update/ add more insight to the following soon. In the meantime, enjoy reading, the information below remains accurate)

What is the difference between gluten sensitivity and sensitivity to natural sugars found in foods?

Is IBS similar to Celiac disease?

Some people may experience bloating and flatulence in response to FODMAPs,

Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols instead of gluten. FODMAPs are small chain carbohydrates that are poorly absorbed in the small intestine and are present in most commonly consumed carbohydrates like, bread and fruits.

As they are poorly absorbed in the GI tract, FODMAPS can cause more water to be pulled into the colon and can also rapidly ferment, or be broken down, by bacteria in the bowel. This causes symptoms like increased gas, bloating, constipation/ diarrhoea and abdominal cramps. 

These symptoms are a part of the diagnosis of Irritable Bowel Syndrome (IBS) and to a large extent Celiac Disease. For people with irritable bowel syndrome, which has some overlap in gastrointestinal symptoms with celiac disease, FODMAPs can exacerbate symptoms.

The idea of FODMAPs as a possible culprit came from an Australian research group who accidentally helped popularise the idea of gluten sensitivity. A study of people with irritable bowel syndrome found that subjects felt better when they ate a gluten-free diet. The same research group did a follow-up study, in which they put gluten sensitive subjects on a diet free of both gluten and FODMAPs until they felt better.

They then gave some of the subjects gluten and found that they did not react to it, suggesting the problem was FODMAPs and not gluten.

The FODMAPs content of every good is not yet measured, it is a work in progress.

Here is a handy list of foods high FODMAPs foods:

The lists of foods below are classified according to their sugar molecule,

single, double or long chain.

Oligosaccharides, complex chain sugar molecule foods:

High FODMAPs

• Kidney beans, baked beans, garlic, onion, prunes, watermelon, rye, wheat, barley, inulin, chicory root, pistachio nuts and cashew nuts

Low FODMAPs

• Gluten-free breads, rice cakes (high GI), almonds, peanuts, walnuts, pumpkin seeds, carrots, zucchini, lettuce, cucumber, spinach, green beans and potatoes

Disaccharides, double sugar molecule foods:

High FODMAPs

• Ricotta cheese, cottage cheese, milk, evaporated milk, ice cream, yogurt and custard (beware the high sugar content)

Low FODMAPs

• Brie, lactose-free cottage cheese/yogurt/ice cream, sorbet, almond milk, lactose-free milk and Swiss/ cheddar/ mozzarella cheese

Monosaccharides, single sugar molecule foods:

High FODMAPs

• Apples, sugar snap peas, agave, honey, high fructose corn syrup (HFCS), tomato paste and asparagus

Low FODMAPs

• Banana, strawberries, blueberries, cantaloupe, raspberries, pineapple, orange, lemon/limes, grapes, rhubarb, kiwi, (limit fruit to 1 serving per meal or less) pure maple syrup, table sugar and brown sugar (beware high sugar content)

Polyols (sugar alcohols), complex sugar-alcohol molecule foods:

High FODMAPs

• Cauliflower, mushrooms, snow peas, apples, pears, watermelon, prunes, sugar alcohols (found in sugar free gum/mints, some medications, and cough drops

Low FODMAPs

• Banana, Oranges, strawberries, blueberries, cantaloupe, grapes, kiwi, pineapple, lemons/limes, rhubarb, raspberries. Sweeteners: table sugar

IBS, Celiac disease and FODMAPs:

Celiac disease is caused by a reaction to gluten (the protein found in wheat, rye, barley, and Brewer’s yeast).

On the other hand, a person who is already sensitive to FODMAPs reacts to a specific type of carbohydrate, fructans in wheat, barley, and rye.

Those who exhibit symptoms of celiac disease or gluten sensitivity may also be adversely affected by FODMAP carbohydrates.

Whilst both gluten and FODMAPs are present in many of the same foods, it is important to note that GLUTEN is NOT a FODMAP.

Studies show that those with celiac disease who continue to have gastrointestinal symptoms after adopting the gluten-free diet may benefit from a trial of a low-FODMAP diet.

In fact, many who are newly diagnosed with celiac disease have some degree of lactose intolerance, lactose being a disaccharide.

With the correct dietary intervention, the intestinal inflammation lowers and optimal gut bacteria diversity and absorption of nutrients in the intestines is re-established.

More dietary tips to alleviate symptoms of Intestinal discomfort coming next.