Nutritional Medicine , Separating Fact from Fiction
When the FODMAP Diet came out there was a flurry of support for it. What else could be displayed but enthusiasm for something new that might help an illness the doctor’s do not understand and for which no standard treatment exists.
FODMAP refers to a group of carbohydrates, any of which a person may be sensitive to and, theoretically, react to with symptoms similar to those of irritable bowel syndrome (IBS) – abdominal pains, cramping, gas, diarrhea and has developed into a dietary treatment for IBS.
The FODMAP diet was developed around the theory that quite a few foods could cause gastric distress and most were carbohydrates – lactose, or milk sugar, fructose, sorbitol, polyols and oligosaccharides. Theoretically, if these were known problematic foods caused gastric problems in the general populations, what if some people were overly sensitive to these carbohydrates? Thus, the FODMAP or fermentable, oligosaccharide, disaccharide, monosaccharides and polyols elimination diet was born.
Since about 2006 the FODMAP diet claimed to relieve symptoms in 76% of IBS patients.However, a recent study claims studies on the results of this diet are either scarce or absent. Evidence cannot be found via well-designed clinical studies on the effects of this theoretical diet and when reviews were conducted the conclusion was that the FODMAP diet’s success was based on a huge amount of bias, possible placebo results and needs validation by randomized control trials with human subjects, male and female, who have also had a complete diet assessment prior to the study.
After all, medicine as well as nutritional medicine should be approached from an evidence based standpoint. Of course, we do not have studies to back up every observation of success. However, the long-range plans should always be to evaluate and show evidence for out theories in this Evidence Based Environment.
Application: Client comes to Dietitian requesting FODMAP diet to relieve her symptoms of irritable bowel. A comprehensive review, however, found several lifestyle contributions to her symptoms. The doctor had placed her on an irritating dose of iron with her ulcer and never checked for a g.i. bleed. And, the type of iron could have been switched to one less irritating on stomach. The biggest concern was the food-drug interaction. Patient was on two medications where the listed side-effects were the same one’s client complaining about. Now all this new information brings choices into the picture. Dietitian believed a FODMAP diet was inappropriate, too restrictive and not the problem.
So, in this case, and possibly many others, if you look closely at the case at hand, the problem may be a multifactorial problem with several interventions and none of them involving the FODMAP.
I look forward to further stringent studies of this diet due to its complexity in teaching it, following it, and the creation of possibilities for many nutritional deficiencies.
Krogsgaard LR, Lyngesen M, Bytzer P. Systematic review: quality of trials on the symptomatic effect of the low FODMAP diet for irritable bowel syndrome. Aliment Pharmacol Ther. 2017; 00:1-8. https://doi.org/10.1111/apt.14065
Gibson, Peter. History of the low FODMAP Diet. Journal of Gastroenterology and Hepatology. 2017; 32.