Wheat among foods targeted in FODMAP diet

by Josh Sosland
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BOSTON — While FODMAPS is hardly a household term, the Grain Foods Foundation believes increasing attention to a diet bearing that name merits industry attention. The acronym for a category of carbohydrates, the FODMAP elimination diet entails at least temporary avoidance of wheat-based foods.

The diet was the subject of a G.F.F. conference call for investors May 2. The call was led by Ashley Reynolds, a registered dietitian who has been with the agency Mullen for four years, working on behalf of the Grain Foods Foundation.

Introducing Ms. Reynolds, Christine Cochran, executive director of the G.F.F., said the call was part of what would be a regular monthly activity at G.F.F., highlighting the foundation’s work around a number of areas, including emerging research such as that connected with FODMAPS, media relations, feedback from influencers and emerging trends “we see on the horizon.”

As recently as two years ago, the concept of FODMAPS was “not on anyone’s radar screen,” Ms. Cochran said.

FODMAPS stands for fermentable oligo-di-mono saccharides and polyols. Ms. Reynolds went on to offer as a definition, “a class of carbohydrates that are osmotically active and rapidly fermentable.”

She continued, “The issue here, and why FODMAPS are becoming such a class of study, is that FODMAPS are an area of carbohydrates that draw water into the intestine and have almost a balloon effect. They feed the bacteria in your gut and produce gas. They have been associated with I.B.S.-like symptoms in some people — that being pain, gas and diarrhea — stuff that people want to stay away from.”

She cited data that indicate 15% of the worldwide population has what some people call “functional gut symptoms.” The condition also is sometimes referred to as SIBO (small intestine bacterial overgrowth).

“Especially as we’re watching the gluten-free movement and non-celiac gluten sensitivity, everyone is wondering what is the dietary culprit associated with these symptoms nearly a fifth of the population is dealing with,” she said.

In the case of FODMAPS, though, the definition of a culprit is not simple. In contrast to the ironclad link between gluten and celiac disease, FODMAPS are associated with but do not cause IBS symptoms, she said.

A number of staple foods fall within the FODMAPS group, Ms. Reynolds said. While wheat is the most prominent grain in the group, other dietary FODMAPS mainstays include milk (not all dairy products), onions, apples, high-fructose corn syrup and ice cream.

The chemical categories under which various FODMAPS fall are free fructose (includes apples, cherries and high-fructose corn syrup); lactose (which includes several dairy products); fructans (the largest category, which includes wheat, rye, barley, legumes and several vegetables), galacto-oligosaccharides (legumes) and polyols (includes several fruits and vegetables).

Illustrative examples of FODMAPS offered in the presentation included 13 fruits, 13 vegetables, 3 cereal grains, all legumes plus a variety of other ingredients and additives.

“Food group by food group, foods that are the larger sources of carbohydrates are ones that need to be avoided,” she said. “Wheat, rye and barley are why the Grain Foods Foundation is interested.”

Also of interest among FODMAPS sources are inulin and fructo-oligosaccharides (FOS), food additives that have become more popular because they help narrow the dietary fiber deficit faced by many consumers. Ms. Reynolds highlighted these because avoidance could have further adverse effects on grain foods consumption.

“(Inulin and FOS) are found in a number of grain products, dairy products … across the food spectrum,” she said.

While celiac disease necessitates permanent avoidance of gluten-based foods, a FODMAP diet is different, Ms. Reynolds said.

“The diet we are talking about is the FODMAP elimination diet,” she said. “FODMAP elimination diet is not meant to be lifelong avoidance. Someone with I.B.S.-like symptoms would go to a dietitian. They would cut out all sources of FODMAPS for a couple of weeks. FODMAPS, one-by-one, would then be introduced. The ultimate goal is to have the most liberal and varied diet possible.

“It’s not an anti-grains diet. It’s a personalized approach. It’s up to the clinician to work with the patient to see what works and what doesn’t.”

Even though it isn’t anti-grain, Ms. Reynolds expressed concern fad diet advocates may cite the FODMAP diets when they vilify carbohydrates.

Illustrating the degree to which interest in FODMAPS remains in a nascent stage, Ms. Reynolds noted media mentions over the past year have totaled 125. By contrast, gluten media mentions have reached 45,900.

“Research around FODMAPS is really growing with much of the research out of Australia’s Monash University,” she said. “That’s where a lot of the food testing is being done. We are watching because there is chatter going on. It ties back to a lot of the issues around the assertion there have been changes in wheat, that grains are somehow different now.”

One researcher at Australia’s Monash who has written about the FODMAP diet is Peter Gibson, a professor and director of gastroenterology at the school. In a 2010 paper published in the Journal of Gastroenterology and Hepataology, he described the diet as “effective” at treating patients with gut symptoms.

“The restriction of their (FODMAPS) intake globally (as opposed to individually) reduces functional gut symptoms, an effect that is durable and can be reversed by their reintroduction into the diet (as shown by a randomized placebo-controlled trial),” he said. “The diet has a high compliance rate. However it requires expert delivery by a dietitian trained in the diet. Breath hydrogen tests are useful to identify individuals who can completely absorb a load of fructose and lactose so that dietary restriction can be less stringent.”

Another proponent of the FODMAP diet has been Stanford University Medical Center. A newsletter briefing on the diet suggests it may help individuals with I.B.S. as well as “those with similar symptoms arising from other digestive disorders such as inflammatory bowel disease.”
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