Today I want to introduce Patsy Catsos, a friend, colleague, and dietitian. She has a private practice in nutrition, specializing in FODMAPS. It is highly likely you have never heard of it, I hadn’t either. I wonder if it may be an answer for some folks who don’t meet the diagnosis for celiac disease, but know they feel better on a gluten free diet. I’ll let Patsy explain below.
Patsy is giving away a copy of her easy to understand book about FODMAPS, called . I asked Patsy to guest post after reading this book. It gets high praise on Amazon reviews.
Be sure to leave a comment below by February 3, a random winner will be chosen February 4, 2010.
Have you discovered that you feel much better when you don’t eat wheat? Less gas, bloating, abdominal pain and irregularity? Skin conditions, energy level and mental acuity improved? What is it about wheat, anyway?
That deceptively simple question has more than one answer. For one solitary grain, wheat can cause quite an assortment of problems! Readers of this blog are well aware of gluten-related health problems that can result from eating wheat. But wheat is more than just gluten. Wheat contains a complex assortment of proteins, carbohydrates and fats. To understand why you react poorly to wheat it’s important to key into the difference between reactions to the protein in wheat versus reaction to its carbohydrates.
Sometimes people have bad reactions to one of the many proteins in wheat. Examples? Gluten is the wheat protein that causes the symptoms of celiac disease. Several different wheat proteins can cause classic food allergies or trigger delayed, immune-mediated food sensitivities. This group of undesirable reactions can cause gas, bloating, abdominal pain, constipation or diarrhea, but the symptoms aren’t limited to the gastrointestinal (GI) tract. The affected person can experience the reaction all over the body, from rashes, headaches, and joint pains to overall malnutrition.
What if you know from experience that you get GI symptoms after eating wheat, but you’ve tested negative for celiac disease and food allergies? You are confident that you feel better on a wheat- free diet. You might wonder if the results of your celiac test were wrong (which does happen) or if you are sensitive to gluten in some other way. There is another possible explanation you could consider after celiac disease has been properly ruled out: fructans intolerance.
Wheat contains certain carbohydrates, called fructans, which can cause abdominal pain and bloating for some people. If your symptoms are mostly GI in nature, you’ve been evaluated by a doctor and diagnosed with irritable bowel syndrome (IBS), or have noticed you sometimes get similar symptoms when you eat or drink too much milk, ice cream, certain fruits or juices, garlic, onions, soy or other beans, this possibility deserves serious consideration. These foods all contain carbohydrates that are rapidly fermented by bacteria in the gut. They are referred to as a group by the acronym “FODMAPS.”
Fructans are food fibers made of interlocking chains of ring-shaped fructose sugar molecules. Humans don’t have the enzymes it takes to break these fructose molecules apart so they can be absorbed with other sugars in your small intestine. But the bacteria that live in your large intestine can digest them, just fine, thanks, and they do so with gusto! In the process, they produce a lot of gas, which, in turn, gives you gas, and might make you feel bloated. Fructans, as well as other FODMAPS carbohydrates, are also capable of attracting and holding water in your large intestine, kind of like a sponge. The gas and water together make you large intestine swell somewhat. Some people can tolerate this just fine, but people with IBS can experience this as a painful sensation, and can have diarrhea or constipation.
Hey, you might be wondering, if we don’t have the right enzymes to break down fructans, does that mean that wheat is not a proper human food? Not at all. It just means that wheat is one of many foods that contain fiber. Part of the very definition of dietary fiber is that it’s not digestible (by humans, anyway). Fiber in food is usually a good thing! But too much of this good thing is not helpful for many people with IBS, and recent medical studies back this up. If you’ve tried the high fiber route and found it only makes your symptoms worse, you’re not alone. Maybe it’s time to try limiting foods in your diet that contribute loads of fructans. Because the US diet revolves around wheat, it’s by far the biggest food source of fructans for Americans. If you’ve already reduced your wheat intake, consider other sources: onions, garlic, leeks, green bananas, artichokes, asparagus, pineapple, zucchini, summer squash, chicory root, inulin (a food additive) and FOS (sometimes added to probiotic supplements).
If you find out that you don’t tolerate fructans (and you definitely do NOT have celiac disease), I have some good news for you! Unlike someone with celiac disease who needs a completely gluten-free diet, the fructans-intolerant person can usually manage symptoms by just eating smaller portions of wheat and picking the onions out of your soups and stews. You don’t actually have to be wheat- or fructans-free altogether.
In my practice, I’ve found some clients find it hard to believe that even white flour wheat products could be contributing to their IBS symptoms. They’ve been aware they don’t tolerate fruits, vegetables and milk very well, but they seem to get by with a very limited diet of mostly meat and bread or pasta. They often find that by reducing their intake of wheat products, it makes room in their guts for more fruits, vegetables and milk products. They get a much more varied and nutrient-rich diet this way.
Earlier in this article, I mentioned the term FODMAPS. In addition to fructans, the other categories of FODMAPS carbohydrates are lactose (found in milk and milk products), fructose (found in honey, agave nectar, fruits, and high-fructose corn syrup), sugar alcohols (food additives or naturally found in certain fruits) and galactans (found in soy, beans and certain vegetables). All of the FODMAPS carbohydrates can cause GI distress in more or less the same way as fructans.
If you have celiac disease and already eat a wheat- and gluten-free diet, but still suffer from gastrointestinal complaints, what else can you do? Experiment with the FODMAPS idea! It’s a relatively easy, safe and inexpensive way to see if you can feel better by tweaking your diet. Especially early in your diagnosis, before intestinal healing is complete on your gluten-free diet, you may be especially prone to poor absorption of lactose, fructose and sorbitol. Once you have been gluten free for a long time, your ability to tolerate foods containing these carbohydrates may improve a good deal.
Sometimes it’s easier to sort things out with a big-picture look at all the FODMAPS at once, instead of focusing one at a time on just fructans or just lactose. For more information about learning a diet that will help you identify your problem carbohydrates, I invite you to visit my web page, www.ibsfree.net.
Patsy has graciously agreed to answer questions, please post them in the comment section below. And be sure to enter for a chance to win the book, IBS-Free at Last.
Update 2-4-10. From Linda: Thanks to everyone who commented. I learned from your comments, questions, Patsy’s answers.
And congratulations to the winner of IBS-Free at Last, Renee G. Update 2-10-10. We could not contact Renee G, so have awarded the book to the next random winner, Vicki.