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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.

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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.

31 Responses to “Wheat-Free, Gluten-Free, FODMAPS-Free? IBS-Free at Last Book Giveaway”

  1. Sharon Olson says:

    I would love a copy of this book. I have been tempted to buy it but it would be great to win it. Good luck on the recipe book. I would like some kind of substitute for brown sugar. It would make cookies so much easier to make.

  2. Vicki says:

    Hi, I have just been diagnosed with FM and LI. I have been following the FODMAPS diet (I am from Australia) for a few weeks but still have bad symptons. I wake at night with really pain, gas and nausea – particularly in the upper left side. Does it take a few weeks for the symptons to reduce? Or do you think I need now to eliminate gluten free pasta and bread too? Or do you think the symptoms are worse as I seem to be going through perimenapause as well? (darn those hot flushes!). I would love to have your cookbook too as at the moment food is pretty boring ;(

    • In my experience it doesn’t take more than a week or two for symptoms to settle down IF they are totally caused by FODMAPS.

      One might try keeping a food diary for a couple of days and ask someone to look at it for sources of FODMAPS not previously considered. People who are EXTREMELY intolerant to lactose or fructose might have to avoid even small portions of usually well tolerated lower fructose fruits and milk products. What about medications that contain lactose (many tablets or capsules) or sugar alcohols (many liquid medications). Could these be a factor–a pharmacist might be able to help.

      Some gluten free breads have a lot of xanthan gum or other fermentable gums that can cause symptoms.

  3. Bern says:

    I too was baffled at why I still had tummy problems while eating a strict gluten free and dairy free diet! I was also getting sick all the time. In an effort to get ‘healthy’, I adopted a kind of detox diet involving eating just raw fruits and vegetables (lots of FODMAPS!), seeds and nuts.. then I got really sick!! I read about fructose malabsorbtion in a gluten free cookbook of mine and joined the dots together! I have seen a dietition who gave me all the info and I commenced an a FODMAP elimination diet. Now have a much happier tummy, better sleep and feel like my concentration is improving. And I haven’t had a cold, flu or tummy bug since before I started this diet. Would love to win this book to use as a resource myself and also to share with my support group. I would also like to write a low FODMAP cookbook one day, so the information may help guide this path too!

  4. Kris says:

    Hello, I’d love a chance to read your book, and thanks for letting us ask you some questions. I became aware of FODMAPs after going on an intensive elimination diet. The nutritionist and I found that I improved after eliminating fructose and most fructans. As you said, doctors in the US don’t know as much and testing is scarce. I had a negative hydrogen breath test, but haven’t had the methane one, as none of the doctors under my insurance cover it. In your experience, are there often false results as in celiac? Thank you so much for your time!

    • Yes, false negatives are common, since about 20% of individuals are not colonized by bacteria that produce Hydrogen. Other causes of false negatives are recent antibiotic use or not fasting before the test. If the tested individual experiences GI symptoms during the test, that should be considered along with the H output when interpreting the results.

  5. Barb Hennings says:

    FODMAPS, what an acronym! It explains why, even though I have been on a gluten-free non-dairy diet for more than five years, I still have GI complaints. Leeks bother me more than onions and I have to eliminate onions when I’m making dinner in a slow-cooker. Black beans and garbanzos bother me more than navy beans — sometimes! I can eat commercially prepared hummus but not when I make it myself from canned garbanzos. I cannot tolerate green peppers, fresh or cooked, and garlic must be lightly sauteed before used in a recipe. Although my choices sound limited, I love to cook and do eat quite well, thank you, but I’m always looking for new ideas.
    I’d love to win the book in order to further understand FODMAPS and then pass information about the book to my support group.

  6. Wendy says:

    I’d love a copy of this book. It might explain a lot.
    I’m already on a gluten free diet, and I’m much better, but not quite right.

  7. Shannon Longhurst says:

    I would like to read this book to better enhance my practice!

    Shannon Longhurst, RD, CD

  8. Renee G says:

    I’d love to have a copy of this to share with my husband.
    rsgrandinetti@yahoo(DOT)com

  9. Sarah says:

    I just had this conversation at my first trip to a dietitian. We didn’t get into great detail, but onions, garlic, ice cream, gluten free oats, beans ended up on my list of foods to eliminate from my diet individually. This after eating a soup that contained 4 types of onions among other potential trigger foods.

  10. Nina says:

    This may explain a few things! I’ve given up gluten and dairy already but sometimes still have symptoms. Sometimes after eating fruit . . . sometimes after eating lentils or vegetables. I need to read this book (and would love to win the giveaway!).
    Thanks.

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