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What's the Deal with FODMAPs and Gluten-sensitivity in IBS?


Are some IBS patients really sensitive to wheat, gluten and FODMAPs? Photo: CC--Roy Blumenthal

Celiac.com 06/06/2016 - Irritable Bowel Syndrome (IBS) is one of the most common types of functional bowel disorder. As researchers attempt to unravel the mysteries behind IBS, they have payed increasing attention to the possible impact of food and diet.

For many people with IBS, certain foods seem to trigger or worsen symptoms, such as abdominal pain and bloating. Wheat is suspected as a major IBS trigger, although which exact aspects of wheat might be involved is not yet known. Gluten, and other wheat proteins, such as amylase-trypsin inhibitors, and fructans, which belong to fermentable oligo-di-mono-saccharides and polyols (FODMAPs), have been identified as possible factors for triggering or worsening IBS symptoms.

A research team recently set out to examine the issue, especially with respect to gluten and FODMAP sensitivity. The research team included Roberto De Giorgio, Umberto Volta, and Peter R Gibson. They are variously affiliated with the Department of Medical and Surgical Sciences, Centro di Ricerca Bio-Medica Applicata (C.R.B.A.) and Digestive System, St. Orsola-Malpighi Hospital at the University of Bologna in Bologna, Italy, and the Department of Gastroenterology Alfred Hospital at Monash University in Melbourne, Australia.

The researchers suspect that sensitivity occurs through different mechanisms, including immune and mast cell activation, mechanoreceptor stimulation and chemosensory activation. The lack of certainty regarding the actual triggers has opened a scenario of semantic definitions favored by the discordant results of double-blind placebo-controlled trials, which have generated various terms ranging from non-coeliac gluten sensitivity to the broader one of non-coeliac wheat or wheat protein sensitivity or, even, FODMAP sensitivity.

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The role of FODMAPs in eliciting the clinical picture of IBS goes further since these short-chain carbohydrates are found in many other dietary components, including vegetables and fruits.

In their review, they assessed current literature in order to unravel whether gluten/wheat/FODMAP sensitivity represent 'facts' and not 'fiction' in IBS symptoms.

This knowledge is expected to promote standardization in dietary strategies, especially gluten/wheat-free and low FODMAP diets, as suitable ways to manage IBS symptoms.

Read more at: Gut. doi:10.1136/gutjnl-2015-309757

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