Dr. Schär Institute

In this issue of the Forum we focus on the low FODMAP diet for the management of Irritable Bowel Syndrome (IBS). In previous issues we have uncovered the links between IBS and gluten sensitivity. A number of current reports provide evidence of symptom resolution for some IBS sufferers while following a gluten free diet. Research has indicated that anti-gliadin antibodies are present in approximately 12% of the general population, versus 17% of IBS patients in whom celiac disease has been excluded. [1,2] Positive response to the FODMAP diet can be predicted by the presence of intestinal antibodies (to gluten) [3] and the prescence of HLA DQ2 or DQ8 genotypes [4] has been reported in a sub group of IBS patients, without celiac histology and with diarrhea predominant symptoms The low FODMAP diet restricts the intake of fermentable, poorly absorbed, short chain carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) such as fructans, present in wheat, on the basis that they provoke gastrointestinal symptoms in IBS patients through mechanisms that interplay with gut microbiota, gas production and gut fermentation. The success of this approach has led some researchers in the field to ponder the question of whether gluten is the only cause of symptoms in IBS patients reporting sensitivity to wheat, or whether other components of the wheat grain may be responsible for inducing symptoms. The multifactorial nature of IBS etiology would suggest that the answer to this dilemma is complex and the explanations for a positive symptom response on a wheat free diet may vary between individuals.