This story raises many questions, perhaps more than it actually answers. We are told that some people who have difficulty with gluten-containing foods may not be suffering from true celiac disease. We are also provided with a list of foods with both high and low levels of a type of carbohydrate known as a “FODMAP.” But that is just about where the information ends. The research referred to is not well described, and the story doesn’t do an effective job of quantifying the benefits of a low-FODMAP diet. The single source for the story is one of the developers of the FODMAP diet and is an author of a book on the topic.
Though it would’ve benefited from more specifics, the story is careful not to make overly broad recommendations about the value of a low-FODMAP diet, and that’s something we genuinely appreciate. As we’ve seen with the recent gluten craze, people are more than willing to restrict their diets in the pursuit of better health. But diets that are too restrictive can be harmful, especially for growing children who need a variety of nutrients. This story is at least clear that FODMAPS are not something that most of us need to worry about.
Celiac disease, once thought to be somewhat rare, is now increasing in its incidence. Some estimates suggest that 1 out of every 133 people suffer from the disorder. Left untreated, celiac disease can cause damage to the GI tract, so distinguishing true disease from other disorders is important. The recognition that gluten sensitivity may not be celiac disease is a useful observation. Dietary restriction is an important component of living with either of these conditions.
Cost is really not a consideration in this story. The foods listed are found in the average grocery store and are not esoteric.
The article only provides us with a glimmer of understanding concerning the perceived benefits of a low-FODMAP diet in people with non-celiac gluten intolerance. There is no quantification of the benefit. The story says, “A low-FODMAP diet eased their symptoms, as it does for about 70 percent of people who suffer from irritable bowel syndrome, a condition that causes abdominal pain and bowel changes.” How much were their symptoms reduced? Was the reduction clinically important or statistically significant but unimportant? Did everyone fare equally as well with the diet change?
This is the strongest aspect of the story and the area where readers are likely to find some value. The story explains that the low-FODMAP diet has drawbacks, since foods high in FODMAPS are thought to stimulate growth of certain bacteria associated with digestive health. We’d add that anything that restricts consumption of fruits and vegetables has the potential to reduce the quality of your diet and potentially impact your health. This is especially true for children. The story rightfully stresses that a low-FODMAP diet should be used “to reduce specific symptoms, not as a way to improve health.”
There are two major claims made in the article. The first relates to the effects of dietary changes in a group of subjects enrolled in a research project by Dr. Gibson. The story says that Gibson “has found that some people who believed they were gluten-sensitive were, instead, FODMAP-sensitive.” The story links to an abstract of that study, but otherwise gives no information on the size of the study or the specifics of the results. The reader is given no help in judging the quality of this evidence. The second claim is that there are benefits to a diet high in FODMAP-rich foods if one can tolerate those foods. While there is research that supports this concept, we again receive no description of what that evidence might be.
We’d like to rate the article satisfactory here, since it does counter widely held views about the prevalence of gluten sensitivity that are inaccurate. However, it’s possible that disease-mongering of gluten sensitivity is being replaced by disease-mongering of FODMAPS. We are told that 10% of the population has a problem with foods high in FODMAPs, but we aren’t provided with any validation of that statistic.
The only source quoted is Dr. GIbson, one of the creators of the low-FODMAP diet and an author of a book entitled, The Complete Low FODMAP Diet: A revolutionary Plan for Managing IBS and Other Digestive Disorders.
An elimination diet — where foods are systematically removed and then reintroduced to the diet in order to see which ones are causing problems — is considered by many to be the most effective approach to treating people with suspected food sensitivities. People diagnosed with irritable bowel syndrome may also be treated with a variety of medications. The story doesn’t really address any of the other options available for people with food sensitivities or IBS.
The article provides a good listing of foods to choose from that are both high and low in FODMAPS. All are widely available.
The research referenced in the article was published in 2013, so it is not new. The concept of non-celiac gluten sensitivity is not new either. So, exactly what is new that caused the article to be written?
There is no evidence of a press release as the source of the story.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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