Put on your thinking cap!

I thought I would provide a few updates from the 2 BIG conferences I attended in September.  The 17th Annual Neurogastroenterology & Motility Scientific Meeting and The International Celiac Disease Symposium.

I was so honored to be asked to speak at the Rome Symposium of the Neurogastoenterology & Motility Scientific meeting.  My topic: Practical guidelines for implementing dietary management of IBS.  Of course, the highlight of my topic was the low FODMAP diet.  There was a great deal of interest in this diet approach and I was asked many questions about the diet after my talk.  One of the pressing questions was:  Could the diet’s effectiveness just be the placebo effect?  In other words, do people feel better on the diet because they think the diet will make them feel better?  Do people feel better on the diet because they eat healthier on this diet?  I do think my clients eat healthier on the low FODMAP diet–perhaps because I am teaching them to eat healthier–after all, I am a dietitian! Isn’t that what a dietitian should do!?! But not everyone noting symptom improvement eats healthier–some people figure out what packaged/manufactured foods are low FODMAP and they at lots of them!

From my clinical experience working with patients, I truly do believe the diet is effective.  Most of my patients have tried numerous dietary approaches that failed them before embarking on the low FODMAP diet. Not to mention, there is mounting research that shows the low FODMAP diet is a therapeutic approach to managing symptoms in 3 out of 4 people with IBS.  And SO many of my clients report life changing results with the low FODMAP diet.  The low FODMAP is an evidenced-based (well researched) strategy for managing GI symptoms in those with IBS.

But certainly, not all IBS patients benefit from the low FODMAP diet…about 25 % require other interventions.

Another topic of discussion was the evaluation of defecatory disorders in IBS-C.  The importance of being evaluated for what is known as a pelvic floor dysfunction.  Learn more about pelvic floor dysfunction here.

Another growing topic in scientific research is the role of gut bacteria in GI disorders and beyond.  This is an area of science that I find truly fascinating!  Here are a few interesting poster abstracts that I would like to share with you:

  • Methane producing bacteria and gastric emptying–there is a trend towards delayed gastric emptying among individuals that have higher levels of methane producing gut bacteria. (My take away: if you get breath tested for bacterial overgrowth–be sure both hydrogen and methane gases are measured–this may give more insights into your GI symptoms) ? role in gastroparesis!!
  • Another abstract from research at UNC, found that in those with IBS-C with bloating–that the pH (acid level) in the colon was lower suggesting greater amounts of fermentation (bacteria breaking down undigested food) while the small intestine did not show any change.  This may indicate that individuals with IBS-C w/ bloating have more bacteria or dysbiosis–a poor balance of bacteria in the colon.

Interestingly, researchers also provided information about transplanting fecal matter ( I know, this may sound unusual–sorry for being so science-y)  from one rat to another can change the rat’s personality. What!!!??  Weird, right?  But fecal transplants are actually used effectively for C. Diff infection –an often difficult to treat bacterial infection. So…we are learning more about innovative approaches to treat GI disorders and more.

Yes we all have bacteria in our intestines–accounting for about 4-6 pounds of our body weight.  And they are not just hanging out….they help create vitamins, help our body digest foods, BUT when they are out of balance…can likely contribute to a cascade of GI symptoms and researchers are working hard to determine how to take this science and apply it to help humans (that’d be us) feel our best! Gut bacteria are also linked with obesity! Some bacteria are very efficient of getting calories out of our food.  How generous! Not!

While I am on this topic–for those of you who find gut bacteria and their impact on our health and even our personality interesting….check out these links:

In this report, a researcher from Boston has found that altering gut bacteria can help control obsessive compulsive disorder.  Link here!

Researchers at University of Colorado in Boulder, have been analyzing gut bacteria in a project called The American Gut project.  Check out more here!

And about 80 Universities and research centers are working on a multitude of gut microbiome studies funded by the US National Institute of Health.  Learn more here!

So…from the Neurogastroenterology & Motility Symposium…I headed to Chicago with researchers interested in celiac disease from across the globe at The International Celiac Disease Symposium.

Here are a few take aways from this conference:

The biggest topic of interest from my vantage point was the notion of Non-Celiac Gluten Sensitivity (NCGS).  Unlike celiac disease where gluten is downright toxic to the intestine, we really don’t have a way to test for NCGS. A group of researcher have defined “NCGS as a condition in which gluten ingestion leads to morphological or symptomatic manifestations despite the absence of CD.”  (Gut 2013, The Oslo definition for coeliac disease and related terms).

What was very exciting to me –was that FODMAPs made their way into many of the topics at The International Celiac Conference.  Whether as an option for a subset of individuals that are self-described as having NCGS or perhaps as an add on to the gluten free diet in an individual with celiac disease  that does not have FULL resolution of gastrointestinal symptoms.

One abstract suggested that for those who feel they have non celiac gluten sensitivity–the majority in fact, are sensitive to FODMAPs….but still a small subset, does in fact have a sensitivity to gluten.

Another interesting topic of discussion was the role of amylose trypsin inhibitors also known as ATI’s.  These proteins found in wheat may initiate immune reactions especially in the presence of gluten.  Interesting, ATI’s are more prevalent in the wheat used today in the US.

And, I was so happy to see Jessica Biesiekierski present her paper looking at the specific and dose-dependent effects of gluten on individuals that self describe themselves as having non celiac gluten sensitivity.  Jess’ paper and research provides ground breaking science in a very well designed study looking specifically at the impact of gluten on GI symptoms in those who describe themselves as having NCGS. In the study Jess presented to all of us at the International Celiac Disease Symposium–the following key points:

  • There was significant improvement in overall GI symptoms and tiredness with the low FODMAP diet in individuals who said they had NCGS that previously reported themselves to be well controlled on a gluten free diet.
  • There was no specific or dose dependent GI effects of gluten observed in this study.
  • Many people who believe they are sensitive to gluten, may in fact, be sensitive to fructans.  There is an overlap in the gluten free diet and low FODMAP as both diets modify intake of wheat, barley and rye–the low FODMAP diet removes the poorly absorbed fructans in wheat, barley and rye…while on a gluten free diet–the focus would to be remove the protein (gluten) in wheat, barley and rye.

Throughout the conference–the concept of NCGS was a hot topic.  Ideally we need some type of test to help doctors and patients diagnose NCGS–some type of biomarker.  We need to understand the prevalence of NCGS–and the mechanism for its action.

Everyday, I learn a bit more about digestive health…from the researchers, from my patients, from my blog followers….It is a very exciting time in digestive health and nutrition…

As always, thanks to you for sharing your insights and thoughts…as we all do learn so much from one another.


22 replies on “Put on your thinking cap!

  • Lora

    Thank you Kate! You are so wonderful to share so much helpful information with us. I have learned so much from your gracious sharing and education. I’m grateful!

  • Sanne

    Hi Kate,
    thanks for all this information. And I was wondering, do you have the title and/or name of the authors of the following to abstracts that you mention about the methane producting bacteria and gastric emptying, and title of thw article from the research at UNC about IBS-c and the pH level? I would like to read them and discuss this with me gastroentologist on my next appointment. Thanks you very much!

    And I had another question. This weekend I made your quinoa granola bars, but during cutting, the quinoa granola mixture didn’t really stick together, so some bars became more pieces or granola than a sticky bar. Do you have any tips for next time? Maybe adding a bit more maple syrup or coconut oil? Thank you! 🙂

    • katescarlata

      Sanne–yes try a bit more coconut oil and maple syrup and press them into the pan firmly.
      The information I provided on my post are unpublished abstracts–this means that they are not been accepted yet for publication. The advantage of going to these digestive health conferences is that the attendees can see what research is happening in the labs up to 3 years before the study gets published –its quite a time consuming process to get a study published–so your doctor won’t be able to access the info that I had access during the conference.

  • Cory

    Kate, thanks so much for talking about pelvic floor dysfunction and its role in IBS symptoms. I’ve been diagnosed with that, and physical therapy, biofeedback, and special exercises are starting to improve my symptoms. Even if you do all you can to modify your diet, things won’t work if you have muscle or nerve coordination issues, so it’s really important to make sure people are aware of this aspect of digestive disorders!

  • dkaj

    Hi Kate, Thank you for sharing all the information from the conferences. I am so excited to see all of these various areas being studied. This is huge progress and it helps to know that all the various areas are being looked at, especially when it comes to not only the GI symptoms but also how it affects mood and behavior. We have so many little ones in our facebook FM group, whose FM children experience not only the digestive and motility issues, but also mood and behavior changes. If ever you want to do a survey on any of this, we would be more than happy to supply information on what we see in our children. Also, info on how the diet is helping. My daughter’s reflux was so bad, that she was getting sinus infections because it was going into her sinuses at night when she laid her head down. This has all changed since removing the offending sugars and sugar alcohols, and really scaling back on even the safe sugars. And, for those doubting medical professionals still out there, I would be more than happy to send you a copy of my daughter’s barium enema study that showed how much reflux she had because she got backed up from HFCS. Of course, this was before we knew about FM and only had her on the reflux diet that wasn’t eliminating the sugars,sugar alcohols, and other triggers, just chocolate, greesy high fat foods and acidic foods. It has truly been a life changing experience here! She is so much happier, her anxiety levels have gone way down, her eczema went away, and she is sleeping so much better. It is still work, but at least we know what to avoid and gives us some control to help our children be happy children. I do have one request, can you put a bug in someones ear sometime to look at all the sugar (corn syrup solids) that are in many of the baby formula’s. Some contain over 50% corn syrup solids. I just don’t know how that much sugar can be good for any baby when that is the only thing they are drinking for the first 4 to 6 months of life. I know corn syrup solids are supposed to be straight dextrose, but even that can’t be healthy, especially for the babies who are genetically predisposed to GI issues. Thanks again for advocating. Your work is dear to the hearts of many!!

    • katescarlata

      Thanks Deborah. I think that is a great idea to survey your group to get a better sense of what the kids with FM are able to tolerate in the way of acceptable low FODMAP fruit and general foods that seem to work. I know the wiggle room in the diet seems to be tighter for the little ones. I think the baby formula should be tested! I know they have tested some formulas used for hospital tube feedings but not sure about baby formulas. I will ask about that.

      • dkaj

        Thanks Kate and you just let me know about any surveys you or anyone else would like to do. I know all the moms would be more than happy to provide any information that would help. Oh, and I meant to say barium swallow vs barium enema. The barium swallow showed the reflux being caused because of the HFCS and just plain too much sugar in the rice crispy bars from the marshmallows (we’ll never have those again!). Amazing how that sugar stops the bowels from moving. Of course I didn’t know this at that time, but we do now.

  • Mary

    Thank you Kate! It is exciting to see all of the medical research underway on gut bacteria. I have found that my IBS symptoms improved when taking a probiotic. I have done PubMed searches on this topic and have found numerous studies on the subject. Is there a link to a particular study (or website) that would help me to determine which probiotics are shown to be the most effective for IBS? Also I found the relationship of mood and gut bacteria fascinating. Thanks so much! Mary

  • Julia

    Hey, Kate!

    What’s the skinny on pumpkin?? I’m reading its a FODMAP no-no, yet I’m seeing it in FODMAP-friendly recipes. Even pumpkin pie!

    With the holidays approaching, can you clear this up for us?

    Thanks, Kate, for all you do. It is appreciated so much.


    • katescarlata

      Julia….We should know about US pumpkin by Thanksgiving. It is undergoing testing at this time. I sent 4 different canned pumpkin products myself…so I know we will have the info soon enough!

  • EA-The Spicy RD

    Great information Kate and thanks so much for sharing! As someone with NCGS without any GI symptoms, I do hope the research in this area will continue in MANY directions, as the gluten-free diet has helped me tremendously with neuropathies, muscle aches & pains, fatigue, insomnia, exercise intolerance & so much more! I’m curious to know if there was any discussion on NCGS and overlap between autoimmune conditions? Thanks again for sharing all the highlights of the conference!

    • katescarlata

      Hi EA–there was some discussion and research abstracts that discussed fatigue/depression in NCGS induced from gluten. There was discussions regarding migraines and other systemic symptoms due potentially from gluten in NCGS. BUT there remains controversy around the NCGS diagnosis in the sense that although it likely exists perhaps in a much smaller cohort of people than previously thought. That FODMAP sensitivity likely outnumbers gluten sensitivity-in regard to GI symptoms. More research in the area of amylase trypsin inhibitors (ATIs), gut microbiome alterations may help us further understand NCGS or provide insight into some of the systemic impact shown. ATIs are pest resistant molecules of grains (found in gluten containing grains/cereals) and seem to activate innate immune response in celiac disease and perhaps in NCGS. ATIs shown to exacerbate symptoms of multiple sclerosis. GREAT conference that provided more questions than answers (for me) but progression of our understanding of NCGS.

  • Ron

    Thanks so much for all you do to keep your readers updated on the latest research. Any suggestions as to how to determine if it is the gluten or fructans in wheat and rye that is the problem? Also, if the alcohol content in pure vanilla extract is not low fodmap, is there an extract without any fodmaps?

    • katescarlata

      Your most welcome Ron. You could undergo more of a gluten challenge vs. a fructan challenge. Working with a dietitian to help you with this–of course. Vanilla extract should not pose a problem–and I allow it with my clients.

  • Kriss Spencer

    Thank you SO much for this wonderful site! I have doing the low fodmap diet for my husband, who suffers severely with IBS-Constipation. We have been doing this for about 6 weeks. We are gluten free now and have been living on the low fodmap probably 90% of the time. He has not had any improvement. We try to stay away from the items that have mixed info on different sites. I’ve changed everything, so I am wondering if we need to go completely fodmap free? Do you think that would help, or is that the next step?
    Thanks so much!

    • katescarlata

      Are you working with a dietitian? She/he can assess if your husband is getting enough fiber or following the diet in an appropriate manner. It does take longer from my experience for those with IBS-C to get benefit from the diet–but certainly by 6 weeks most people either can determine that they are making progress or not. Not sure what you mean by fodmap free? When you go on the diet–you try your best to avoid all high FODMAP foods and to keep the ‘moderate’ FODMAP food to limits as described on my check list. If you husband is not having regular BMs at this point–I would discuss with his gastroenterologist what an appropriate bowel regimen would be. Assessing for other issues that may be contributing to his symptoms with his GI doctor such as small intestinal bacterial overgrowth (particularly check methane levels), motility issue that might require medicine to help manage, etc.

  • Antonia Pogue

    Hi Kate. I’m am a mom of a three year old that just tested positive for fructose malabsorption via a breath hydrogen test. It’s been a long road determining what her tummy troubles were due to. Now that I have a direction to move in, I am trying to get my daughter on a diet that is both healthy and keeps her feeling good. In my research on FM thus far, I’m troubled by two facts that I cannot determine if they are truth or myth. (1) Should fructose malabsorbers avoid fermented foods with live cultures? I’ve read that consuming live cultures will increase fermentation of FODMAP’s in the gut. My daughter tested negative for lactose and I want know if she can have yogurt, cheese, etc. (2) Is brown rice high in fructose or fructans? So many wheat free products are made with brown rice, not white rice, as whole grains have become more popular for overall, good health. I wish I knew if they were OK for my daughter to consume.

    Appreciate any help you can provide. I am a food scientist, so even directing me to experts on the subject would be helpful. We don’t have any MD’s or RD’s with expertise on FM in our area, that I know of, so I am researching through the internet for information to help my daughter.

    • katescarlata

      Not sure if fermented foods would be helpful or detrimental. I think that might vary person to person–depending on the motility of the small intestine and number of cleansing waves and their current gut microbiota. Brown rice was shown to only have a trace of fructans so think it is okay and low FODMAP. Also –consider small intestinal bacterial overgrowth as a co-existing diagnosis. Note FODMAPs draw water into the intestine–so even if they are NOT malabsorbed –they can still trigger symptoms in individuals with a sensitive gut. So see how she tolerates lactose containing foods such as yogurt. Cheese especially hard cheeses have minimal lactose so should be okay from a FODMAP standpoint.

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