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.