Dr. McDougall's Online Discussion Board

My adult son and I are plant based eaters but both have wheat sensitivities. I have cut out wheat in recent times as well as following a strict starch based diet and feel great for it. However, my son has a lot of gastro upsets and is trying to help his condition by cutting out the FODMAP foods as well but is struggling with this additional regime. I researched the newsletters and noted that Dr McDougall does not seem to say the FODMAP theory is incorrect. What is the latest opinion with regards to the efficacy of the FODMAP restrictions?

FODMAP & the ED

viewtopic.php?f=22&t=57914

In regard to gas and bloating

viewtopic.php?f=22&t=10054&p=76842#p76842

In health
Jeff

My two cents is the elimination diet really gets to your issues fast. Fodmaps leaves a lot of possibilities open. It's also not as healthy as the elimination diet leaving some meats and dairy available. When you simplify the diet to just a starch or two and eliminate everything else you will quickly get to a place to build your eating regimen out from.
f1jim

A Systematic Review and Meta-Analysis Evaluating the Efficacy of a Gluten-Free Diet and a Low FODMAPs Diet in Treating Symptoms of Irritable Bowel Syndrome.
Am J Gastroenterol. 2018 Sep;113(9):1290-1300. doi: 10.1038/s41395-018-0195-4. Epub 2018 Jul 26.

Dionne J1, Ford AC2,3, Yuan Y1, Chey WD4, Lacy BE5, Saito YA6, Quigley EMM7, Moayyedi P8,9.
Author information
Abstract

OBJECTIVE:
Dietary triggers such as gluten and highly fermentable oligo-, di- and monosaccharides and polyols (FODMAP)-containing foods have been associated with worsening irritable bowel syndrome (IBS) symptoms. However, the true impact of dietary restriction on IBS symptoms has remained unclear. The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the efficacy of exclusion diets (we focused on low FODMAP and gluten-free diets (GFD)) in IBS.

METHODS:
We conducted a search of the literature using the electronic databases MEDLINE (1946 to November 2017), EMBASE (1974 to November 2017), Cochrane Central Register of Controlled Trials (November 2017), and Cochrane Database of Systematic Reviews (2005 to November, 2017) for RCTs of exclusion diets in IBS. Two independent reviewers screened citations and a third reviewer resolved disagreement. Two independent reviewers performed eligibility assessment and data abstraction. For inclusion, RCTs that evaluated an exclusion diet versus an alternative or usual diet and assessed improvement in either global IBS symptoms or abdominal pain were required. Data were synthesized as relative risk of symptoms remaining using a random effects model. Quality of evidence was assessed using GRADE methodology.

RESULTS:
A total of 1726 citations were identified. After full-text screening a total of nine studies were eligible for the systematic review. There were two RCTs of a GFD, involving 111 participants. Both selected patients who responded to a GFD and then randomized them to continue the diet or have the diet "spiked" with gluten. A GFD was associated with reduced global symptoms compared with a control diet (RR = 0.42; 95% CI 0.11 to 1.55; I2 = 88%), although this was not statistically significant. There were seven RCTs comparing a low FODMAP diet with various control interventions in 397 participants. A low FODMAP diet was associated with reduced global symptoms compared with control interventions (RR = 0.69; 95% CI 0.54 to 0.88; I2 = 25%). The three RCTS that compared low FODMAP diet with rigorous control diets had the least heterogeneity between studies, but also the least magnitude of effect. The overall quality of the data was "very low" according to GRADE criteria.

CONCLUSIONS:
There is insufficient evidence to recommend a GFD to reduce IBS symptoms. There is very low quality evidence that a low FODMAP diet is effective in reducing symptoms in IBS patients.

PMID: 30046155 DOI: 10.1038/s41395-018-0195-4