Is Gluten Really the Problem? The Role of FODMAPs in Gluten-Related Disorders with Dr. Sue Shepherd, Creator of the Low-FODMAP Diet March 26, 2014 facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 1 The Relaonship Between Food and Health: A $10,000 Challenge Grant • NFCA invites you to join us in raising dollars to iniAate an overarching plan to explore the relaonship between the food we eat and your health • Your giQ of $10 will Be matched By a secured donor, dollar for dollar, up to $10,000 • Please visit CeliacCentral.org/donate to make your giP today • Your dollars will help us to help you live life to the fullest • NFCA looks forward to sharing more informaon as 2014 progresses • Thank you in advance! facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 2 Important Reminders! ① Will this informaon be availaBle at a later date? • Yes, always! • WeBinar recording will Be posted along with the weBinar slides within 72 hours aQer the live weBinar ends. Download recorded webinars and slides at the Archived Webinars page: CeliacCentral.org/webinars/archive/ ② Are conSnuing educaSon credits availaBle? • Yes! • NFCA will provide a cerAficate as proof of parAcipaon for each webinar. Aendees must complete the follow-up survey in order to access this cerSficate. Program parScipants will receive a link to complete the follow-up survey on Monday, April 7th through an email from NFCA. • To ensure that you receive this email, make sure that NFCA ([email protected]) is on your allowed senders list. If you have unsubscribed from any NFCA emails, please register for the webinar with a new email address. Make sure your email address is spelled correctly when registering, as we will use this for our follow-up communicaons. • Please note that RDs and DTRs are not permiZed to claim credits by viewing archived webinars. Only those who register and aend live webinars will receive the opportunity to oBtain connuing educaon credits. • Each parAcipant must register for and log in to the webinar in order to receive credit. In the case of group viewing, only the registered and logged in parcipant will receive credit for the webinar. facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 3 Learning ObjecAves ① Define “FODMAPs” – what does this acronym stand for anyway? ② Discuss the history of the low-FODMAP diet and its benefits for people with IBS ③ Understand how FODMAPs can trigger IBS-like symptoms ④ IdenAfy foods that contain high and low amounts of FODMAPs ⑤ Understand why the low FODMAP diet may be helpful for some people with celiac disease ⑥ Review recent research about the link between the low-FODMAP diet and gluten-related disorders facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 4 Welcome! Sue Shepherd, PhD, Advanced Accredited Praccing DieSSan • Bachelor of Sciences in Health PromoAon • Master’s in NutriAon and DieteAcs • Founded Shepherd Works, a dieteAc pracAce outside of Melbourne, Australia • Representaons and affiliaons include: • The University of Queensland • La Trobe University • Coeliac Research Fund • Gastroenterological Society of Australia • The FODMAP Friendly Food Program • Rome Foundaon • Coeliac Australia • 100 Women of Influence •TherapeuAc Guidelines facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 5 Disclosures • Author of cookbooks for celiac disease and IBS including: – Irresis'bles for the Irritable – Two Irresis'ble for the Irritable – Gluten Free Cooking – The Gluten Free Kitchen – Allergy Free Cooking – Food Intolerance Management Plan – Gluten and Wheat Free Diabetes – Low FODMAP Recipes • Co-author of the dieteAc resource manual Gastrointes'nal Nutri'on • Consultant to Gluten-Free Food Show in Melbourne, Sydney, Brisbane, and Launceston • Consultant to food companies for development of specialty food products • Co-ownership/Co-Director of The FODMAP Friendly Food Program and its trademark facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 6 What are FODMAPs? • Complex names for a collecAon of molecules found in food • Poorly absorbed short-chain carbohydrates facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 7 What does the acronym stand for? Fermentable Oligosaccharides Disaccharide Monosaccharide And Polyols facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 8 The Spectrum of FODMAPs • FermentaBle: – Meaning they can be broken down by bacteria in the bowel facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 9 The Spectrum of FODMAPs • Oligosaccharides: – “Oligo” means many – “Saccharide” means sugar – Examples include fructans and galactans (GOS) facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 10 The Spectrum of FODMAPs • Disaccharide: – Includes lactose facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 11 The Spectrum of FODMAPs • Monosaccharide: – “Mono” means single – “Saccharide” means sugar – Contains fructose in excess of glucose – Fructose is only a potenAal FODMAP if it is present in foods in amounts greater than glucose facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 12 The Spectrum of FODMAPs • Polyols: – Sorbitol – Mannitol – Xylitol – Isomalt facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 13 The History of the Low-FODMAP Diet • Why do so many paents • Received referral for paent without celiac disease experience with IBS symptoms and a posiAve IBS-like symptoms when eang fructose breath test Shepherd wheat? • “Fructose malabsorpAon diet” • Is there another trigger? Works • No dietary guidelines! • IdenAfied fructans 1999 • IdenAfied excess fructose • Already aware of lactose intolerance • Well known that beans, e.g. galacto-oligosaccharides, can trigger symptoms • Packaged food products containing polyols already include warning statements facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 14 The History of the Low-FODMAP Diet • Logical approach to explain how the FODMAPs sugars could cause symptoms • Created an “experimental diet” of foods to include and avoid – first Ame these sugars were idenAfied as a dietary management for IBS-like symptoms • Taught diet to paents for four years in private pracAce • Began well-designed clinical trial to confirm diet’s posiAve impact as part of PhD research • The low-FODMAP diet is now scienAfically proven facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 15 The Link to IBS • FODMAPs trigger symptoms of IBS (Shepherd & Gibson 2008) • It is well-understood how FODMAPs trigger symptoms (BarreO et al, 2009; Ong et al, 2010) • The low-FODMAP diet provides symptom relief in ~75% of IBS paents (Shepherd & Gibson 2006) • The low-FODMAP diet is sustainable – paents have conAnued the diet since it was developed • The diet has seen success internaonally (Staudacher et al, 2011) • The low-FODMAP diet is also effecAve for: • Those with celiac disease who have ongoing symptoms • Non-celiac gluten sensiAvity facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org www.CeliacCentral.org/webinars ©2014 All rights reserved. 16 How do FODMAPs trigger symptoms of IBS? facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org ©2014 All rights reserved. 17 www.CeliacCentral.org/webinars Adapted from Barrett, et al 2009 How do FODMAPs trigger symptoms of IBS? Increased water delivery facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org ©2014 All rights reserved. 18 www.CeliacCentral.org/webinars Adapted from Barrett, et al 2009 How do FODMAPs trigger symptoms of IBS? Increased gas producSon facebook.com/nfceliacawareness NATIONAL FOUNDATION FOR CELIAC AWARENESS @CeliacAwareness www.CeliacCentral.org ©2014 All rights reserved. 19 www.CeliacCentral.org/webinars Adapted from Barrett, et al 2009 How do FODMAPs trigger symptoms of IBS? Bowel distension