fodmaps and csid

Why FODMAPs doesn't offer relief for a CSID patient

If you have been diagnosed with Irritable Bowel Syndrome (IBS), you may have heard about a low-FODMAP diet. FODMAPs are specific groups of short-chain carbohydrates (sugars) and sugar alcohols that may trigger gastrointestinal (GI) symptoms in people with IBS. FODMAP is an acronym that stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides And Polyols. Ok, so what does all that mean?

Here is a chart that may help put the diet in perspective:

You may be wondering why healthy foods, like beans, apples, and yogurt, would be restricted. Well, the low-FODMAP diet was developed as a way to map out what foods may or may not trigger digestive symptoms associated with IBS. The low-FODMAP diet is not for everyone and not something to try on your own. It takes a dietitian with FODMAP experience to map out a plan that promotes success in identifying foods that trigger GI symptoms and, at the same time, ensures the diet is healthy and well-balanced.

The FODMAP diet is an elimination diet (eliminating the high FODMAP foods in the chart from the diet) and is only intended to be followed for two to six weeks to help alleviate GI symptoms. After the elimination phase, each FODMAP is systematically added back, one at a time, to determine individual tolerance to the differing types of carbohydrates.

If you have been diagnosed with IBS and you have eliminated high FODMAP foods from your diet but still have lingering GI symptoms, you may need to talk to your doctor and consider further testing for other diagnoses.

One possibility is an enzyme deficiency called Congenital Sucrase-Isomaltase Deficiency (CSID). If someone has deficient sucrase and/or isomaltase, they are not able to completely digest sucrose (table sugar) and/or starch. Poorly digested sucrose (a disaccharide) and starch (a polysaccharide) can cause gas, bloating, and other GI symptoms.

Look at the low-FODMAP diet and note that it does not eliminate sucrose or starch, so someone with CSID will not get symptom relief on a low-FODMAP diet. Since the GI symptoms associated with IBS mimic those of CSID, it can be hard to determine the real, underlying diagnosis and which food groups may be triggering symptoms. Is it sucrose or fructose? Is it starch or fructans?

Again, there are no quick and easy answers. Finding the answer requires a thorough investigation by a gastroenterologist and dietitian with experience in diagnosing and managing food intolerances. Pinpointing the correct diagnosis and mapping out the best treatment plan will help get you back on the road to recovery.



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