A recent minor spat between the University of Iowa & the University of Melbourne brings awareness to the roles that prunes, sorbitol & FODMAPs play in Irritable Bowel Syndrome.
Prunes were the topic of discussion in a recent debate over their effectiveness in treating Irritable Bowel Syndrome constipation. The debate started over a bit of research done by the University of Iowa’s Department of Gastroenterology which suggested that prunes were possibly a more effective treatment option than psyllium husks for those with Irritable Bowel Syndrome constipation.
However not all were satisfied with methods or the results of this research. Prof Peter Gibson and dietitian Emma Halmos of Monash University in Melbourne wrote a retort to the journal “Alimentary Pharmacology and Therapeutics”, which is the same journal the original study appeared in. The retort suggested that the prune’s laxative effects were probably due to their large quantity of sorbitol, which itself is used as a laxative when given in high enough of a dosage. Sorbitol is essentially an indigestible sugar & is part of the “fermentable oligo-, di-, mono-saccharides and polyols” family aka (FODMAPs) of which Prof Peter Gibson and dietitian Emma Halmos have written extensively on. They suggested that too much sorbitol may actually be detrimental to those with Irritable Bowel Syndrome, possibly making their symptoms worse by contributing to bloating due gas production from the fermentation of the indigestible sorbitol.
The study original authors wrote back suggesting that sorbitol was not the reason for the positive benefits people received from taking the prunes. They felt that the prune’s fiber, polyphenols & other contents played a larger part than the sorbitol. The response also closed with somewhat of a jab at their detractors by suggesting that they were being overzealous in their desire to make a connection between FODMAPs & Irritable Bowel Syndrome.
My personal feelings are that it could go either way. I know that a lot of people with & without Irritable Bowel Syndrome have issues with sorbitol & other indigestible sugars. Some also have issues with fibrous fruits & vegetables. There are some who can’t handle psyllium husk or prunes, especially those who seemingly have alternating Irritable Bowel Syndrome symptoms. As usual it really depends on the individual & that’s probably the best thing a doctor can gain from this at the moment until more research is done. Treatment should be on an individual level & if something is not working for your patient or making it worse, listen & don’t be afraid to try something different.
Source: Irish Medical Times