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Taming Stomachs With Fodmap Diet Spurs $8 Billion Market

By Jason Gale on October 29, 2012

Sue Shepherd says she never expected to become famous for taming cantankerous stomachs.

The 38-year-old Australian dietitian invented a food regimen with a bizarre name in her early 20s to relieve symptoms of bloating and stomach cramps. It's now being adopted internationally, changing the way doctors manage a set of digestive troubles known as irritable bowel syndrome.

Shepherd initially set out to help the 1 percent of people with a gluten intolerance causing celiac disease. She found even those without the condition felt better when they avoided the grain-protein and foods containing certain sugars named Fodmaps, an abbreviation for potentially tough-to-absorb molecules. Shepherd's diets low in gut irritants have spurred an $8.3 billion market, encouraging the likes of Abbott Laboratories (ABT) to introduce products devoted to food intolerance.

"This approach has really revolutionized the way we treat a common condition," said Jason Tye-Din, a gastroenterologist at the Royal Melbourne Hospital and celiac researcher at the Walter and Eliza Hall Institute. "The significance has been realized around the world."

Screening for celiac disease in Australia alone has increased 25 percent over the past four years, according to Tye- Din, who runs two of Australia's four celiac disease clinics. That's bolstered demand for gluten-free foods and other products for so-called functional gastrointestinal disorders.

"Gluten-free food is flourishing," said Ewa Hudson, head of health and wellness food and beverages research at London- based Euromonitor International Ltd., who predicts retail sales of food intolerance products will reach $10.5 billion worldwide by 2017, especially as more grocery chains carry them.
Food 'Revolution'

The market in developed nations "has undergone a revolution," Hudson said in an e-mail. "Prior to that, gluten- free had been the preserve of pharmacies and specialist health- food stores."

Abbott and Mead Johnson Nutrition Co. (MJN) have about 7 percent each of the global food-intolerance market by value, according to Euromonitor. Abbott, which sells intolerance products under the Vital and Ensure labels, introduced a limited-ingredient, gluten-free nutrition bar called Perfectly Simple in June.

"We expect to launch an additional 20 products and formulations this year and have more than 30 clinical studies," Abbott said Oct. 17, when it reported third-quarter earnings.

Shepherd said she's sold almost 200,000 copies of her eight cookbooks, which include Irresistibles for the Irritable, that help people choose bowel-friendlier foods. The recipes avoid sugars that aren't well absorbed in some people's bowels, found in products ranging from onions to yoghurts.
Too Much Gas

These foods can cause bloating, excess gas, abdominal discomfort and diarrhea in some people -- hallmarks of irritable bowel syndrome experienced by at least 10 to 15 percent of adults, according to the International Foundation for Functional Gastrointestinal Disorders, a research and education group in Milwaukee, Wisconsin.

"I pieced together what was an experimental diet," said Shepherd, who began teaching the regimen in her private dietetics practice in early 1997. "I wasn't randomly picking these foods -- they all had something in common: they were all potentially not absorbed in the small intestine."

Peter Gibson, gastroenterology professor at Melbourne's Monash University, helped coin the term Fodmap to describe the molecules people with irritable bowel syndrome have difficulty stomaching -- fermentable oligosaccharides, disaccharides, monosaccharides and polyols found in dozens of everyday things from apples and wheat to milk, high-fructose corn syrup, and sugarless chewing gum.
'Fell Off My Chair'

Shepherd, who has celiac disease, tested her diet on 25 people, preparing all their meals herself for 22 weeks in a study that formed part of a PhD thesis at Monash. She found the diet quelled symptoms in at least 70 percent of participants, compared with 12 percent given a placebo meal resembling typical Australian fare.

"I honestly nearly fell off my chair because it looked just too good to be true," said Shepherd, who now employs 13 dietitians in a practice that sees about 4,000 people a year. "I still pinch myself at how successful it is and how big it's become. It's literally gone global."

The research drew attention to the role of diet in medicine and gastroenterological diseases especially, said Josh Butt, a gastroenterology fellow at Monash.

http://www.businessweek.com/news/2012-10-28/taming-stomachs-with-fodmap-diet-spurs-8-billion-market

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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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