Diet fads: We’ve all been tempted by promises of weight loss and increased energy. But, while diets have been traditionally associated with losing or maintaining weight, today we are seeing more diets emerge that are geared towards improving gut microbiota and alleviating the symptoms associated with gastrointestinal disorders. With symptoms ranging from nausea, vomiting, weight gain or loss, acid reflux, heartburn, bloating, gallstones, gas, constipation, diarrhea, hemorrhoids, and pain, there are now over 20 identified functional gastrointestinal disorders (FGID)1 alone. And, that doesn’t include GERD, Celiac Disease, Crohn’s Disease, Ulcerative Colitis, IBS… you get the idea.
According to estimates from the CDC, inflammatory bowel disease is on the rise in the US.2] Studies are also demonstrating the rise of gastrointestinal diseases in Asia,3 the United Kingdom4 and Europe as a whole5 as well as Latin America and the Caribbean.6 Okay, so the world is having gut problems. Why are we seeing this rise in GI diseases? Let’s take a stroll into your average grocery store and breakdown what the average American eats in a day. The USDA’s Economic Research Service reported that majority of America’s daily calorie intake came from grains, fats and oils.7 And we’re talking an average intake of 3,770 calories per day.8 Not only that, but the average American consumes nearly 17 teaspoons of added sugar per day.9] Behold, the “central aisle,” packed with additives like sugar (because it’s delicious), soy (for moisture retention and added protein), MSG (enhance flavor), food coloring (so your food looks pretty), sodium nitrate (to inhibit bacterial growth), and guar gum (thickener), to name a few.
Chances are you may be one of the 74% number of Americans suffering from said gastro discomfort and pain.10 In fact, we are seeing more documentaries attempting to shed light on the food industry and consumption and disease such as Food Inc, Fed Up, Supersize Me, or The Gut: Our Second Brain. As a culture we are becoming more aware of health risks posed by GMO’s, pesticides, and food additives. There is a greater demand for cleaner food sources including organic produce, humanely raised animal proteins as well as pre and probiotic foods.Today let’s talk about FODMAPs.
The term FODMAP may be a new one for you. Developed in Australia in 2004 by Dr Peter Gibson and Dr Susan Shepard[11 the FODMAP diet is gaining popularity. A variety of studies are showing improvement in patients with IBS and IBD. And not just in a few patients. We’re talking an improvement in 75% of patients with IBS,12 and 50% of patients with IBD.13 In fact, a low FODMAPs diet has shown helpful to patients with functional gastrointestinal disorders (FGID) in general.14
While some foods promote the growth of beneficial bacteria, western diets are high in sulfates, protein, simple sugars, and refined carbohydrates. Diets high in simple sugar can increase bile that some intestinal bacteria utilize as food, and slow bowel transit timing (motility) increasing fermentative bacterial activity. Yes, fermenting.
We’re talking Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. FODMAPs refers to a variety of short chain carbohydrates that are resistant to digestion. And because our short intestine is unable to absorb these FODMAPs into the bloodstream, they move on to the large intestine where they become fodder for bacteria in the colon (the far end of the intestine where bacteria colonies are highest). FODMAPs are osmotically active, meaning that they draw water into the intestine, causing them to ferment. Instead of being fuel for your body, they end up being used as fuel for bad gut bacteria.
As these FODMAPs ferment, carbon dioxide, hydrogen, short-chain fatty acids, and other gases are produced. This process causes bloating, nausea, gas, abdominal pain and distention, diarrhea or constipation.15
So, let’s take a moment to meet our FODMAP’s shall we?
Monosaccharides consist of one saccharide (or sugar) molecule and are broken down into four subcategories:
- Glucose: is the one of the primary molecules used for energy. Found in the sap of plants such as honey, agave and molasses. Indeed, much of our food is broken down into glucose during digestion, as the body synthesizes or creates glucose.16 In the blood stream, glucose is referred to as blood sugar.
- Dextrose is a simple sugar made from corn.
- Fructose: sugar found naturally in fruits and can also be used as a sweetener and food additive.
- Galactose: sugar found in dairy products, avocados, sugar beets. Galactose is also synthesized by the body.
Disaccharides are made of two saccharides molecules and are often referred to as double sugars, these are:
- Sucrose: its what’s in your sugar bowl. Found naturally in sugar cane and sugar beets, you also find sucrose in many fruits and vegetables as well as molasses, honey, maple syrup.
- Lactose: is one of the main components of mammal milk, our source being largely obtained in cows milk in the form of milk, yogurt, cream, butter, cheese, ice cream as well as a variety of products such as baked goods, sauces and salad dressings, etcetera.17
- Maltose: found in malt and molasses.
Oligosaccharides are made of three to nine saccharides and fall into two subcategories:
- Fructans: grains, especially white rye and barley as well as vegetables such as onions, leeks and artichokes.
- Galactans: think beans. Lentils. Chickpeas. Black, Kidney, Pinto, Cannellini, Lima, Fava. You get the idea.
Polyols are sugar alcohols. They are water soluble and can occur naturally or be produced. Examples are isomalt, sorbitol, mannitol, maltitol, and xylitol.
Every bodyis different. Even those with intolerance to FODMAPs can find that they can handle a bit of one group and zero of another. While some find they have no problems with fructans for example, they find they are ix-nay on the eans-bay. If you know what I mean.
Which is why FODMAP diet protocol is to eliminate all high FODMAP foods together. Then reintroduce them individually in order to distinguish which foods specifically cause the individual pain and or discomfort. For more on the FODMAP diet, see Monash University website. Reason being, we all have unique digestive systems largely due to our gut microbiome. For more on our microbiome read our recent article here. And due to that unique footprint, we all digest foods differently.
We are seeing more research demonstrating that when it comes to lifestyle and diet, there is no one size fits all. Genetics, microbiota, and the overall health of an individual can all play a part in what works for you. Paleo, Keto, Carnivore, Atkins, Zone, Vegan, Raw, South Beach, Dukan, intuitive eating, gluten free, HCG… even intermittent fasting. There are a dizzying numbers of options out there when it comes to diet. But, if you’re like many Americans who find themselves suffering from GI pain or discomfort, consider turning your attention to reducing FODMAPs in your diet, being sure to consult your doctor and/or nutritionist. Your gut (and in the case of those bean intolerant folks – your family) will thank you.
1https://www.austingastro.com/2018/06/01/9430/
2https://www.livescience.com/56760-inflammatory-bowel-disease-on-rise-in-us.html
3https://www.medtechintelligence.com/feature_article/gastrointestinal-diseases-rise-in-asia/
6https://www.sciencedirect.com/science/article/pii/S1542356519306688
7https://time.com/2818849/these-are-the-most-popular-foods-in-america/
11https://onlinelibrary.wiley.com/doi/pdf/10.1111/jgh.13685
12https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423692/
13https://www.healthline.com/health-news/low-carbohydrate-diet-helps-with-ibd
14https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952847/
15https://www.healthline.com/nutrition/fodmaps-101#bottom-line
17https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/lactose