Introduction
Digestive complaints affect nearly 100 million Americans. In most cases, the symptoms reflect disturbed digestive function or food intolerance rather than an underlying disease. Functional gastrointestinal disorders include occasional indigestion or heartburn, functional dyspepsia, excessive flatulence, and the irritable bowel syndrome (IBD). Relatively recently, a great deal of attention has finally started to look at certain foods that play a central role in digestive disturbances such as excessive gas, bloating, and changes in regularity. However, as discussed in the Commentary below, maybe the problem is not with the food, but rather how it is digested. Nonetheless, one of the most common culprits in causing digestive disturbances are FODMAPs – small carbohydrates in certain foods. FODMAP is an acronym for:
Fermentable – foods that are quicken broken down (fermented) by bacteria in the large intestine
Oligosaccharides – “oligo” means “few” and “saccharide” means sugar. These molecules are made up of individual sugars joined together in a chain. Beans are a common source of oligosaccharides.
Disaccharides – “di” means two sugar, so a disaccharide is composed of two sugar molecules bonded together. Sucrose is a disaccharide.
Monosaccharides – “mono” means single, so a monosaccharide is a single sugar molecule. Fructose is a monosaccharide.
And Polyols – these are sugar alcohols often used as sweeteners. Some examples are xylitol, maltitol, and erythritol
Background Information:
A low FODMAP diet refers to a temporary eating pattern, usually 7 to 10 days, that has a very low amount of FODMAPs. It is used in clinical medicine to relieve digestion-related symptoms such as gas, bloating, and irregularity in people dealing with IBS and other Functional Gastrointestinal Disorders (FGID).
Here is a list of some common foods and ingredients that are high in FODMAPs. Soto follow a low FODMAP diet, these foods are to be avoided:
- Vegetables: Artichokes, asparagus, broccoli, beetroot, brussels sprouts, cabbage, cauliflower, garlic, fennel, leaks, mushrooms, okra, onions, peas, shallots.
- Fruit: Apples, applesauce, apricots, blackberries, boysenberries, cherries, canned fruit, dates, figs, pears, peaches, watermelon.
- Dairy products: Milk (from cows, goats and sheep), ice cream, most yogurts, sour cream, soft and fresh cheeses (cottage, ricotta, etc).
- Legumes: Beans, chickpeas, lentils, red kidney beans, baked beans, soybeans.
- Wheat: bread, pasta, most breakfast cereals, tortillas, waffles, pancakes, crackers, biscuits.
- Other grains: Barley and rye.
- Beverages: Beer, fortified wines, soft drinks with high fructose corn syrup, milk, soy milk, fruit juices.
- Sweeteners: Fructose, honey, high fructose corn syrup, xylitol, mannitol, maltitol, sorbitol.
Recent Data:
A new study aimed to identify factors predictive of an efficacious response to a low-FODMAP diet in FGID patients with fructose or lactose intolerance. To determine whether patients had either fructose or lactose intolerance, breath tests were performed in FGID patients to determine intolerance (positive symptom score) and malabsorption (increased hydrogen or methane gas concentrations on the breath test). Once the patients with fructose or lactose intolerance were identified they consumed a low-FODMAP diet. A total of 81% of 584 patients completing the low-FODMAP diet achieved adequate symptom relief. These results were quite significant. Those with higher breath methane levels indicating fructose intolerance experienced the greatest degree of improvement in IBS symptoms. However, given the high overall response
Commentary:
This study provides some interesting insights. First, fructose could be a bigger issue for people than previously thought. Not only may it lead to a malabsorption issue causing looser stools it is thought to disrupt the microbiota or gut flora. My biggest comment on the study is that it may be more effective to support digestive function by using natural digestive aids rather than try to eliminate so many health promoting foods. Many of the foods excluded on the low-FODMAP produce beneficial effects on the intestinal microbiome – the collection of microbial genetic material in the gastrointestinal tract. A more rational approach may be to focus on supporting FODMAP absorption through the use of supplemental enzyme formulations rather than eliminating these foods.
It is well-established that taking lactase, the enzyme that helps breakdown lactose (milk sugar), can be very effective in helping those with lactose intolerance (about 75% of all adults worldwide). Fructose is a monosaccharide so malabsorption of fructose may indicate damage to the absorptive surface of the small intestine or lack of other digestive enzymes. When fructose is not absorbed in the small intestine, it is transported into the large intestine, where it is fermented by the colonic flora. That produces a lot of gas and causes a lot of symptoms such as bloating, diarrhea, flatulence, and gastrointestinal pain.
Here is my take on the situation, if fructose is not being absorbed it means that foods are not being properly digested and other nutrients are not being absorbed. The answer is not to go on such a restrictive diet, but to use digestive enzymes. A broad-spectrum enzyme formulation that contains the enzyme alpha galactosidase. This enzyme is the key in digesting the sugars and FODMAPs from beans, grains, raw vegetables and other foods. The great thing about digestive symptoms like flatulence (gas), bloating, and regularity is that when a product or diet works it is usually quite obvious. To wrap this newsletter up, here is what I recommend:
Follow a low-FODMAP diet for 10 days supplemented with digestive enzymes. This ten day period will help determine if FODMAPs are an issue in your digestive health complaints. If symptoms dramatically improve, then I would recommend to continue to keep FODMAP intake low, but not necessary totally avoided, we need those good foods. Just be sure to continue to use the digestive enzymes. You can then slowly increase the intake of FODMAPs to determine your intake threshold for producing symptoms. With the enzyme support, it should be significantly higher and they may not be an issue at all.
Reference:
Wilder-Smith CH, Olesen SS, Materna A, Drewes AM. Predictors of response to a low-FODMAP diet in patients with functional gastrointestinal disorders and lactose or fructose intolerance. Aliment Pharmacol Ther. 2017 Apr;45(8):1094-1106.
