This post is dedicated to our Facebook fans! A couple weeks ago I asked on Facebook:
“Tell me one thing you’d like to learn more about (the low-FODMAP diet) and I’ll choose ten comments to respond to via a blog post.” There was a huge response, and many of the ten questions I chose did not come with simple explanations (as you all know perfectly well, this is certainly not a simple diet!). Also, everyday I receive dozens of questions about the diet via Facebook, Instagram, Twitter and email. So I felt it was a great opportunity to do something different and bring you the Low-FODMAP Diet Q & A Sunday.
When ever you see the image above on my social media channels, just ask your question below the image and check my blog every Sunday to see if I’ve answered your question. Take this opportunity to read other fans’ questions as you will learn much about the low-FODMAP diet!
So without further ado, here are two REALLY GOOD questions to which I’ve got great answers:
Question 1: Rachel Wittman Cox- Question: “What is a good filling easy fodmap breakfast and how long do most people stay on it before noticing improvements?”
Answer: I tend to go with eggs whites in the morning for some nice filling protein. I’ll then add a low-FODMAP cheese like mozzarella, a low-FODMAP veggie like spinach and a piece of gluten-free toast with coconut oil or butter. Other ideas are:
- Gluten-free oats with 1 tbsp slivered almonds and 10-20 blueberries
- Quinoa flakes with almond milk, 3/4 cup strawberries and 10 macadamia nut halves or other low-FODMAP nut.
- Lactose-free yogurt with 10 raspberries, 10 walnut halves and a sprinkle of unsweetened coconut flakes.
- Gluten-free toast with 1 tablespoon sunflower, peanut or almond butter and two small, peeled kiwis.
To answer the other question, some people feel results in a couple days, some a couple of weeks. Everyone is different, and it also depends how diligent you are about following the diet. Thankfully up to 70% of people following the diet can find an improvement in symptoms (per research by Peter Gibson, a professor of gastroenterology at Australia’s Monash University, and co-founder of the low-FODMAP diet).
Question 2: Karen Hazlett – Question: “I know I can’t digest high fodmap foods but I have no idea why, medically speaking. Is there a known reason?”
Answer: Some people have trouble digesting FODMAPs due to the fact that FODMAPs ferment, causing gas/wind, bloating, diarrhea, distention and/or constipation. FODMAPs are short-chain carbohydrates which are poorly absorbed in the small intestine (your small intestine is supposed to absorb nutrients and minerals from food) and then are rapidly fermented by bacteria in the gut. The bacteria produces gas which plays a large role in the onslaught of symptoms. The bacteria are basically eating FODMAP carbohydrates and then fermenting the sugar molecules.
Since fermentation causes gas it can make diarrhea worse or contribute to constipation. The methane gas that is produced can cause constipation while the hydrogen can increase GI motility. What is GI motility? It is defined by the movements of the digestive system, and the transit of the contents within it. When nerves or muscles in any portion of the digestive tract do not function with their normal strength and coordination, a person develops symptoms related to motility problems.
These FODMAPs or small undigested remnants of oligosaccharides, disaccharides, monosaccharides and polyols accumulate gases and cause what is called an osmotic effect.
FODMAPs are “osmotic” which means they cause water to be drawn into the intestines, leading to diarrhea. Stool stays more watery than usual which leads to bloating, gas, diarrhea, and pain.
The food we eat is broken down by one or more enzymes which are chemicals that digest foods into energy for your cells. In order for carbohydrate digestion to take place we need amylase. Amylase is produced in the pancreas and the glands that make saliva. As you chew, the amylase continues to break down carbohydrates throughout your digestive system. Amylase breaks down carbs into their individual sugars as they pass from the mouth to the stomach and the gut. The cells lining your gut can absorb them and distribute them to other parts of your body for energy.
Since FODMAPs aren’t completely digested in the small intestine like other carbs, they manage to pass through to the large intestine intact, instead of being absorbed in the gut and used for energy. Why does this happen? It’s because we can’t break down FODMAPs (a) or we can’t absorb them in the small intestine (b):
(a) Amylase is the main enzyme responsible for starch digestion, and if the quantity of starch consumed is so high that not enough amylase is available to keep up with it, your gut may not digest everything. Some FODMAPs reach the large intestine intact because a person does not have the enzymes necessary to digest them. People who have lactose (the disaccharide “D”) intolerance have a deficiency of the enzyme lactase (needed to break down lactose down into simple sugars). Everyone reacts to raffinose (one of the oligosaccharides, the “O” in FODMAPs), because humans lack the enzyme to completely break it down. Raffinose is a sugar present in sugar beet, cotton seed, and many grains. It is a trisaccharide containing glucose, galactose, and fructose units.
(b) Fructose (the monosaccharide “M” in FODMAPs) is a simple sugar and doesn’t need to be broken down further. It is difficult to absorb, so it stays in the intestine instead of getting transported through the intestinal wall into the body. So for instance, with fructose malabsorption there is an increased concentration of fructose in the entire intestine. In order for fructose to be absorbed in healthy people, only about 25–50 g can be consumed per sitting. People with fructose malabsorption absorb less than 25 g per sitting.
Humans can produce small amounts of the enzymes needed to break up galacto-oligosaccharides and fructans into their individual subunits. One person to the next may handle galacto-oligosaccharides and fructans differently. As an example, you might be able to enjoy hummus and break down the galacto-oligosaccharides in it, but you may not be able to break down the fructans in the bread you used to dip in the hummus. It might be the opposite for someone sitting next to you with IBS. Our immune systems (for people with and people without IBS) handle food, outside pathogens and stress differently. And to be very scientific:
“Malabsorption of fructose generates an osmotic force which increases water influx into the lumen and then leads to rapid propulsion of bowel contents into the colon, which is then fermented and leads to production of gas.
“The most common structural forms of fructan are inulin, levanare and geraminan. The human body has limited ability to break down these oligo- or polysaccharides in the small bowel and only absorbs 5 – 15% of fructan [22, 23]. The mechanism for malabsorption and intolerance is related to the lack of enzymes to fully hydrolyze glycosidic linkages in the complex polysaccharide, and therefore results in the malabsorbed fructans to be delivered to the colon, which are then fermented . Furthermore, the small molecule of fructans draws more water into the intestine which can result in bloating and diarrhea .
“At least 70% of polyols are not absorbed in healthy individuals .
In our gastrointestinal tract, we have two primary types of bacteria called bacteroidetes and firmicutes. Bacteriodetes are good because they will eat carbs, protein and fat, but firmicutes eat mostly carbs and fiber. Research has found that people with IBS, (which is often a SIBO related condition) tend to have more firmicutes than bacteriodetes. The more firmicutes one has in the gut, the more there is to ferment FODMAPS. “Approximately 100 trillion bacterial cells live in the GI tract, mostly in the large intestine. While colonic bacteria predominantly are from two bacterial phyla, Bacteroidetes and Firmicutes, there are about 400 species represented and the gut flora profile (type of bacteria and amounts of each type) is highly variable from one individual to another and even within individuals over time. Family members, however, share more similar gut flora than unrelated individuals.”
Then there is STRESS and did you know that stress can affect bacteria? When you are going through a rough time like the death of a loved one, the loss of a job or the ending of a relationship, the emotional stress you experience releases adrenal stress hormones, like cortisol and adrenaline. Your brain gets worked over by these stress hormones as your vagus nerve gets stimulated. The brain-gut connection is this same vagus nerve that is involved with stress. Your blood supply is reduced and therefore it’s harder for your body to properly digest foods and manage the balance of bacteria (a balance is essential for your gut-microbiome). Stress hurts your digestion, and poor digestion makes you feel more stressed.
And finally, please read this response from Jane G. Muir, PhD and Peter R. Gibson, MD in Gastroenterology and Hepatology July, 2013, The Low FODMAP Diet for Treatment of Irritable Bowel Syndrome and Other Gastrointestinal Disorders: “The topic of food intolerance is a challenging area of research, and more quality research is required. The success of the low FODMAP diet for control of gastrointestinal symptoms associated with IBS and the controversy surrounding gluten sensitivity have stimulated greater interest in dietary research. Besides carbohydrates, there are many other food components worthy of study. For example, dietary fat has been shown in acute studies to change visceral hypersensitivity. Naturally occurring chemicals are widespread in foods and can interact with receptors in the gut or have direct, possibly pharmacologic actions on the enteric nervous system and mast cells. Although dietary approaches that restrict natural salicylates, glutamates, and amines are currently in practice, few well-designed studies investigating the potential role of food chemicals in patients with functional gut disorders have been performed. Clearly, more work is required in this area.”
That’s it for this Sunday. Have a great rest of your day, and I look forward to your questions!
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- What is GI Motility? www.aboutgimotility.org/site/about-gi–motility
- Dietary fructose intolerance, fructan intolerance and FODMAPs Amy Fedewa1 and Satish S. C. Rao2 Author information ►
- FODMAPs and Paleo Cynthia Perkins
- Fermentable Foods: Trouble in Your Diet By David Warmflash
- Low FODMAP smartphone app
- Gut Bacteria, By Megan D. Baumler, PhD, RD, CD Today’s Dietitian sources:
- Chow J, Lee SM, Shen Y, Khosravi A, Mazmanian SK. Host-bacterial symbiosis in health and disease. Adv Immunol. 2010;107:243-274.
- Eckburg PB, Bik EM, Bernstein CN, et al. Diversity of the human intestinal microbial flora.Science. 2005;308(5728):1635-1638.
- Turnbaugh PJ, Gordon JI. The core gut microbiome, energy balance, and obesity. J Physiol. 2009;587(17):4153-4158.