Part II - GFD & FODMAP
Updated: Aug 8, 2018
In last month’s article we presented information about the currently popular gluten-free diet (GFD) and expressed concern about people substituting processed gluten-free food (frequently high in sugar, carbohydrates and fat) for known health promoting natural whole grain products. These processed foods are touted as healthy by the media, supermarkets, and restaurants as they typically profit more from the sale of the more expensive concoctions. We described last week the very common condition of irritable syndrome (IBS), a benign but disabling condition manifested by chronic intermittent symptoms of abdominal pain, gas and bloating, and change in bowel habits. The GFD has been promoted to improve this condition. However, many gluten- containing foods are high in simple carbohydrates and the symptomatic benefits that are experienced on a GFD appear to be wrongly attributed to the removal of gluten and more accurately the result of a reduction in carbohydrate intake.
Carbohydrates are composed of chains of sugars chemically linked together. The basic molecules (units) of these chains are simple sugars and the number of sugar molecules linked ranges from two (table sugar is a molecule of glucose linked to a molecule of fructose) to thousands (as in starch and fiber). This group of short chain carbs that have been shown to be potentially problematic have been classified as FODMAPs. This cumbersome acronym stands for fermentable oligo-, di-, mono-saccharides and polyols. Saccharides means sugar and the prefix indicates the number of sugars in the chain: oligo-many, di-two, mono-one. Polyols are sugar alcohols, not to be confused with ethanol in ‘spirits’. Carbs must be digested (broken-down) to a single sugar molecule in order to be absorbed by the intestine and then into the blood. There is a tendency for FODMAPs to be poorly absorbed in the small intestine because they are not completely digested into a single sugar molecule and they pass into the colon (large intestine) where they are fermented by bacterial flora (normal “gut bugs”). A by-product of fermentation is gas which results in bloating and discomfort. This can result in the embarrassing urgency to “expel rectal wind” (terminology my mother insisted on using instead of f_ _t). Diarrhea and other symptoms occur in people with IBS as described in last week’s article.
There is robust scientific evidence that has shown that restricting FODMAPs affords relief of GI symptoms in the majority of patients that benefit from the GFD. Many foods classified as FODMAPs are staples in any diet and tend to be healthy and an individual is not likely sensitive to all of them. The goal is to identify which foods in the group are problematic to each individual and not to attempt to eliminate all FODMAPs long term. If you have been diagnosed with IBS, NCGS (non-celiac- gluten sensitivity) or simply have frequent issues with gas and abdominal bloating, it is highly possible that you would benefit from avoiding certain high FODMAP foods. If symptoms are not very frequent, this could possibly be accomplished by keeping a detailed food diary and noting when problems occur after consuming certain foods. An aggressive approach for more frequent or severe symptoms involves eliminating all FODMAPs for several weeks (somewhat difficult) and if symptoms improve, high FODMAP foods are gradually re-introduced to determine where the intolerances lie. This is best done under the supervision of a dietician.
Examples of high FODMAP foods include onion, garlic, apples, pears, mushrooms, asparagus, and watermelon. An example of a polyol (sugar alcohol and the P in VODMAP) is sorbitol used as a sweetener in place of sugar and commonly used in sugar-free gum. Did you ever consider that chewing gum could cause gas and bloating? How ironic, using gum for bad breath and….well, you can deduce the possible trade-off! These are just a few common examples. To review an extensive list, please visit my webpage at www.drtippett.com and click on the News tab.
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Dr. Tippett is the founder of Comprehensive Quality Healthcare Providers located at 1210 Commerce Dr. Greensboro, Ga 30642. He can be reached at 706-510-3659. Visit his webpage at www.drtippett.com.