leaky gut

Food Friday: Gastrointestinal Health, Bloating, IBS and FODMAPS

FODMAPS is the newest of the dietary buzzwords in the blogosphere today. If you struggle with bloating or irritable bowel symptoms, learning about FODMAPS may help.

FODMAPS stands for fermentable oligosaccharides disaccharides monosaccharides and polyols.

 

FODMAPS include:

Fructose – fruits honey high fructose corn syrup, Etc.

Lactose–regular dairy products

Fructans-wheat garlic onion etc.

Galactan-Legumes such as beans, lentils, and soybeans etc.

Polyols-sweeteners like mannitol, sorbitol, and xylitol; stone fruits such as avocado, cherries, apricots etc.

You will notice that a lot of the foods on this list appear to be what we normally consider to be healthy. However if eaten in excess or by those who are sensitive to this phenomenon, they can produce undesirable symptoms such as excessive gas, bloating, diarrhea, and constipation. Such a situation is uncomfortable in and of itself but may also produce a systemic increase in inflammation.

According to the Stanford FODMAPS protocol, FODMAPS eaten in excess cause problems because they pull water into the intestinal tract, may not be digested or absorbed well and therefore could be fermented by the bacteria which reside in the intestinal tract. Fermentation produces gas and other by products which irritate the lining of the gut. This can produce increased intestinal permeability, also known as leaky gut syndrome. This produces the symptoms of bloating, pain, excess gas, and inflammation.

This sort of thing can happen to anyone who eats these ingredients to excess. However, in those for whom this occurs easily and chronically, and for whom other disease is ruled out, it is called irritable bowel syndrome or IBS for short.

Click below for the Stanford FODMAPS protocol diet handout which will will elaborate on these concepts and give you a handy chart for foods to use and foods to avoid. 

 

Stanford FODMAPS protocol

 

Bear in mind that water and fiber are part of this equation. Either too much fiber or too little fiber can aggravate symptoms. You simply have to experiment to find your unique sweet spot. I think a good place to start is a small bowl of soft (not sticky) hot oat bran cereal every day. I have taken a page from the Giada DiLaurentis playbook and take my oatmeal with a little olive oil and kosher salt. This is pleasant in a popcorn kind of way and avoids the sugars that make symptoms worse.

On the other side, drinking plenty of water can fix a multitude of ills. Drinking water all through the day aids digestion, helping to avoid fermentation in the first place. It also flushes out any irritating by products of unwise dietary choices sooner rather than later. It resolves constipation and rehydrates after diarrhea. 

If you are really struggling with symptoms of bloating, abdominal pain, excess gas, diarrhea and constipation, consult your doctor. Discuss the advisability of a low FODMAP diet for you. Remember that this is cutting edge thinking, and pertains specifically to FODMAP induced symptoms. Your doctor may discern other patterns in your clinical presentation that prompt him or her to check lab studies or imaging which they believe may be pertinent to your condition. If in the end, they think this would be helpful, try it with concerted effort for about 6 weeks. After that, you may find you can “ add back" desired items one by one, in small quantity. If your intestinal tract calms down and heals well, things that irritated you before may no longer do so. 

 

 

 

 

Medical Monday: More questions than answers on gluten and gut health

We are all aware of the new interest in gluten free diets. Should you be concerned ? To answer, I would first say that if you are well and feeling fine, you need simply eat properly and exercise regularly to keep it that way. You need not avoid gluten. However, if you suffer from bloating and cramping, a visit to your doctor is in order. To prepare, keep a simple food and symptom diary. Be prepared to undergo certain lab studies, or even get a referral to the Gastroenterologist. There are many conditions which might cause these symptoms. Sometimes it is challenging finding out what is wrong. 

Celiac disease is an autoimmune destruction of the lining of the gut, stimulated by gluten, in those that react to it. Gluten is a protein in various grains. Gluten intolerance is very specific reaction and even a small amount can set it off. It can be diagnosed by blood work and sampling at colonoscopy.  Avoidance of gluten allows the lining of the gut to heal. 

If celiac disease proceeds unchecked, the lining of the bowel becomes overly permeable, giving rise to the so called " leaky gut. " The leaky gut is associated with various forms of autoimmunity, but it is not known whether it is the cause or the effect. Regardless, a leaky gut means poor digestion and increased inflammation. 

People without celiac disease can get a leaky gut. They may suffer from other chronic or autoimmune illnesses, or from high levels of chronic stress which influence the gut directly. They may simply have a very unhealthy diet or take in toxic substances like alcohol and tobacco which damage the lining of the gut, leading to a cascade of additional problems later. Again, it is unclear whether the leaky gut is the cause of the effect. 

According to Dr. David Rakel, Assistant Professor and Director of the Integrative Medicine Program, Department of Family Medicine, University of Wisconsin, Madison, treatment for a leaky gut includes the Four R's. 

The four R's are: 

1. Remove irritants

2. Replace enzyme agents 

3. Reinoculate with probiotics 

4. Repair the mucosal lining with exercise fiber and fluids. 

For more information, please see his excellent handout here

I hope this reduces concern about this hot topic. Just be aware, it is a relatively new area of study, and we do not yet have all the answers. Beware of any blanket prescriptions or quick fixes out on the market. And by all means, whatever you do, enjoy your meals.