Nowadays, do you find that more people appear to be becoming increasingly ‘intolerant' to certain food groups?
This may be due to several different factors including, diet and dietary related habits, the sterilisation of the gastrointestinal (GI) tract and the mainstreaming of diagnostic tools such as hydrogen breath testing.
Food intolerances can lead to various health difficulties and can also have social implications.
In the case of FODMAPs intolerance, associated symptoms tend to be obscure and highly individual. Self-diagnosis and treatment informed by the internet is very common and can result in overwhelming and non-specific misinformation.
Even once a professional has undertaken diagnosis, identification and elimination, the road to recovery is only half completed. Unfortunately, this is the point where many people stop working with a health professional.
As you read on, we hope to discuss the importance of treating the underlying cause and the negative implications of long-term dietary exclusions in FODMAPs intolerance.
Let’s Talk About FODMAP
FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) represents a group of poorly absorbed, short-chain carbohydrates found in grains, vegetables, legumes, milk, fruit and sweetened products.
In FODMAPs intolerance, there is a reduced ability to properly digest these foods, leading to symptoms such as bloating, gas and changes in bowel regularity (Mansueto et al., 2015).
Some high-FODMAP foods, such as high-fructose corn syrup and artificial sweeteners, are ultra-processed and do not help promote a healthy gastrointestinal lining.
However, a lot of nutritionally dense whole foods also sit under the FODMAP umbrella, including a range of legumes, fruits and vegetables*. These whole foods contain fibre components referred to as ‘prebiotics’, which are indigestible to humans, but provide energy for the beneficial bacteria of the gut.
Let’s Talk About The Gut
The bacterial composition of the gut (microbiome) has got a lot of press in the past 15 years. Science is constantly learning about the role that micro-organisms play in our body.
Some of the most important functions of micro-organisms have in the digestive system include:
The human microbiome is the collection of trillions of microbes living in and on the human body. This microbiome is not stable, but constantly in flux.
While genetics and early life development play a significant role in its composition, our microbiome responds to its environment. For example, it is significantly influenced by diet, lifestyle habits, certain medications and stress (Rinninella, 2019).
When the quality of the microbiome is compromised, we lose our ability to properly digest fibre rich foods, as the bacteria that digest these kinds of fibre are plainly absent.
The reason why certain people diagnosed with FODMAPS intolerance experience different levels of tolerance to different foods, is influenced by what kinds of bacteria their gut is housing. A compromised microbiome directly leads to symptoms of FODMAPs intolerance (bloating, gas, changes in bowel motion), as there is a lack of beneficial bacteria in the gut to properly digest food. The inflammation caused by the undigested food causes and perpetuates damage to the gut lining. This reinforces symptoms of FODMAPs intolerance as it is difficult to establish a healthy microbiome when the integrity of the gut is compromised.
In the case of FODMAPs intolerance there is risk of getting tied up in symptom reduction rather than treating the underlying problem. FODMAP intolerance is less of a diagnosis and more of a symptom. Short term actions, such as removing the food triggers is likely to reduce symptoms, which is an important step required to take the pressure off the digestive system and allow it to heal. But long term, the individual factors need to be addressed to treat the cause and promote health long term.
How Do We Heal Out Gut?
In order to allow the gut lining to properly heal we need to look at three key actions:
1 - Limit anything that affects the gut (from diet, drugs, pathogenic microorganisms, etc)
2 - Encourage nutritional support for the growth of the gastrointestinal cells
3 - The gut needs to be restored with beneficial bacteria.
4 – The bacteria need to be maintained (fed) with prebiotics
The lining of the GI tract is like skin, cells turn over in a cycle, but the quality of those cells is dependent on what they are exposed to. Are they exposed to more damage while healing? Do they have adequate building blocks?
As High-FODMAP foods make up a substantial proportion of a normal healthy diet the low-FODMAP diet is not intended long term. Different vegetables contain different phytonutrients which feed different bacteria. Research demonstrates that healthy gut function appears to be dependent on diversity of bacteria. The low-FODMAPs diet involves exclusion of a range of nutritionally valuable prebiotic foods. By removing this we can negatively impact the nutritional status and the ability to establish a healthy and diverse microbiome (Stern & Brenner, 2018).
Re-introduction of certain foods is recommended after 2-6 weeks (Hill et al., 2017). This should be carefully planned to reduce the resurgence of symptoms and ensure nutritional adequacy.
Working with a professional can be of great help during this process – assisting in creating an individualised plan around identification of foods, eliminations, re-introduction, and long-term maintenance.
It is also important to acknowledge the mental and behavioural impacts of such a restricted diet. Symptom reduction following diet adherence, may induce some anxiety around re-introduction.
The gut and brain communicate via the enteric nervous system. Stress activates the Sympathetic Nervous System (‘fight or flight’ mode) which reduces digestive function. Therefore, experiencing anxiety with food actually reduces digestive capabilities.
This point is particularly interesting when you consider the role of the microbial environment within the enteric nervous system. The communication with the gut and brain is highly dependent on the quality of the microbiome. As we discussed before, a low-FODMAPs diet doesn’t exactly promote microbial diversity, suggesting another potential relationship between how FODMAP intolerance and long-term low-FODMAP diets may be self-perpetuating (Hill et al., 2017).
Can Naturopathy Help?
In the practice of naturopathy, we look at all aspects of the patient, which is then used to create appropriate treatment plans.
There are particular stages of treatment that should be acknowledged. For example: re-introduction is not likely to be successful if the underlying issue has not been treated. You also cannot help the gut develop more beneficial bacteria if the environment you introduce it into is not conducive to growth.
At Komyuniti we are well equipped to assist with a range of different herbal and nutritional supplements targeted to: reduce symptoms; restore the integrity of gut lining; support healthy eating habits; and create individualised plans around food elimination and re-introduction in order to support long term management and convalescence.
Every case is different. Each person is unique.
Overcoming FODMAPs intolerance can take time. But the goal is to identify and address your individual needs and create a positive relationship with the foods you eat.
Contact us today to discover for naturopathy at Komyuniti can help you on the road to better health.
*List of High-FODMAPs foods can be found here: https://www.monashfodmap.com/about-fodmap-and-ibs/high-and-low-fodmap-foods/