The Whole View, Episode 457: The Problem with a Low-FODMAP Diet
Welcome back to episode 457! (0:28)

Sarah and Stacy last covered FODMAPs in detail in TPV Podcast Episode 238, What's a FODMAP and Why Do Some People Avoid Them?

The science on them has definitely evolved, so it's time to revisit what FODMAPs are and why there can be a problem with a low-FODMAP diet!

This show is sponsored by Stacy and Sarah's favorite probiotic company, Just Thrive!

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Stacy and Sarah only invite brands they love to be a part of this show and never endorse something they don't use themselves.

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Quick Review of FODMAPs
The term FODMAP is an acronym for Fermentable Oligosaccharides, Monosaccharides, Disaccharides, and Polyols. (4:10)

FODMAPs are sugar alcohols and short-chain carbohydrates rich in fructose molecules. 

These molecules are inefficiently absorbed in the small intestine but are highly fermentable by our gut bacteria in the large intestine.  

Many dietary carbohydrates that have prebiotic actions are members of the FODMAP group of carbohydrates: Fructo-oligosaccharides (FOS), galactooligosaccharides (GOS), xylooligosaccharides (XOS), polyols, and fructose. 

These FODMAPs selectively stimulate the growth of super beneficial specific types of bacteria. They include Bifidobacteria, Lactobacillus, Akkermansia municiphila, Faecalibacterium prausnitzii, Roseburia intestinalis, Eubacterium rectale, and Anaerostipes caccae.

When FODMAPs enter the large intestine full of those wonderful beneficial bacteria, they increase the metabolic activity of our gut bacteria. This increases the production of SCFAs and gasses. 

Because of the increase in production, we might notice even if we eat a ton of FODMAPs all at once is an increase in flatus frequency. Sarah adds that this is perfectly normal.

 

FODMAP Intolerance
Where it flips into FODMAP intolerance is when it becomes uncomfortable. (10:34)

Typical symptoms of FODMAPs include bloating, gas, cramps, diarrhea, constipation, indigestion, and sometimes excessive belching. 

This is why a typical diagnosis is Irritable Bowel Syndrome. Some researchers even believe that 100% of IBS is caused by FODMAP intolerance.

So, what causes FODMAP intolerance? There's three potentially overlapping, causes

Gluten and/or Dairy sensitivity

Fructose malabsorption

Gut dysbiosis


Gluten Sensitivity
The biggest source of FODMAPs in the Standard American Diet is wheat. 

This is because wheat is consumed in large quantities, not because it is a concentrated source of FODMAPs.

Additionally, up to 55% of the population (in North America) has gluten sensitivity genes! 

Symptoms of non-celiac gluten sensitivity include IBS bloating, gas, cramps, diarrhea, constipation, indigestion, and belching.

PLUS extra-intestinal symptoms, such as brain fog, fatigue, lethargy, skin rash (including eczema), headaches, fibromyalgia-like symptoms (joint and/or muscle pain), carpal tunnel and peripheral neuropathy-like symptoms, depression, anxiety, and anemia

2012 double-blind elimination and challenge study showed 30% of IBS was wheat sensitivity.

Stacy and Sarah discussed these genes in detail in TPV Podcast, Episode 293: Do I Have to Be Gluten-Free Forever?

Dairy Sensitivity
And lactose is a FODMAP! Lactose intolerance is caused a deficiency in the enzyme lactase.

Rates of intolerance vary widely based on ethnicity, ranging from 5% among Northern Europeans to over 90% of the population in some Asian and African countries. 

In fact, in the US alone, somewhere between 30 and 50 million people are lactose intolerant!

Also, epidemiological reports of cow's milk allergy