Food Intolerance & the FODMAP Diet
The rising of food intolerances and irritable bowel syndrome (IBS) in the past decade has been noticeable especially in the western countries partly due to poorer food quality, increased usages of pesticides and food additives, stress levels and imbalances in gut microbiota.
In fact, is the most common gastrointestinal condition seen by general medical practitioners and dietitians today (1). Patients come to see me in my clinic, because their food intolerances are causing them stomach cramps, bloating, irregular toilet habits and have tried everything but nothing worked!
What is a food intolerance?
A food intolerance is very different from a food allergy though they are often mistaken for each other. A food allergy is an immune system response when the body reacts to a particular food such as nuts, milk, fruits, IgE antibodies are released and can cause a severe allergic reaction. Whereas, a food intolerance, often called a non-allergic food hypersensitivity, doesn’t involve the immune system and therefore less severe symptoms yet are much more common in humans than a food allergy.
There are many different types of food intolerances, including enzymatic and pharmacologic reactions. Pharmacological intolerances involve reactions to certain naturally occurring substances in foods such as vaso active amines – of which histamine is one example, salicylates – substances chemically similar to aspirin found in a wide variety of plant foods, and caffeine or theobromine – found in chocolate.
The more common type of food intolerance is enzymatic reaction towards food groups such as fructose, polyols, fructan or lactose, which occurs because one has either too little or no enzyme to help digest specific foods for example the enzyme lactase, which helps to digest milk sugar lactose. However, there are also many food intolerances with unknown mechanisms such as intolerance to food additives and pesticides.
Food intolerances do not involve the immune system and are rarely life-threatening. Reactions to food show a vast range of symptoms, individual to each patient. If left untreated this could result in severe cases of IBS and malnutrition of essential nutrients.
How can you get tested?
Unlike food allergies, there are not many good clinical tests for food intolerances. There exist many commercial tests such as measure the levels of antibodies called IgG antibodies which hold no clinical value. Current clinical tests available to help diagnose include a hydrogen-breath test, which measure levels of bacteria in the gut and reactions to lactose and fructose. Recently, newer testing methods such a DNA test measuring genetic mutations associated with impaired enzymatic production for specific to nutrients like gluten, lactose, fructose and histamine.
Can you treat a food intolerance?
For years symptoms of food intolerances have been “treated” or rather temporally helped with use of medications but never curing the actual cause. Today many countries like the UK and Australia first line of treatment is not prescribing medications but rather a specialised diet known as FODMAP. FODMAP stands for “Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols and was developed by some of the leading experts. The diet eliminates a group of highly fermentable carbohydrates proven to cause indigestion and overgrowth of gut bacteria, which can cause you to suffer from IBS symptoms. The FODMAP diet is backed by over hundreds of clinical studies, proven to treat over 86% of IBS cases in just 4 weeks (2). The simple two-step programme is designed to identify what foods you are intolerance to and help rebalances your good natural gut microbiome. The booklets are currently not available online so find a health professional trained in FOMDAP diet.
1. Thompson W, Heaton K, Smyth G, Smyth C. Irritable bowel syndrome in general practice: prevalence, characteristics, and referral. Gut. 2000;46(1):78-82.
2. Nanayakkara WS, Skidmore PM, O’Brien L, Wilkinson TJ, Gearry RB. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clinical and experimental gastroenterology. 2016;9:131.
This is a guest post. The opinions expressed are the writer’s own.