Gluten or FODMAP?

In tips, Sera pointed at an article per Gluten sensitivity. The claim is that the original researcher went back, did a far more detailed and complete study, and found it wasn’t gluten.

https://chiefio.wordpress.com/2016/07/06/tips-july-2016/#comment-69841

As a few of my friends are on “gluten free” diets (and I’ve tried it), this is of some significant import to me. Interestingly enough, the “Old College Roomie” was first diagnosed with hypoglycemia, then Gluten Intolerance, then later testing showed it to actually be a different category of actual allergy to wheat. Put a spoon of wheat in anything, even without his knowing, and he’s “got issues”.

So over the last decade or three I’ve gotten pretty good at cooking with “wheat alternatives” for things. (I’d do the group thanksgiving dinner… it got to be an ever increasing challenge as we slowly accumulated various food tolerances. The list finally reached, for various folks: No corn, no wheat, no beef, no hydrogenated oils, organic, vegetarian, vegan; then ‘wheat’ expanded to include rye, barley and maybe oats… and then a soy reaction had one person with ‘no soy’… Ever try to cook vegetarian without soy, wheat, corn, rye, barley, and oats?…)

Back at the story…

The basic idea is that there are short chain carb and sugar like things that don’t digest well, but do ferment in the large intestine causing distress (along with gas). This is in addition to the folks who have actual IBS Irritable Bowl Syndrome from the wheat. Now, by my take, we’ve got at least three things going on here that will be confounding. IBS, actual allergies, and those short chain things. They are collectively called “FODMAP”.

https://en.wikipedia.org/wiki/FODMAP

FODMAPs are short chain carbohydrates (oligosaccharides), disaccharides, monosaccharides and related alcohols that are poorly absorbed in the small intestine. These include short chain (oligo-) saccharide polymers of fructose (fructans) and galactose (galactans), disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols) such as sorbitol, mannitol, xylitol and maltitol.

The term FODMAP is an acronym, deriving from “Fermentable Oligo-, Di-, Monosaccharides And Polyols.” These carbohydrates are commonly found in the modern western diet. Some evidence has been presented that the restriction of these FODMAPs from the diet may have a beneficial effect for sufferers of irritable bowel syndrome and other functional gastrointestinal disorders (FGID), including one low FODMAP diet.

A low FODMAP diet has been shown in studies to be efficacious in short-term management of many individuals with FGID, but this diet can adversely affect the gut microbiota and nutrient intake. Currently, the long-term efficacy and safety of low FODMAP diet are not established.

Some of these we already know. Beans, for instance, have the gas making part in that list as galactans. In fact, several ‘problem foods’ known traditionally for some folks can be found in the list containing these substances. Lactose, for example. All those “lactose intolerant” folks lacking the enzyme to digest it, get the ferment issues. Beans “the musical fruit”. The cabbage family that for some folks cause gas / ‘aroma’ issues (fructans and polyols) and even some of the artificial sweetener issues (mannitol, sorbitol) that cause some folks “issues”.

Just based on that list of known foods with issues, I can see where some folks are likely to “have issues” based on the group of compounds. But that also points to the fact that each individual is unique and some folks, like me, have no problem with lactose, but may have issues with the other bits. I also note that the list is a shopping list for “The Usual Additives” that are in almost every processed food product out there. Perhaps why so many folks benefit from a “whole foods / natural foods” diet. Nothing to do with “organic” or “vegetarian” so much as “non-FODMAP”?

From the link Sera provided:

http://www.sciencealert.com/scientists-who-found-evidence-for-gluten-sensitivity-have-now-shown-it-doesn-t-exist

For a follow-up paper, 37 self-identified gluten-sensitive patients were tested. According to Real Clear Science’s Newton Blog, here’s how the experiment went:

Subjects would be provided with every single meal for the duration of the trial. Any and all potential dietary triggers for gastrointestinal symptoms would be removed, including lactose (from milk products), certain preservatives like benzoates, propionate, sulfites, and nitrites, and fermentable, poorly absorbed short-chain carbohydrates, also known as FODMAPs. And last, but not least, nine days worth of urine and faecal matter would be collected. With this new study, Gibson wasn’t messing around.

The subjects cycled through high-gluten, low-gluten, and no-gluten (placebo) diets, without knowing which diet plan they were on at any given time. In the end, all of the treatment diets – even the placebo diet – caused pain, bloating, nausea, and gas to a similar degree. It didn’t matter if the diet contained gluten.
[…]
On top of that, these other potential dietary triggers – specifically the FODMAPS – could be causing what people have wrongly interpreted as gluten sensitivity. FODMAPS are frequently found in the same foods as gluten. That still doesn’t explain why people in the study negatively reacted to diets that were free of all dietary triggers.

They then go on to a ‘catchy phrase’ that you can not only smell the bread now but eat it too… ignoring the statement that “FODMAPS are frequently found in the same foods as gluten”… so if you react to them you STILL can’t have bread as the FODMAPS are there… I do wish science writers had at least basic logic training…

Back at the wiki:

Poor absorption of most FODMAP carbohydrates is common to everyone. Any FODMAPs that are not absorbed in the small intestine pass into the large intestine, where bacteria ferment them. The resultant production of gas potentially results in bloating and flatulence. Most individuals do not suffer significant symptoms but some may suffer the symptoms of IBS. Restriction of FODMAP intake in the latter group has been found to result in improvement of symptoms.

Fructose malabsorption and lactose intolerance may produce IBS symptoms through the same mechanism but, unlike with other FODMAPs, poor absorption is found only in a minority of people. Many who benefit from a low FODMAP diet need not restrict fructose or lactose. It is possible to identify these two conditions with hydrogen and methane breath testing and thus eliminate the necessity for dietary compliance if possible.[3]

Yet fructose is the sugar of choice in the processed food industry and is used by the megaton in sodas and snack foods. IFF you are one of that minority with poor absorption, you get a major problem. My family has tried restricting the massive fructose (“corn syrup”) load in the typical diet and it isn’t easy. You mostly end up making everything yourself. (FWIW, I didn’t notice any real change from fructose reduction in my clan… then again, I don’t drink sodas on any regular basis nor like packages snacks other than when “on the road”… and even then tend to making my own sandwiches and eating potato chips.)

Yet many “typical Americans” live by the canned soda and “sugary snacks” made with fructose. I wonder how many of them have no idea their fructose absorption level?

Given that each person will have a unique metabolism, though often similar inside any given clan, any given person could have a problem with any given part of the list of substances. (For me, I know beans can be very gassy, so I clearly don’t handle galactans well. But it usually causes no discomfort. To me anyway ;-)

Sources in the diet

The significance of sources of FODMAPs varies through differences in dietary groups such as geography, ethnicity and other factors. Commonly used FODMAPs comprise the following:

oligosaccharides, including fructans and galacto-oligosaccharides;
disaccharides, including lactose;
monosaccharides, including fructose;
polyols, including sorbitol, xylitol, and mannitol.

That’s the short list of the categories. Each of those 4 tends to come from specific plant sources. (Meat eaters, rejoice… it’s a plant problem ;-) Simple sugars (fructose), sugary alcohols (sorbitol), sugars made with two sugar units (lactose), and sugars with several units (galactans – polymer of galactose). Essentially, if you are missing the enzyme to break down any particular sugar / sugar chain, it goes to your gut bugs to do the fermenting, and that can be a gassy uncomfortable process.

Fructans, galactans and polyols (mandatory restriction)

Sources of fructans

Sources of fructans include wheat (although some wheat strains such as spelt contain lower amounts), rye, barley, onion, garlic, Jerusalem and globe artichoke, asparagus, beetroot, chicory, dandelion leaves, leek, radicchio, the white part of spring onion, broccoli, brussels sprouts, cabbage, fennel and prebiotics such as fructooligosaccharides (FOS), oligofructose and inulin.

Inulin is a starch like stuff that is useful for diabetics as they can eat it without screwing up their sugar levels. It comes from “Jerusalem artichokes” which are really a root related to sunflowers. Also called “The Windy Root” for their tendency to cause gas… I’ve tried them. Once… so I know I don’t digest inulin well. The aliums (leeks, onions, garlic) cause me no problems. For some folks, the brassicas (cabbage, Brussels sprouts, cauliflower, kale, broccoli, turnips, etc.) cause issues. Not for me. So “YMMV” and it works best if you know what plants are related.

Sources of galactans

Pulses and beans are the main dietary sources (though green beans, tofu and tempeh contain comparatively low amounts).

This varies a LOT by variety. Lentils cause me no gas. Pintos? Baked Beans? Oh yeah… (Though changing the cook water three times eliminates most of it.) There is also a “gasless Jacob’s Cattle” bean… For when Lentil Chili just doesn’t cut it… ;-)

Sources of polyols

Polyols are found naturally in some fruit (particularly stone fruits), including apples, apricots, avocados, blackberries, cherries, lychees, nectarines, peaches, pears, plums, prunes, watermelon and some vegetables, including cauliflower, mushrooms and mange-tout peas. They are also used as bulk sweeteners and include isomalt, maltitol, mannitol, sorbitol and xylitol.

I have no problem at all with fruits. Peas can be an issue, but I suspect that’s the galactans. Note the bulk sweetener list for those with polyols issues. Not something you find in home cooking, though…

For fructose and lactose the wiki points you on to other lists. Likely because they are in so many foods. Lactose from milk along with other sources. Fructose from fruit, but now massively from corn syrups and solids.

Fructose and lactose (discretionary restriction)
Sources of fructose

See: Foods with high fructose content
Sources of lactose

See: Avoiding lactose-containing products

So what’s “in”? I presume in the below list when they say “alfalfa” they mean the sprouts. Meats and animal products are generally free of FODMAPs (though watch out for heavily processed things).

Low-FODMAP diet suggested foods

Below are low-FODMAP foods categorized by group according to the Monash University “Low FODMAP Diet”.

Vegetables: Alfalfa, bean sprouts, green beans, bok choy, capsicum (bell pepper), carrot, chives, fresh herbs, choy sum, cucumber, lettuce, tomato, zucchini
Fruits: Banana, orange, mandarin, grapes, melon
Protein: Meats, fish, chicken, tofu, tempeh
Dairy: Lactose-free milk, lactose-free yoghurts, hard cheese
Breads and cereals: Gluten-free bread and sourdough spelt bread, rice bubbles, oats, gluten-free pasta, rice, quinoa
Biscuits (cookies) and snacks: Gluten-free biscuits, rice cakes, corn thins
Nuts and seeds: Almonds (<10 nuts), pumpkin seeds
Beverage options: water, coffee or tea

Other sources confirm the suitability of these and suggest some additional foods.

Oddly (or maybe not so oddly…) that list is largely how I’ve been cooking the last few years, even without the idea of a FODMAP. Though add potatoes, sweet potatoes, and the occasional canned peas and fresh parsnips. Onions frequently in cooking. Some soft cheeses and yogurt; but not much.

Yes, there are more exceptions. Frosting on cakes at special events. Apple cider and beer. But the core is “plain foods simply cooked” and then the diversion into gluten free for a while.

My conclusion is that I’m likely avoiding those things that cause issues for my clan just from trial and rejection. Few beans (and cooked with lots of changes of water when done) just to reduce the “social aspect”. Not much from the brassica family as the spouse doesn’t like them. Few canned beverages with the chemical shopping list as many of them don’t like me. Etc. etc.

Knowing there’s a set of broad groups to test “orders” that whole process and lets you know that if one group has a member with a red flag, for your clan, others in that group ought to be considered ‘yellow flag’ until tested in your own meals.

It is also quite clear to me that individual clans will have strikingly different reactions. I’m from the Nordic / Germanic clan and have no problems at all with lactose. (Though IgE and LOTS of beef / milk consumption has left me with a beef reaction leading to arthritic joints – so I use goat and sheep products instead). Similarly, potatoes are no problem (likely due to the Irish grandparents clan living on little else for a generation or two). Yet others eat baked beans with gusto (and no bloating later) and for me “that’s an issue”. So I see this list as a “search / sort list”, not as a blanket condemnation. IFF having “issues”, you can eliminate all, and see if it resolves. But then selective adding back can lead to an exact problem food and a much easier time of the diet design.

For me, one very key “takeaway” was just that wheat DOES come with some of these things in it, so it may not be “gluten intolerance” for some folks, but it still means wheat avoidance for them.

For us? Well, the wheat is back in and we didn’t notice much either way. Mostly I’m happy with the “meat and potatoes” with a side vegetable that has been our clans’ norm for 100 years… YMMV and every body is unique.

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About E.M.Smith

A technical managerial sort interested in things from Stonehenge to computer science. My present "hot buttons' are the mythology of Climate Change and ancient metrology; but things change...
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10 Responses to Gluten or FODMAP?

  1. tom0mason says:

    Makes me wonder how ‘Modified starch’ affects the mix of sugars and polyols in them. There are certainly enough processes that come under the umbrella of ‘Modified Starch’.

    https://en.wikipedia.org/wiki/Modified_starch

  2. E.M.Smith says:

    Interesting point….

    These are all sugars and sugar polymers as is starch. What does “modified food starch” mean?

    I don’t know. I hate not knowing something…

    Thanks!

    UPDATE:

    OMG! Having read the wiki, I’m now way over the top WTF? about “modified food starch”. It isn’t any longer ‘starch’ in any way shape or form, but who knows what…

    I think I need to go on a roast chicken and potato diet for a week while I ponder ;-)

  3. p.g.sharrow says:

    @EMSmith; Don’t forget your veggies! ;-)…pg

  4. E.M.Smith says:

    @P.G.:

    Potatoes are a veggy… As is Apple Cider, right? ;-)

  5. tom0mason says:

    The problem with the “modified starch” listing on food labels is there is no provenance for the origin of the starch — wheat, GM corn, insecticide soak rice? You can never know.
    It is the food processors’ universal thicker and the ‘low fat’ market’s major replacement for fat.

  6. Gail Combs says:

    HMMmmmm,
    That is pretty much the diet I have migrated to. Mostly home made with lots of meat no wheat, corn, rye.. I can tolerate rice with no problem. Some green leafy, Bok Choy, garlic, green onions mushrooms, eggplant.

    The ‘low carb’ diet seems to correspond pretty well.

    VEGGIE — Carb (grouped from very low to high)
    Spinach 0.2
    Radish 0.5
    Lettuce 0.5
    Bok Choy 0.7
    Celery 0.8

    Mushroom 1.0
    Garlic (1 clove) 1.0
    Cabbage 1.1
    Squash, yellow 1.4
    Broccoli 1.7
    Cucumber 1.8

    Pickle (1 medium) 2.0
    Eggplant 2.0
    Asparagus (6) 2.4
    Beans, green 2.9

    Tomato 3.2
    Zucchini 3.3
    Peppers, Red 3.3
    Peppers, Green 3.4

    Onion 4.0
    Carrot 5.1
    Beets 6.5
    Parsnip 9.0
    Peas 6.5
    >>>>>>>>>>>>>>>
    Rice is rather interesting. It is a ‘starch’ but does not have the same effect as most starchy veggies. (And yeah I only use Basmati rice or add a bit of ‘wild rice’ which is not a rice.)

    …Wholegrain Basmati rice has the lowest GI (glycaemic index) of all rice types, which means once digested it releases its energy slowly keeping blood sugar levels more stable, which is a crucial part of diabetes management. On the other hand, sticky and risotto type rices have much higher GIs, so less suitable in a diabetic diet. The varying GIs of rice depends on the type of carbohydrate present in the grains. Basmati rice has the greatest amount of a type known as amylose which does not gelatinize during cooking and results in fluffy, separate grains. Whereas grains with more amylopectin burst on cooking resulting in sticky rice that can be eaten with chopsticks. The more intact the structure of a grain of rice the lower the GI because once consumed the particle size maintains intact for longer, slowing the digestive process. The higher quality brands of rice like Tilda have the technology to reject broken grains from their products, further guaranteeing the low GI of the rice. Steaming rice helps to better maintain the structure of the grain compared with boiled rice so generally steamed rice has a lower GI than boiled.

    Wholegrain Basmati rice is also a good source of fibre which is important for gut health and improves bowel function. High fibre intakes have also been associated with a lower risk of bowel cancer, reduced risk of type 2 diabetes complications, increased satiety and weight management. A high intake of wholegrain foods has been associated with lower risk of heart disease and stroke.

    Both wholegrain and white Basmati rice contains a type of fibre known as resistant starch. This has a prebiotic effect in the bowel, which means it can help to increase the number of ‘friendly’ bacteria. This in turn, protects the bowel and keeps it healthy and boosts the body’s immunity. Resistant starch also increases satiety, helping to keep you feeling fuller for longer, so including Basmati rice in a meal can help regulate appetite and prevent cravings for sugary drinks and snacks between meals.

    Finally, both wholegrain and white Basmati rice has a superior nutrient content compared with other rice types. They contain higher amounts of B vitamins and minerals such as copper and magnesium. The higher magnesium content found in Basmati can help with blood sugar control. These properties combined together with the antioxidant and anti-carcinogenic properties of numerous compounds found in rice, especially those found in the bran and germ (minerals, trace elements, vitamins, polyphenols), means rice can make a valuable contribution to the diets of people with diabetes….
    http://www.tilda.com/news/basmati-rice-diabetes

  7. Adrian Camp says:

    We don’t all have the same intestinal flora. That makes a difference. Nor do we always have the same gut flora over time. Especially if we’ve had a course of anti-biotics or even a real gut-clearing bowel ‘event’ or D&V illness. If the researchers above didn’t account for that they will have got not-so-useful results.

  8. Gail Combs says:

    Adrian,
    Agreed. One of the reasons to eat cheese or what ever (like apples) with active cultures is to replace your gut flora. The FDA/USDA throwing hissyfits about too much bacteria in French cheeses is anti-health. You NEED to eat food with ‘good bacteria’ especially after ‘ a real gut-clearing event’ If I get an upset tummy I eat cheese and apples and Voila it goes away. If I do not I am miserable for days with a grumpy tummy.

    Then they came for the Roquefort

  9. E.M.Smith says:

    Oddly (or maybe not so oddly…) I’ll buy yogurt with “live cultures” listing as many varieties as possible and eat most of it (applying a finger full to ‘the other end’…) and things are great in hours…

    I use varieties of blue cheese when a bug is trying to give me a sore throat. Dissolved slowly in the mouth, 6 oz or so of Danish Blue (my favorite ;-) will have enough penicillin in it that things are usually cured in a day or two. (Yes, you can not swallow penicillin and have it survive the stomach unless encapsulated. However, it is absorbed through the mucosa of the mouth and “slow dissolved” coats the throat where you want it anyway…)

    I’ve had folks look at me oddly when I buy a wedge of “blue” and a bit of french bread / butter for “lunch”… but done two days in a row it has cured me more than once. (When “on a contract’ on the other side of the mountains it’s not a good time to take a sick day… so when “that tickle” starts that is absolutely a bacterial attack on the tonsils getting started, I hit the local grocer…)

    I’ve never used more than 8 ounces in one day (in two batches) and think about 6 is plenty. One tsp at a time, slowly melted on the tongue and spread around the mouth… Then wait a few minutes… Drink of water and bite of bread, then repeat… Never gone more than the second day.

    Any blue seems to work.

    They need to keep their hands off my blue cheese… I go out of my way to buy that with the most blue in it… (It is also the part that tastes best ;-)

  10. Gail Combs says:

    The blue cheese sounds like a great idea. Worth having some around in case of a SHTF scenario (along with the goats for the milk to make more cheese.)

    Another naturally available antibiotic is puffballs and other mushrooms. Puffballs are the easiest to ID correctly.

    https://ethnobiology.org/sites/default/files/pdfs/JoE/3-1/Burk1983.pdf

    http://www.shareguide.com/mushrooms.html

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