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Dr. Mendez

FODMAPS Diet

low fodmap foods

FODMAP diets have been a hot topic lately! This diet was created by clinical researchers at Monash University in Australia. The diet was designed to treat Irritable Bowel Syndrome (IBS) as well as other bowel-related conditions. IBS is a very common gastrointestinal disorder that affects 1 in 7 people. FODMAPS are a collection of short-chain carbohydrates (sugars) that aren’t absorbed properly in the gut, which can trigger symptoms in people with IBS. 

FODMAP:

  • Fermentable: The process in which gut bacteria ferment shorts chain carbohydrates producing gases.
  • Oligosaccharides: Sugars including fructans and galactooligosaccharides (GOS) found in wheat, barley, onions, garlic, and legumes.
  • Disaccharides: Lactose, which is found in dairy products such as milk, soft cheeses, and yogurt.
  • Monosaccharides: Fructose, a simple sugar found in honey, apples, high fructose corn syrup, and agave.
  • Polyols: These include sorbitol and mannitol, which are found in some fruit and vegetables and are used in artificial sweeteners.

How do FODMAPs affect the gut?

When FODMAPs reach the small intestine, they move slowly, attracting water. When they pass into the large intestine, FODMAPs are fermented by gut bacteria, producing gas as a result. The extra gas and water cause the intestinal wall to stretch and expand. These characteristics may lead to bloating, gas, cramping, and diarrhea in certain individuals. In people with IBS, the ‘stretching’ of the intestinal wall causes sensations of pain and discomfort. Fermentation of FODMAPs in the colon produces carbon dioxide, methane hydrogen, and other gases. It slows colonic transit (time that it takes for a substance to move through your colon) and alters the microbiome. This may negatively impact tight junctions and activation of the mucosal immune system. 

How does low FODMAP diet help?

Researchers at Monash University have found that a low FODMAP diet has been shown to reduce abdominal pain and discomfort, reduce bloating and distension, improve bowel habits (reduce diarrhea or constipation), and improve the quality of life.

How is a low FODMAP diet used?

A FODMAP diet is meant to be undertaken in three phases. 

Phase 1: All high-FODMAP foods are eliminated from the diet for an extended period of time. 

Phase 2: Systematically reintroduce restricted foods, noting how well you tolerate increasing quantities of the foods you’re reintroducing. 

Phase 3: Only avoid foods in quantities that cause symptoms.

Is a Low FODMAP diet for everyone?

No, FODMAPs are found in a wide range of foods, and most people eat high FODMAP foods every day without digestive issues. Following a low FODMAP diet is a systematic dietary intervention that can be complex and requires substantial food knowledge. FODMAP ingestion is a great source of prebiotics (great source of food for the bacteria in our gut). Therefore it is not intended to be followed indefinitely, as this can lead to a reduction in beneficial microbes in the gut. 

Does the research support it? YES!

A meta-analysis of multiple studies showed that, compared to those on a standard IBS diet, patients on a low FODMAP diet enjoyed a significantly greater improvement in symptoms.  The authors conclude that a dietician-led low FODMAP diet could be a first-line approach to IBS management. Eliminating FODMAP foods and then slowly reintroducing them can help specify offending foods, leading to a less restrictive overall diet.

Can Low FODMAPS diets help athletes? YES!

A recent study published by the Journal of International Society of Sports Nutrition provided evidence showing that recreational athletes implementing a short-term LOW FODMAP diet under free-living conditions may experience benefits in exercise-related GI symptoms and perceived improvements in exercise intensity and frequency. However, authors advise caution when implementing the Low FODMAPS diet to minimize unnecessary reductions in total caloric and/or carbohydrate intake that may impact on nutritional quality. 

At Miami Spine + Performance, we use Functional Medicine to address the root cause of your gut symptoms. Every treatment is personalized to your needs. If you are interested in learning more about Low FODMAPS or other nutritional interventions, please give us a call!

 

Eswaran S, Farida JP, Green J, Miller JD, Chey WD. Nutrition in the management of gastrointestinal diseases and disorders: the evidence for the low FODMAP diet. Curr Opin Pharmacol. 2017;37:151-157. doi:1016/j.coph.2017.10.008.

Varjú P, Farkas N, Hegyi P, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: a meta-analysis of clinical studies. PLoS One. 2017;12(8):e0182942. doi:1371/journal.pone.0182942.

Dolan R, Chey WD, Eswaran S. The role of diet in the management of irritable bowel syndrome: a focus on FODMAPs. Expert Rev Gastroenterol Hepatol. 2018:1-9. doi:1080/17474124.2018.1476138.

Wiffin, M., Smith, L., Antonio, J., Johnstone, J., Beasley, L., & Roberts, J. (2019). Effect of a short-term low fermentable oligiosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet on exercise-related gastrointestinal symptoms. Journal of the International Society of Sports Nutrition, 16(1), 1. https://doi.org/10.1186/s12970-019-0268-9

https://www.monashfodmap.com/

Third-Party Testing

 

There is no shortage of supplements in today’s society. You can find multivitamins, fish oil, probiotics, herbal blends, protein powders, etc online or at your local health food store. The use of supplements to fill “dietary gaps” or enhance your diet can very useful. For example, if you live in areas where you do not get sufficient sun exposure, it is useful to supplement with Vitamin D to avoid nutritional deficiencies. 

However, how can we be sure that the supplement(s) we are consuming are contributing to our health goals? Ideally, nutrient supplementation is informed by advanced nutrient testing to cover any nutritional gaps. We can test our nutritional status, supplement adequately, and retest to ensure we achieved our nutritional goals. Third-party testing can also help us as consumers make informed decisions about the quality of the supplements we are purchasing.

 

Supplements Are Not Created Equal

The Food and Drug Administration (FDA) states “.. manufacturers of dietary supplements are responsible for making sure their products are safe before they go to market. Dietary supplement products are not reviewed by the government before they are marketed, but FDA has the responsibility to take action against any unsafe dietary supplement product that reaches the market”1. According to the U.S Food and Drug Administration, the FDA does not keep a list of manufacturers, distributors, or the dietary supplement products the supplement companies sell. The manufacturer or distributor of a particular supplement must be contacted by the consumer for detailed information.2 

The supplement manufacturer is responsible for ensuring that the “Supplement Facts” label and ingredient list are accurate, dietary ingredients are safe, and that the content matches the amount declared on the label. As of June 2007, supplement manufacturers are required to comply with the FDA mandated Current Good Manufacturing Practice (CGMP) guidelines. These guidelines are considered the baseline to “ensure the quality of the dietary supplement and ensure that the dietary supplement is packaged and labeled as specified in the master manufacturing record”. Beyond CGMP, many supplement manufacturers may opt to apply voluntary third-party certification to their manufacturing or ingredient sourcing standards.3

What is a Third-Party Certification?

Third-party certification means that an independent organization has reviewed the manufacturing, sourcing, and distribution processes of a product and has determined that the final product complies with specific standards for safety, quality, or performance. The product review includes formulation/material reviews, testing, and facility inspections. Supplement companies may opt into third-party certification processes to provide labeling transparency for consumers. This helps to improve confidence that the supplement being sold has been validated for quality by independent auditors that screen the supplement development process of that product or prove that product claims are true. 

Most certified products bear the certifier’s mark on their packaging to help consumers and other buyers make educated purchasing decisions. Some companies like Metagenics go above and beyond to ensure the quality and consumer transparency. Metagenics offers an online platform called “TruQuality” that offers full visibility to testing information for every single product they create. 

Takeaways

This is not to say that all supplement companies lacking third-party certifications are unreliable, but independent validation of sourcing, manufacturing, and distribution processes, as well as labeling claims, provides added assurance of supplement quality.  Before using a supplement it is important to consult with your doctor. Dietary supplements may not be risk-free under certain circumstances. If you are pregnant, nursing a baby, or have a chronic medical condition, such as diabetes, hypertension, or heart disease, be sure to consult your doctor or pharmacist before purchasing or taking any supplement.

Next time you are shopping for supplements look for third party certifications in the chart below. You can also visit the company’s website and find information regarding their product’s quality, potency, and purity. 

 

Get the scoop on POOP!

“What does my stool have to do with my health?! ”

Patients in my practice are often surprised when I ask about their bowel movements. Let’s face it, talking about our pooping habits can be embarrassing. We may feel shy or uncomfortable talking about something so private and as a result, we may choose not to discuss our symptoms with our healthcare provider. Sometimes we may not be aware that our pooping habits are irregular at all. We may be accustomed to bothersome symptoms like gas, bloating, constipation, and accepted them as part of our “norm”. Addressing our gastrointestinal (GI) symptoms can have favorable effects on our health. 

Our poop can offer us valuable insight into our health status. It can inform us about the health of our digestion, absorption, inflammation, gut health, brain health, and many other systems in our bodies. The gut is the gateway to our health. It’s the home of 80% of your immune system and powerful neurotransmitters are made there as well.1 Trillions of microflora work together to ensure proper digestive function. They aid in the production of essential vitamins such as B vitamins and act as a protective barrier for the immune system. The bacterial balance in our gut also discourages the growth of unfavorable bacterial, parasitic, and/or fungal infections from compromising our gut function. Because our stool is formed in our GI tract we investigate the integrity of our gut to understand it’s a contribution to our signs and symptoms. 

The Bristol Stool Chart is otherwise known as the “poop chart” is a very helpful tool used to characterize our stool. This chart was devised by doctors in the Bristol Royal Infirmary in England and it is used by doctors around the world to help characterize different types of stool.  

  • Type 1–2 indicate constipation
  • Type 3–4 are ideal stools as they are easier to pass
  • Type 5–7 may indicate diarrhea and urgency.

Every person will have different bowel habits, but there are a few important characteristics to consider when discussing our stool. Ideally, poop should be soft, well-formed, and easily passed within a few minutes of sitting down on the toilet. The bowel movement should pass without pain or straining, and you should experience complete emptying of the bowels.

 

The following situations may suggest that it’s time to get your poop checked:

  • You’re not pooping every day or not pooping enough. 
  • You see undigested foods in your stool except for some fibrous foods like beans, corn, grains, such as quinoa, peas, seeds, sunflower seeds, flax seeds, sesame seeds, or skins of vegetables, such as bell peppers or tomatoes.
  • You’re exhibiting some other type of digestive discomforts such as consistently loose bowel movements, stomach cramping, bloating, gas, indigestion, and hemorrhoids.
  • You’ve been diagnosed with an autoimmune condition. Scientific evidence shows that imbalances in our gastrointestinal bacteria are related to inflammation and autoimmune conditions. 2
  • Gut imbalances can also present as chronic fatigue, brain fog, skin-related symptoms, and other symptoms.3

 

Testing our poop can give us valuable information about our symptoms. Stool testing can help you and your doctor identify the types of bacteria that live in your GI and any potential bacterial, yeast or parasitic infections in the gut. A comprehensive stool test also looks at how well you break your food down into fiber, screens your immune system, determines your level of digestive enzymes, and how well you are digesting and absorbing your fats.

I want to encourage you to speak to your healthcare provider about your bowel habits and gut health. Get comfortable sharing information about your poop and don’t allow embarrassment to discourage you! At Miami Spine + Performance we offer comprehensive stool testing via Doctor’s Data Lab, to understand your unique digestive system. If you are interested in learning more about stool testing, please give us a call.

 

*If you’re getting gut symptoms regularly and experiencing any of the following symptoms, make sure to see your doctor immediately: unexplained weight loss, changes in bowel habits, such as loss of bowel control, persistent diarrhea, persistent constipation, blood in the stool.

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