No Fermentable Foods? Yes Please!

Created by Kaylee Helfrich

Many foods aren’t allowed on the low-FODMAP diet.

No bread. No sugar. No rice, potatoes, corn, soy, milk, onions, garlic, chocolate, processed meats, or alcohol. Is this a starvation diet or a method of torture? Actually, this is a diet with a 7086% success rate in relieving the symptoms of a disorder that is notoriously difficult to treat. This diet is called the “low-FODMAP” diet, which is short for “restriction of Fermentable Oligosaccharide, Disaccharide, Monosaccharide, and Polyols in the diet”. Thank goodness for the FODMAP acronym to prevent that mouthful of words!

The low-FODMAP diet treats a disorder called Irritable Bowel Syndrome (IBS), which is characterized by stomach pain, bloating, diarrhea or constipation, and general gastrointestinal discomfort. According to Dr. Miranda van Tilburg, an associate professor in medicine from UNC-Chapel Hill who studies IBS, people with IBS often have a very low quality of life. “Those with IBS frequently miss days of work and school, and anxiety and depression are very common as people worry about future symptoms and how those symptoms will impact their life,” she says.

IBS is a common disorder with a global prevalence of 10-20%. It is clinically diagnosed based on certain symptoms. Unfortunately, the exact cause of IBS is unknown, but it is thought to be triggered by multiple issues including changes in gut motility, increased sensitivity of intestinal nerves, bacterial growth in the small intestine, intestinal inflammation, and psychological factors. Although medicines exist to treat IBS, they do not always provide adequate relief and often cause unwanted side effects. Instead, a combination of diet, exercise, and even hypnotherapy often provide more relief with fewer side effects.

A large component of treatment for IBS is diet management. Tilburg points out a few well-known triggers of IBS symptoms, including spicy and fatty foods, along with incompletely absorbed carbohydrates. The low-FODMAP diet specifically addresses the latter dietary component.

What are FODMAPs, and how can a diet low in FODMAPs treat IBS symptoms? FODMAPs are carbohydrates, such as lactose, fructose, and sugar alcohols, that are difficult to absorb in the small intestine. When the FODMAPs are not absorbed, they produce intestinal water and gas. For various reasons, those with IBS often have more difficulty when consuming FODMAPs than other people.

Created by Kaylee Helfrich

FODMAPs can cause gastrointestinal discomfort via 2 methods.

The mechanism behind FODMAP-induced discomfort is twofold. First, when FODMAPs are not fully absorbed, they remain in the small intestine and attract water, which enters the small intestine in a process called osmosis. This leads to bloating as well as increased water delivery to the large intestine, which can cause diarrhea. Second, incompletely absorbed FODMAPs can be fermented by intestinal microbiota, leading to gas, which causes pain, bloating, and general discomfort.

Consequently, for some people with IBS, a diet low in these offending carbohydrates can be beneficial. In fact, six randomized controlled trials have shown benefits for IBS patients who consume a low-FODMAP diet. However, this diet is very restrictive concerning which foods can be eaten, so people can have trouble adhering to the diet if they are not properly supported by clinical guidance.

One question that many people ask is: how can someone follow a diet that cuts out virtually all of the delicious foods that are normally eaten? Although this diet is restrictive, it offers a good chance at relief for people who have usually lived with pain for years. And this diet is not meant to be followed forever. Tilburg explains that “every person’s case of IBS is unique, and every person will have different foods to which they are sensitive.” So after following the low-FODMAP diet for 2-6 weeks to reduce the food-induced symptoms, the excluded foods are slowly added back, and the patient is monitored by a dietician for adverse symptoms. If a certain food increases symptoms, then it is removed from the diet and other foods are tried instead.

Although it may seem impossible to go without your favorite chocolate cake or garlic bread, people with IBS often welcome the chance to reduce their symptoms, even if it requires a sacrifice of ice cream and deli sandwiches.

Peer edited by Alexandria Mullins.

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Don’t Fear Nutella Just Yet!

“Did you hear that such-and-such causes cancer?” Every time you turn around, there is a new report about a study supposedly linking a food or ingredient to some form of cancer. Your Facebook news feed is probably littered with posts about such studies. Or maybe your family and friends talk about it. It seems like there’s always something to be afraid of. The newest scare? The beloved and ever-so-delicious spread, Nutella.

Claims linking the famous chocolate-hazelnut spread to cancer should be taken with a grain of salt.

Claims linking the famous chocolate-hazelnut spread to cancer should be taken with a grain of salt.

Recently, a study from the European Food Safety Authority (EFSA) determined a chemical by-product produced in refined oil to be potentially cancer-causing. In the study, rodents exposed to it eventually developed tumors. The by-product is produced most highly in palm oil when it is cooked. Palm oil is a key ingredient in Nutella. Eventually, headlines claiming that Nutella causes cancer spread throughout the internet, causing sales to drop and leaving many to wonder whether they should adopt a Nutella-free lifestyle.

However, the claim that Nutella causes cancer is not really accurate. In truth, the EFSA study did not specifically look the effect of Nutella and it is not clear how much of the worrisome chemical is actually produced during the making of Nutella. The study did raise concerns about the safety of palm oil, but palm oil is found in many processed foods so there’s no real reason to specifically single out Nutella. Moreover, the study only looked at exposure and tumors in rats.  Although animals experiments are useful, more studies need to be done to determine the effect on actual humans.

So does Nutella cause cancer? The study cannot accurately claim that it does. While the headlines linking Nutella to cancer might be eye-catching, they are probably doing more to incite fear than convey any real information. If you’re deciding on the risks of eating Nutella, understand that a real link between Nutella and cancer has not been made. People should be aware of this flawed claim and keep an open eye and open mind…and maybe continue to have the joy of Nutella in your life. For many of us, that’s a risk worth taking.

Peer edited by Michelle Engle.

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