Late July Health News

When a patient presents to me with digestive issues or a diagnosis of Irritable Bowel Syndrome (IBS), I want to know WHY. Instead of giving medications to suppress diarrhea or decrease intestinal spasm, I strive to understand the factors contributing to these symptoms in each individual case. We discuss history and symptoms at length, and we may order testing. Common factors that contribute to IBS include emotional stress; imbalances in gut flora (which can be a result of stress), including infections; and individual variation in capacity to digest various food molecules, such as lactose, or milk sugar.

What Are FODMAPs?  
There are certain foods that are just more difficult to digest, no matter who you are. In an otherwise healthy person, these partially indigestible foods feed gut bacteria, which ferment them to produce short-chain fatty acids that nourish the cells that line our intestinal tract. So we do need them to an extent. Some gas is released during this reaction, but for most people it is not as issue. Problems may arise when (1) We consume too many of these foods at once, or too frequently; (2) We can’t digest them as well as the average person; or (3) We have an overgrowth of certain bacteria in the digestive tract, leading to too much fermentation (one example of this is SIBO, or Small Intestinal Bacterial Overgrowth). Fermentation produces gas, which can lead to pain, bloating, diarrhea, and constipation, some of the hallmarks of IBS. Furthermore, if these substances reach the large intestine undigested, they pull water into the colon, which can lead to diarrhea (1, 2). There is also evidence that people with IBS are more sensitive to the minor muscle contractions and gas produced during normal digestion that go unnoticed by most people. 

So what are these potentially pesky substances? They are known as FODMAPs, which stands for “Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols.” These are carbohydrates found in many common, healthy foods. Let’s take a closer look --

Fructans, Galactans, and Polyols seem to be more generally problematic, while Lactose and Fructose seem to contribute to IBS in a minority of people. Hydrogen breath tests are available to identify whether you have Lactose or Fructose intolerance.

What is the Evidence? 
Multiple studies have shown a reduction in symptoms of IBS when foods containing FODMAPs are reduced or eliminated from the diet (1, 2, 3, 4). FODMAPs are likely one piece of the puzzle and not the whole story.  For example, gluten, a protein found in wheat, rye, and barley, also may contribute to IBS in some people (this is separate from celiac disease). Stress management and other mind-body approaches are also essential in the treatment of IBS.

How To 
To determine if FODMAPs are contributing to your IBS symptoms, it is generally recommend that you avoid high FODMAP foods completely for at least 4 – 6 weeks, and then possibly reintroduce them in a systematic way, keeping track of your symptoms along the way. The Low FODMAP Diet was developed by researchers Susan Shepherd and Peter Gibson. It shares many features with the Specific Carbohydrate Diet and the GAPS Diet, two other therapeutic diets for people with digestive disorders. These diets help to alleviate symptoms and promote healing while we work on addressing the root cause of digestive upset.  
 
It is important to realize that there is nothing inherently “bad” about any of these foods. Many are extremely healthy! They simply can be difficult for some people to digest at certain points in time. My goal is to identify and treat the causes of FODMAP intolerance, so that these foods can someday be enjoyed in moderation, and do their work to promote healthy intestinal cells via their “pre-biotic” quality.    
 
For more information on FODMAPs

Withania somnifera, commonly known as Ashwagandha, is a member of the Solanaceae family and native to dry regions of India, northern Africa, and the Middle East. It is among the most important herbs in Ayurveda, the traditional system of medicine in India, in which it is known as a “Rasayana,” or tonic. In Sanskrit, Ashwagandha means “smell of the horse” and is thought to instill a horse’s vitality to the consumer. In Western botanical medicine, this plant is known as an “adaptogen,” meaning that it helps people adapt to stress and cope with fatigue, improves general immunity, and promotes balance of a wide variety of physiological functions. As the scientific name suggests, it has been used to induce sleep, but it is also known to improve energy, a testament to its balancing quality.   
 
Evidence to Support the Use of Ashwagandha in Clinical Practice (all studies were done in animals, except where noted):

How To 
The root is most commonly used, and various preparations are possible. The root can be dried and ground into a powder, encapsulated, or decocted and consumed as tea; it can also be soaked in alcohol to make a tincture. I commonly formulate Ashwagandha with other adaptogens such as Eleutherococcus, Rhodiola, and Tulsi. Traditionally, the root powder was combined with milk and honey or ghee and consumed as a tonic or to help with sleep induction. Try mixing 2 Tbl of Ashwagandha powder with 1/3 cup of raw coconut butter and 1.5 to 2 Tbl honey to make a sweet, creamy, medicinal paste.