Can FODMAPs cause Leaky Gut?Butyrate Short Chain Fatty Acids Inflammatory Bowel Disease FODMAPs intestinal permeability inflammation fibre regulation of tight junctions cytokines epithelium
Posted 22 April 2014 - 10:51 PM
Can FODMAPs cause Leaky Gut?
The low FODMAP diet helps alleviate IBS symptoms by eliminating FODMAPs from your diet but it is generally considered only a short-term measure. FODMAPs are generally healthy for the colon because they ferment into short chain fatty acids, in particular butyrate, which in turn lead to hydrogen and methane gases that causes intestinal distress for most of us.
This is where IBS can get confusing. For healthy people, short chain fatty acids are essential for colonic health. Butyrate provides energy for the epithelial cells of the short intestine and also inhibits inflammatory cytokines and plays an important role in regulation of the tight-junctions. Leaky Gut and Inflammatory Bowel Disease symptoms can be exacerbated by a lack of butyrate uptake.
Leaky Gut (intestinal permeability) can be caused by the long-term effects of poor diet and over-processed, low-fibre food or by allergenic or other inflammatory food. Alcohol and NSAIDs can also directly weaken the epithelium.
Doctors often suggest an intake of fibre to cure IBS but this could cause more damage. Most IBS patients can’t tolerate a lot of fibre and it’s possible that continued intake of high FODMAPs may cause long term damage. This link
is to a paper written by the founder of the FODMAP theory, Sue Shepherd “Personal view: food for thought – western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis”. Although she talks about Crohn’s Disease (caused by a leaky gut condition) this paper has implications for IBS as well. She states that:
“There is a paucity of studies linking dietary factors with alterations of intestinal permeability. When the epithelial barrier is impaired in non-physiological conditions, such as consuming a diet completely devoid of fibre, or following small intestinal injury from alcohol, dietary fibre corrects or ameliorates increased epithelial permeability.54–57 Whether dietary fibre influences epithelial barrier function in more physiological situations has not been reported. However, high luminal concentrations of short-chain fatty acids can reversibly impair barrier function,58, 59 presumably by inducing apoptosis of epithelial cells, as do NSAIDs. Short-chain, poorly absorbed carbohydrates increase the permeability of the colon in rats60 (see below). Dietary fats may also potentially play a role. Rats on a high-fat diet have higher distal colonic paracellular permeability61 and transcellular transport and efflux mechanisms are altered in the jejunum of rats fed different long-chain fatty acids.62”
This could explain why fibre makes our symptoms worse. Butyrate has to be taken up by the epithelium in order to regulate the tight junctions. However when the colon is inflamed cytokines can down-regulate transporters that allow the uptake of butyrate. An inflamed colon then works against the short chain fatty acids and this provides a vicious feedback loop that increases inflammation and intolerance to foods.
This sets up a self-perpetuating cycle of inflammation and could explain why “healthy eating of FODMAPs” can make us feel worse.
Sue Shepherd’s low FODMAP diet is designed to alleviate the inflammation from overly-fibrous foods.
The question is: At what stage do we re-introduce FODMAPS and should we be doing this at all? And are certain FODMAPs more harmful than others? Some FODMAPs are clearly problem foods for everyone, for e.g. raffinose (baked beans for instance) of which as much as 90% may not be digested. Legumes and nuts feature in almost all anti-nutrient types – lectins, phytates, saponins, protease inhibitors and many people believe that even heavy soaking doesn't render these foods safe.
Wheat and dairy are well-known allergenic foods although some claim that sprouted wheat is safer. Toast is more easier to digest than bread. Some forms of dairy may be better tolerated, such as yoghurt and hard cheeses.
Some FODMAPs will be better tolerated than others and it could be a matter of simply experimenting.
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Posted 23 April 2014 - 10:08 AM
She's the founder of the FODMAP diet?? I thought that was Monash Univeristy through a private grant. For once it wasn't a food industry giant paying for research.
Ever been to the Museum of Medical Oddities in Philadelphia, PA? My picture is from there. That's the guy with the megacolon. I suppose he lived before surgery could help him. His actual colon is there too, thick as my leg.