‘Pie hole’, colloquial for one’s mouth, is believed to have evolved in the USA in the 1980s from the British expression ‘cake hole’ (coined in the mid 20th century). Pie hole refers to a mouth, as in: Shut your pie hole or, in this case: Put less in your pie hole.

Wednesday, November 16, 2016

6 Things to know about FODMAPs

The term "FODMAP" has cropped up several times in recent posts. Today, rather than adding a link where you can read about it yourself, here's a dedicated post about it. So, without further ado, for all the your FODMAP needs, let's get going!

1. WTF is a FODMAP?
Answer: The acronym means: Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols.

2. So again, WTF is a FODMAP?
Answer: They are specific types of carbohydrates: A monosaccharide is a one-sugar unit, disaccharide is a two-sugar unit, polyols are sugar alcohols. These carbohydrates are poorly absorbed by the small intestine, small and osmotically active, and rapidly fermented - see point 4 below.

3. What is a low-FODMAP diet and who's on it?
Answer: This diet isn't a catchy, trendy one, like say... Gluten-free, but there's evidence that a diet low in FODMAPs improves the symptoms of irritable bowel syndrome (IBS). IBS sufferers (about 1 in 7 people!) exhibit recurring GI symptoms including gas, bloating, bowel pain and discomfort, diarrhoea, and/or constipation. A new U.S. study of patients with IBS and diarrhea found greater improvements for those on a low-FODMAP diet. FODMAP research and diet development took place at Monash University in Australia.
4. What do FODMAP foods do?
Answer: People can't absorb FODMAPs, so they move from the small intestine to the large intestine, taking water with them (they are osmotically active). In the large intestine, these carbohydrates meet the resident large intestine bacteria. The bacteria "eat" the carbohydrates, this is called fermentation. A byproduct of fermentation is, you guessed it, gas! People with IBS are very sensitive to the feeling of distention caused by fermentation and gas production.

5. What foods are high in FODMAPs?
Answer: Pretty much every food group has foods within them that are both high and low in FODMAPs. See table below.

High and low-FODMAP foods. http://www.med.monash.edu/cecs/gastro/fodmap/low-high.html

6. Do low-FODMAP diets help people other than those with IBS?
Answer: There is some research suggesting people who think they have a gluten or wheat "sensitivity" may actually have IBS or similar symptoms to those suffering from IBS. Research shows people with these "sensitivities" would actually benefit from a low-FODMAP diet rather than the trendier "gluten-free" diet (1, 2, 3).

So, there you have it. What FODMAPs are, what a low-FODMAP diet is, and who benefits from being on such a diet.

Should you want to try a low-FODMAP diet, I strongly advise seeking an accredited dietitian who specialises in such diets (see links below.) These dietitians will ensure your diet continues to provide you with sufficient nutrients, vitamin, and minerals, monitor your progress, and guide you through adding back potential FODMAP foods.

In Australia, find an accredited dietitian here: http://daa.asn.au/for-the-public/find-an-apd/
In the USA, find a registered dietitian here: http://www.eatright.org/find-an-expert

Wednesday, October 12, 2016

Gluten-Free Superfoods for the Gluten Intolerant?

The "gluten-free" craze of "superfoods" continues to rear its ugly head. But there's a relatively new player in the medical world, and that's "gluten intolerance" or "non-celiac gluten sensitivity" (NCGS). It's a mouthful to be sure, but what is it?

The number of people following a gluten-free diet (or think they are) has increased since 2009, but the number of people diagnosed with celiac disease remains about the same. Basically, more people are jumping on the gluten-free bandwagon without an actual celiac disease diagnosis, probably because it's trendy and falsely "healthy" (you can probably sense my eye roll and see my air quotes).

Pie Hole devotees will recall several celiac-related articles tackling what it is, how it's diagnosed, and how it's not diagnosed. One such article discussed NCGS and its lack of medical biomarkers, making it difficult to test for and identify.

A new study found subjects with NCGS had:
  • Systemic (widespread) immune activation
  • Different intestinal markers compared to people with celiac disease
In contrast to people with celiac disease, these findings suggest that people with NCGS have intestinal cell damage, and a weakened intestinal barrier. Think of it as a nightclub with a bouncer who lets in the riffraff.

People with celiac disease do not exhibit this systemic immune response, rather, it's strictly localised to the intestine. Think of this where the bouncer does his job and keeps the riffraff out.

The systemic response observed in NCGS subjects is likely due to microbial components that are released from the gut into circulation. This doesn't occur in celiac patients because the intestinal immune response is able to neutralise these microbes and prevent them passing through the intestinal barrier.

The study found immune activation and biomarkers returned to normal after dietary restriction of gluten. The potential mechanism, or trigger molecules responsible for intestinal barrier weakening is currently unknown, hence a great potential for more research.
Some food for thought, though, another recent study investigating NCGS found participant's symptoms significantly improved when following a low FODMAPs diet. Gluten-specific effects were only seen in 8% of participants. FODMAPs predominantly trigger gut symptoms, and many foods that contain gluten (eg: cereals) also contain one or more FODMAPs. So, going gluten-free to keep on point with food trends may be totally useless. And if you think you have NCGS, you might want to tone down the FODMAPs first.

The take home points:
  • Being gluten-free isn't a healthier way to live unless you've been properly diagnosed with celiac disease (which requires more than a blood test)
  • NCGS may be triggered by gluten, but in a different way than celiac disease
  • More research is needed to identify what causes the weakened intestinal barrier seen in people with NCGS
  • It may very well be FODMAPs, rather than gluten, that triggers gut symptoms in people who think they have celiac disease or NCGS
  • FODMAPs needs its own article... Coming soon

Wednesday, August 17, 2016

Healthy, Happy Eating: No Helicopter Parents Needed

What if I told you that forcing your kids to eat is a bad idea? What if you could improve your family's health by making a couple of simple changes? Parents, you're all over this, so let's get down to it!

August is Kids Eat Right Month, which inspired me as a new mum to write this article based on a bunch of new studies about kid's health.

Contrary to many parent's beliefs and actions, children shouldn't be forced or pressured to eat anything (including veggies). What whaaat? Seriously, this latest study is just adding to the body of research showing these results. Read 'em and weep:
  • Children who had more control over food-related decisions were more likely to enjoy eating healthy foods
  • Urging a child to eat increases food neophobia (fear of new foods)
  • Offering new foods reduces food neophobia
  • Children with high neophobia scores tended to like fewer foods
Translation - You, the parent, should present an array of healthy foods to your child and let them decide how much of it to eat. Your child doesn't need to be urged, coaxed, or tricked into eating more.

Next up, family meals. There are numerous researched benefits to families eating meals together:
  • They significantly increase the amount of fruit and veggies kids eat
  • They are significantly associated with BMI z-scores (more family meals equals healthier BMI)
  • They are associated with overall higher diet quality (see a review of earlier studies here, along with tips for fun, fast family meals)
But wait, the fun doesn't stop there... New research shows parent and child food intakes are closely related across various metrics of diet quality including energy intake (total calories). This is most likely due to shared food environments, shared meals, and parental modeling.

If you, the parents, are eating at Mc Donald's (environment), your child is likely with you and either sharing your meal or getting their own Mc Donald's meal (shared food). This is due to you, the parent, modeling the consumption of that particular food. This example is, of course, a negative one.

Finally, the take home messages:
  1. No healthy child self-starves
  2. The less of a fuss you make about your kids eating, the better time you'll have and the healthier food habits your children will have
  3. Eat with your kids (and be a role model: Eat your veggies!)
  4. Make the time, watching your favourite show on Netflix can wait
I happened upon this article whilst writing the above. How to get kids involved in prepping their lunches: