IBS--Free at Last!

Lactose 101

Lactose is known as "milk sugar." It is present in the milk of all mammals, including human, cow, goat, sheep, etc. Most babies and young children all over the world can handle lactose in their diets without a problem. After all, milk is meant to be their primary food! But, as we get older, we may lose the ability to tolerate lactose, especially if we are of Asian, African or Native American descent.

Lactose intolerance can exist on its own, or it can be part of the larger IBS picture. The FODMAPS elimination diet in IBS--Free at Last! can help you figure out how lactose fits into your IBS scenario.

When lactose-intolerant people eat or drink large amounts of lactose-containing foods or drinks, they may get abdominal pain, flatulence, bloating or diarrhea. Small amounts of lactose may be well tolerated, so even lactose-intolerant people may be able to eat cheese or yogurt, or have a little milk in their cereal or coffee.

Milk products are important food sources of protein, calcium and vitamin D, so it's important not to stop consuming milk products without making a plan. One solution might be to drink specially treated, lactose-free milk and milk products. Yogurt is naturally lower in lactose, and most hard cheeses have just a trace. Drinking milk as part of meal helps, too. You might tolerate milk products better on a day that doesn't include a lot of other problem sugars and fibers. All of these variables can make people unsure whether they have a problem with lactose or not!

Diagnostic lactose-tolerance tests are available. But many people figure this one out on their own with a couple of glasses of milk or a big milkshake on an empty stomach! Need I say more?

More technical description of lactose

Buy IBS--Free at Last!

FODMAPS for Poets

"What are FODMAPS?"--in plain English, please!

FODMAPS is an acronym that refers a certain group of carbohydrates in your food. Believe me, I wish the acronym was catchier, but nobody asked me when they were making it up! If I told you what it stands for, this post wouldn't be in plain English any more, so click here if you want the details.

FODMAPS carbohydrates include certain natural sugars in foods such as milk, fruit, honey and high-fructose corn syrup. FODMAPS also include certain types of fiber in foods such as wheat, onions, garlic, and beans. (No, FODMAPS has nothing to do with gluten--its just a coincidence they are both in wheat).

All FODMAPS carbs have a few things in common:

• They are sometimes poorly absorbed in the small intestine. As the hours go by after a meal, these carbs move along into the large intestine.
• They are the favorite foods of the bacteria that live in the large intestine. When bacteria eat FODMAPS, a lot of gas is produced. (Sometimes people have "inappropriate" bacteria in their small intestines that can ferment carbohydrates, too.)
• FODMAPS can act like a sponge to draw and hold excess fluid in the large intestine.

With a little imagination you can picture the combination of gas and fluid causing the large intestine to stretch. People with IBS experience this as a painful bloating sensation. They may pass an excessive amount of gas or have watery diarrhea. Depending on the person, which FODMAPS are involved, and which type of bacteria colonize the gut, sometimes constipation is the result. Sometimes diarrhea and constipation alternate. Chaos. I would have liked to name this group of carbs, "Chaos Carbohydrates."

It  may be plain English but it still doesn't sound like poetry, does it?

Patsy Catsos, MS, RD, LD is a dietitian in private practice with a special interest in nutrition therapy for gastrointestinal disorders. She is the author of IBS--Free at Last!, Pond Cove Press, 2009. Buy IBS--Free at Last!

Fructose Malabsorption and Depression

Do an internet search for the terms "fructose malabsorption" and "depression" and you will find a lot of buzz over the possibility that the two are linked. Google returned over 6,800 hits on this combination. The idea seems to be taking on a life of its own, and is treated as fact on a number of web sites and blogs. I wondered if there was any of that pesky old evidence on the subject.

I've spent several evenings poking around the internet, reading abstracts and peer-reviewed research reports, most of them published in Europe. In fact there are a number of interesting published research reports that suggest there may be a link worthy of further study. It is far from proven, however. The handful of studies that have been done, most by a particular workgroup at the University of Innsbruck, Austria, included a very small number of study subjects. The researchers have tried to discover whether there was an association between fructose or lactose malabsorption and depression. They did find such an association, but only in females. But the studies simply weren't designed to prove that fructose malabsorption causes depression. It is intriguing, though, isn't it?

The researchers did some more small scale studies to explore possible mechanisms for the fructose or lactose malabsorption-depression link. They have discovered that there may be an association between fructose malabsorption and lower levels of tryptophan, zinc and folate in the blood. It is the job of scientists to speculate about how these observations could all fit together, and speculate they do. Could these nutrients be poorly absorbed because the fructose malabsorption causes diarrhea and reduces contact time between the contents of the GI tract and the absorptive surfaces of the small intestine? Could unabsorbed sugars be interfering with the absorption of tryptophan? Could fructose malabsorption be encouraging small intestinal bacterial overgrowth (SIBO)? Could the lower serum levels of tryptophan, zince and folate cause depression?

There are far more questions than answers, here. Scientists are choosing their words with care, using the terms "may" and "suggest" and "associated with," and they point out that further studies are needed.

What is the take-away message here for people with fructose and/or lactose malabsorption? If you're a woman, removing excess amounts of these sugars from your diet might make you feel better mentally as well as physically! That's all, folks.

The report that started it all? Fructose malabsorption is associated with early signs of mental depression, Ledochowski M, Sperner-Unterweger B, Widner B, Fuchs D. Eur J Med Res. 1998 Jun 17;3(6):295-8.

Buy IBS--Free at Last!