Every time we visit more patients with several food intolerances at the same time. When we talk about intolerances we do not refer to a food alone, but to food groups that for one reason or another are not tolerated or eventually cause symptoms. These food groups are characterized by having specific sugars (lactose, fructose, fructans, polyols…) or specific proteins (such as gluten) or other substances such as amines (histamine, tyramine, etc). In general, intolerances produce gastrointestinal symptoms: bloating, diarrhea, abdominal pain, nausea, gas, colic… But they can also cause migraine, itching or rhinitis, muscle aches…

It is important not to confuse food intolerances with tests that analyze 100 to 400 foods and indicate with colors which foods feel good or bad. The mechanism of these tests is to measure immunoglobulins G, antibodies that we generate every time we eat food. They have no scientific evidence, they carry alarmist messages and they can cause false diagnoses and inadequate diets, as the American Academy of Allergy, Asma & Immunology declare.

FODMAPs: What are they?

They are short chain carbohydrates: Fermentable, Oligo-saccharides, Di-saccarides, Mono-saccharides And Poliols. According to the Monash University guide, these sugars are difficult to absorb and are found in many foods and in different quantities. In recent years it has been proven that following a low FODMAPs diet may be beneficial for people diagnosed with Irritable Bowel or Irritable Bowel Syndrome and a dietitian-nutritionist specialized in the field is required to follow the treatment. It is recommended to make this diet low in FODMAPs strictly for a period of 2-6 weeks, although it may vary according to each case.

Overall, these sugars can be classified as:

• Fructose in excess of glucose (monosaccharide): found in some fruits such as apples or cherries and also in honey and syrups.
• Lactose (disaccharide): found in milk and its derivatives.
• Sorbitol and mannitol (polyols): found in some fruits such as apricots or blackberries and in vegetables such as cauliflower or mushrooms. They are also added as sweeteners in some food products (you need to read labels).
• Fructans (fermentable): found in wheat, rye, onions, garlic…
• Galactooligosaccharides (GOS): they are found in many legumes and in nuts such as cashews or pistachios.

Normally, on a low FODMAPs diet, fructans and GOS are always withdrawn, since we humans do not have enzymes capable of digesting them. Then, depending on each case, you can avoid all other types of sugars.

FODMAPs: How is diagnosed an intolerance to sugars?

There are specialists who recommend analyzing sugar by sugar, separately (usually fructose, lactose and sorbitol). And others who prefer to measure the levels of hydrogen and methane in exhaled air after having taken a certain amount of lactulose (synthetic sugar), which is used to find out if there is bacterial overgrowth. If the result is positive, it could be concluded that this increase in bacteria is the cause of poor digestion of sugars due to excess gas.

FODMAPs and Diamine Oxidase deficiency (DAO deficiency)

It may seem like an entry problem, since the diagnosis of both situations makes the diet very strict, but with a good specialist you don’t have to worry. The idea is to recover the intestinal functionality to the maximum and reintroduce part of the food that is eliminated in a first phase later.

We have visited many patients with digestive discomforts that in addition to their metabolic disorder to eliminate histamine and their need to follow a low histamine diet do not tolerate some sugars. About a year ago, a study was published evaluating 439 patients with various digestive problems and it concluded that they found a relationship between the symptoms with multiple combinations of carbohydrate malabsorption and histamine intolerance.

Short chain carbohydrate intolerance, unlike DAO deficiency, does not have a genetic character and can be recovered.

At the beginning of starting the low FODMAPs and histamine diet it can become monotonous, although it doesn’t mean to be boring! Our job is to use available ingredients to develop attractive, healthy and varied diets as far as possible!