What are FODMAPs?

FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides, And Polyols) are short-chain carbohydrates with two caracteristic effects on digestion:

1. they are osmotic active substances - they drag water into intestine and may cause diarrhea;
2. they are fermented by intestinal bacteria, what can yield gas and irritant by-products.

FODMAPs include:

• oligosaccharides: fructans (inulin, fructo-oligo-saccharides (FOS) or oligofructose), galactans, and raffinose;
• disaccharides: lactose;
• monosaccharides: fructose;
• polyols: sorbitol, mannitol, xylitol, isomalt, erithrytol, arabitol, erythritol, glycol, glycerol, lactitol, ribitoll.  

Who Can Benefit from Low Sugar Diet?

People diagnosed with IBS, lactose intolerance, fructose malabsorption (Dietary Fructose Intolerance - DFI), Crohn’s disease, chronic diarrhea, toddler’s diarrhea, and those with ‘indigestion’, ‘dyspepsia’, unexplained bloating, or irregular bowels may all benefit from low sugar (FODMAPs) diet. FODMAP diet may also be a way to lose weight in obese but otherwise healthy people.

Can FODMAP Diet be Dangerous?

FODMAP diet should not be introduced by any person with diabetes, hypoglicemia or other metabolic disorders, or in malnutrition, without prior consultation with a doctor. It may be necessary to interrupt FODMAP diet in any severe acute disease, after injury or surgery, and in other urgent situations. 

What Symptoms Can FODMAPs Cause

FODMAPs malabsorption may result in bloating, gas, abdominal pain, diarrhea, weight loss, symptoms of vitamin and mineral  deficiency, headache, lethargy, and depression.

Fructose Malabsorption

In this article, fructose malabsorption, formerly known as Dietary Fructose Intolerance (DFI), which is a common cause of diarrhea, is described. Another, rare, Hereditary Fructose Intolerance (HFI), which causes impairment of liver, kidneys and small intestine is much more severe. Fructose malabsorption and HFI are NOT allergies.

In fructose malabsorption fructose can’t be efficiantly absorbed from unknown reason. Transport protein GLUT5, responsible for fructose absorption in the small intestine, may not be present or becomes inactive. People with fructose malabsorption have fructose absorption limit lower than 25 grams per serving, but this may differ a lot from person to person. Fructose, unabsorbed in the small intestine, reaches the colon, where bacteria ferment it and yield short chain fatty acids, carbon dioxide (CO2), hydrogen and methane, which cause symptoms. It is estimated that about 1/3 of people are fructose intolerant, and about half of them have symptoms. People with fructose malabsorption may be also sensitive to other non-digestable carbohydrates, such as sorbitol and xylitol, raffinose (beans) and inulin (polyfructose), (5).

Who Can Get Fructose Intolerant?

Anyone at any time can develop fructose malabsorption. Abnormality or lack of GLUT-5, a fructose transporting protein, may be inherited (5). Other causes, suggested so far:

• family predisposition; 
• overuse of High Fructose Corn Syrup (HFCS), or fruit juices in children (toddler’s diarrhea); 
• small intestinal bacterial overgrowth (SIBO);
• celiac disease; 
• chemotherapy or radiation;
• dumping syndrome (rapid stomach emptying).

What Is a Diarrhea?

Diarrhea (from Greek ‘dia’ - through, ‘rhein’ - flowing) means having more than three bowel movements, or passing more than 300g of watery stool daily (1).

What Is Not a Diarrhea?

Ten diapers a day are usual in a 14 days old infant. Three soft bowel movements a day may be considered normal for adult on a fibre-rich diet. Stool soiling in children who are already toilet trained may be due to defective anus. Stool incontinence or mucus seeping in adults may be due to rectal inflammation, rectal prolapse, hemorrhoids, uncoordinated pelvic floor muscles, or anal muscle or nerve damage (2). In all mentioned cases, bowel movements tend to be of normal volume and consistency.

Occasional single loose stool still isn’t a diarrhea. Unripe fruits, green potatoes, spicy or hot food may all irritate the bowel. Insufficiently cooked or chewed food, a heavy sugary or fatty meal may be hard to digest. Wrong food combinations, like meat with sugar, may result in a loose stool. Food which is psychically rejected, after ingesting, might flow through the intestine quickly. Caffeine stimulates peristalsis, as can strong emotions like fear.

Find the Cause of Diarrhea from Symptoms

In this article, typical symptoms are paralleled with common causes of diarrhea. The cause can be also found by tests for diarrhea.

Causes of Diarrhea in Newborns

Newborn normally poops 8-10 times a day.

• fever, vomiting, diarrhea: Rotavirus, rarely other microbes;
• mild diarrhea: overfeeding, neonatal drug withdrawal;
• skin rash, strain to vomiting (gagging), irritability, diarrhea: allergy to cow’s milk or soy formula;
• diarrhea in first 3 days of life: congenital diseases of liver, pancreas, biliary tract, small or large intestine.

Read More….

Diarrhea Tests  

The cause of diarrhea can be determined from diarrhea symptoms, or by below diarrhea tests:

• stool tests;
• blood tests;
• urine tests;
• neurological tests;
• food allergy and intolerance tests; 
• absorption tests;
• abdominal ultrasound, endoscopic ultrasound, CT, X-ray with barium, plain abdominal X-ray, abdominal arteriography, HIDA scan, ERCP and MRCP;
• colonoscopy, EGD, capsule endoscopy, double baloon enteroscopy;
• Octreoscan.

Stool Tests In Diarrhea

Stool tests are done in chronic or heavy acute diarrhea and may include:

• Stool culture can show bacteria, causing diarrhea. Clostridium difficile toxin test is recommended in antibiotic associated diarrhea. For diagnosis of some rare bacteria, like Vibrio cholerae, separate tests may be required. Ova and parasites (O&P) test is recommended when diarrhea lasts more than a week. Specific antigen tests for giardia, cryptosporidium, E. histolytica, Helycobacter pylori, or Rotavirus also exist. False positive results of stool culture are from contamination of stool sample with urine or blood, or due to more than an hour passed between sample taking and testing. False negative results may be from antibiotics, laxatives, antidiarrheal drugs, or recent barium or x-ray investigation.
• Fecal occult blood test (FOBT) should be done when intestinal bleeding is suspected (after hemorrhoids, anal fissure, menstruation, and urinary bleeding are excluded). Bloody diarrhea, or diarrhea with a hidden blood may appear in heavy bacterial or parasitic infection, inflammatory bowel disease, and in diverticulitis. Other causes of bloody diarrhea are rare. Stool guaiac test (e.g. Hemoccult) - may detect daily blood loss of about 10 ml (1). Positive test confirms presence of the blood in the stool, but not its origin. Negative result means, that no blood was in the stool during the testing period, so additional samples at different occasions may be required. Three days before the test, red meat, and food which contains blood have to be avoided to prevent false positive results, and radishes, horseradish, turnips, cauliflower, uncooked broccoli, figs, melon, citrus fruits, and vit C supplements have to be avoided to prevent false negative results. Test should not be done in bleeding hemorrhoids, urinary bleeding, or during the menstruation. Five samples from each of three consecutive stools have to be taken. Immunochemical test - iFOBT (e.g. HemSelect) uses antibodies which react with human hemoglobin. The test may detects smaller amount of blood (50 µg/g stool) than guaiac test, but only from lower GI tract, not from the stomach or above (32). No dietary or drug restrictions are needed before the test; one sample from one or two stools is required. Both guaiac and immunochemical test kits are available in pharmacies without prescription, but testing by a lab or doctor is more reliable.
• WBC stool test. White blood cells in the stool may be found in severe bacterial infection, Crohn’s disease or ulcerative colitis.
• Fecal proteins. Lactoferrin is released from leukocytes, and it can be detected in stool in 5 minutes. Increased lactoferrin is a sign of inflammation, so it is used in acute diarrhea to distuinguish between mild viral or parasitic infection (negative) and invasive bacteria (positive), and in chronic diarrhea to distinguish between IBS (negative) and IBD (positive). In later case lactoferrin test was found to be 86% sensitive and 100% specific (26,27). Calprotein is another leukocyte protein, excreted in stool, which correlates with activity of IBD (29). Fecal A1AT test detects serum protein alpha1-antitrypsin in the stool in the protein losing enteropathy (PLE). Radionuclide labeled proteins, injected into a vein, and then appearing in the stool, also speak for PLE. Tests for proteins, excreted in colorectal cancer, are still in the research phase. Protein CD23 was found in the stool of patients with a food allergy (31). 
• Fecal IgA antibodies may be found in certain food allergies (to milk, egg, soy). In one clinical trial, IgA antigliadin antibodies in the stool were found in only 30% of patients with celiac disease, so they were considered as useless for diagnosis (2).