Gas and Bloating

Does Processed Food Give You Gas?

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Why Does Processed Food Give You Gas?

Author: Dr. Stephen Chaney 

Does it feel like a war is going on in your belly every time you eat? It could be IBD (inflammatory bowel disease). IBD can take several forms, but the two most common are Crohn’s disease and ulcerative colitis.

What do we know about IBD?

  • The symptoms of IBD can make you miserable. They include:
    • Abdominal pain and cramping.
    • Diarrhea with occasional bouts of constipation.
    • Gas and bloating.
    • Loss of appetite and/or unexpected weight loss.
  • There are about 1.6 million Americans with IBD and 70,000 new cases/year.
    • The prevalence of IBD in the United States has increased by 34% between 2006 and 2016.
  • As you might suspect from its name, IBD is a chronic inflammation of the gastrointestinal tract.
    • It is thought to be caused by “dysbiosis of the gastrointestinal track” (In layman’s terms that means damage to your intestine caused by too many bad bacteria and not enough good bacteria).
    • There is also a genetic component to the disease. Some people are much more susceptible to IBD than others.

If you watch TV, you know that there are drugs for treating IBD. The ads make them sound like miracle drugs. But if you listen carefully, you also know that these drugs have a long list of side effects. And some of the side effects are pretty scary.

Are There Natural Approaches For Controlling IBD?

BacteriaSo, if your belly is a bit rumbly, you might be wondering if there is a more natural approach you could take. We know that diet affects the balance between bad and good bacteria in our intestine. Could something as simple as changing your diet, quell the fire in your belly?

While the answer seems obvious, it has been hard to prove. The results of previous studies have been inconclusive. That is because previous studies:

  • Included too few people. 1.6 million people in the US with IBD may sound like a lot, but that represents only 0.4% of the population. Unless you have a really big study, there won’t be enough people who develop IBD to give you statistically significant results.
  • Were too short. IBD doesn’t develop overnight.
  • Did not include a diverse enough population. Previous studies were confined to individual countries or specific regions within a country.

This study (N Narula et al, British Medical Journal, 2021;374:n1554) was designed to overcome the limitations of previous studies. It also looked at the effect of diet on IBD from a different perspective than most previous studies.

  • It did not focus on the effect of individual foods on IBD. Since consumption of processed foods is known to affect the population of intestinal bacteria, the authors of this study asked whether processed food consumption might influence the likelihood of developing IBD.

How Was The Study Done?

Clinical StudyThe authors of this study used data collected from the PURE (Prospective Urban Rural Epidemiology) study between January 1, 2003, and December 31, 2016. The PURE study collected data from a very diverse population. Specifically, it collected data from 21 low-, middle-, and high-income countries across 7 geographical regions (Europe, North America, South America, Africa, Middle East, South Asia, Southeast Asia, and China).

  • This study followed 116,087 adults aged 35-70 years (average age 50, percent women = 60%) in the PURE study for an average of 9.7 years. During that time, 467 participants (0.4%) developed IBD.
  • All participants filled out a baseline food-frequency questionnaire that had been designed and validated for foods specific to their country.
  • Participants were asked if they had a diagnosis of Crohn’s disease or ulcerative colitis as part of an annual follow-up questionnaire. To assure the accuracy of these answers they were validated with medical records whenever possible.

Does Processed Food Give You Gas?

Does processed food give you gas? Does it give you abdominal pain, diarrhea, and bloating? In short, does it give you IBD? That is the question this study was designed to answer. Here are the results of the study:

  • When comparing those eating the most processed food (≥5 servings/day) to those consuming the least (≤1 serving/day), processed food consumption increased the risk of developing IBD by 1.82-fold. This finding was equally true for:
    • Both Crohn’s disease and ulcerative colitis.
    • Adults <50 and adults >50.
    • Every region of the world included in the PURE study.
  • When the investigators looked at different categories of processed foods:
    • Processed meat intake increased the risk of IBD by 2.07-fold.
    • Soft drink intake increased the risk of IBD by 1.94-fold.
    • Refined sweetened food intake increased the risk of IBD by 2.58-fold.
    • Salty food and snack intake increased the risk of IBD by 2.06-fold.
  • When the investigators looked at different categories of unprocessed foods:
    • White meat, red meat, dairy, starchy foods, fruits, vegetables, and legumes had no effect on the risk of developing IBD.
    • Sodium intake (as measured by urinary excretion of sodium) also had no effect on the risk of developing IBD.

Why Does Processed Food Give You Gas?

Question MarkYou may be wondering why does processed food give you gas – and other symptoms of IBD.

The simplest explanation is that whole grains, unprocessed fruits & vegetables, and legumes provide the fiber that supports the growth of friendly gut bacteria. Processed foods displace these foods from our diet.

But these investigators think something else about processed foods may be contributing to the increased risk of IBD. That is because in their study:

  • Processed meat increased the risk of IBD, but unprocessed white and red meat had no effect on IBD.
  • Processed sweetened foods increased the risk of IBD, but unprocessed starchy foods and naturally sweet fruits had no effect on IBD.
  • Processed salty foods and snacks increased the risk of IBD, but sodium intake had no effect on IBD.

The investigators also noted that in mouse studies:

  • Some food additives found in processed foods cause bacteria to stick to the epithelial lining of the intestine and/or cause leaky gut syndrome, both of which can lead to chronic inflammation of the intestine.

The investigators concluded, “In this study, higher ultra-processed food intake was associated with a higher risk of IBD.”

They went on to say, “As white meat, unprocessed red meat, dairy, starchy foods, fruits, vegetables, and legumes were not found to be associated with development of IBD, this study suggests that it may not be the food itself that confers this risk but rather the way the food is processed or ultra-processed…Further studies are needed to identify specific potential contributing factors among processed foods that might be responsible for the observed associations in our study.”

[Note: This is a fancy way of saying that the detrimental effects of processed foods may be due to more than the fact that they displace healthier foods from the diet. It may also be due to the effect of food additives on the risk of developing IBD.]

What Does This Study Mean For You?

Questioning WomanIBD is a rare disease (0.4% of the population). If you don’t have digestive issues, it would be easy to ignore this study and continue with a diet of highly processed foods.

However, I would remind you that in recent issues of “Health Tips From the Professor”, I have shared recent studies showing that highly processed foods increase your risk of:

And these studies are just the tip of the iceberg. We know that diets rich in whole grains and unprocessed fruits and vegetables decrease the risk of heart attack, stroke, and Alzheimer’s disease. And a diet rich in whole grains, fruits, and vegetables is the antithesis of a processed food diet.

The evidence is overwhelming. Highly processed foods may be convenient and tasty. But if you value your health, they are not your friends.

The Bottom Line 

A recent study looked at the effect of consuming processed foods on the risk of developing inflammatory bowel disease (IBD). The study found:

  • When comparing those eating the most processed food (≥5 servings/day) to those consuming the least (≤1 serving/day), processed food consumption increased the risk of developing IBD by 1.82-fold. This finding was equally true for:
    • Both Crohn’s disease and ulcerative colitis.
    • Adults <50 and adults >50.
    • Every region of the world included in the study.

The investigators concluded, “In this study, higher ultra-processed food intake was associated with a higher risk of IBD.”

They went on to say, “…This study suggests that it may not be the food itself that confers this risk but rather the way the food is processed or ultra-processed…Further studies are needed to identify specific potential contributing factors among processed foods that might be responsible for the observed associations in our study.”

[Note: This is a fancy way of saying that the detrimental effect of processed foods may be due to more than the fact that they displace healthier foods from the diet. It may also be due to the effect of food additives commonly found in processed foods on the risk of developing IBD.]

For more details on the study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does The FODMAP Diet Reduce Gas and Bloating

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Author: Dr. Stephen Chaney

 

fodmap dietCan the FODMAP diet help reduce gas, bloating, diarrhea, and constipation? Everyone suffers from one or more of these symptoms, but nobody talks about them. For some they represent an annoyance. For others they can be incapacitating.

When the symptoms become frequent and start to affect quality of life, the medical community starts to give them names. When the symptoms occur at least 3 days/month for at least 3 months and there are no known diseases causing the symptoms, it is called irritable bowel syndrome (IBS). If the symptoms are also associated with inflammation, it is called inflammatory bowel disease (IBD). The principle forms of IBD are Crohn’s disease and ulcerative colitis.

A Primer On IBS And IBD

IBS is fairly common. Between 10-15% of the US population has been diagnosed with IBS, but experts estimate that as much as 25% of the population experiences symptoms consistent with IBS.

It is also important to understand that IBS is a collection of symptoms, not a disease. The only difference between IBS and the gas, bloating, and diarrhea (or constipation) that many people experience on a fairly regular basis is the frequency and severity of symptoms – and that is an arbitrary distinction. Someone experiencing those symptoms an average of 2 days/month is not significantly different than someone experiencing those symptoms 3 times/month.

While severe IBS can be incapacitating, it does not appear to cause lasting damage to the intestine or predispose to other diseases. Finally, the causes of IBS are largely unknown. Stress, obesity, and food sensitivities may all play a role.

IBD is much less common (0.4% of the US population), but much more severe. It can cause permanent damage to the intestine and can predispose to several diseases, including cancer. For that reason, you should always consult with your physician if you have severe, chronic gastrointestinal issues.

Standard treatment of IBS and IBD has traditionally consisted of recommendations to:

  • Reduce weight if overweight
  • Increase exercise
  • Reduce stress
  • Limit caffeine and alcohol
  • Limit fatty foods
  • If diarrhea is the primary symptom, limit dairy products, fruits, and sweeteners such as sorbitol and xylitol.
  • If constipation is the primary symptom, increase dietary fiber

These interventions generally provide only partial relief of the symptoms, so medications are frequently prescribed to control the symptoms. Unfortunately, many of those medications have significant side effects.

Fortunately, research over the past decade suggests that there is a natural, holistic approach that can significantly reduce the symptoms associated with IBS and IBD, thus decreasing the reliance on medications to treat those diseases. It is something called the FODMAP diet. The FODMAP diet is rapidly becoming the standard of care for IBS and IBD, and the same diet also appears to significantly improve symptoms in people who merely experience gas, bloating, and diarrhea more frequently than they would like. More importantly, the principles behind the FODMAP diet can help almost everyone who experiences occasional gas, bloating, diarrhea and/or constipation.

What Is The FODMAP Diet?

The FODMAP diet was devised over a decade ago by a group of scientists in Australia. Basically, they identified all of the kinds of foods that were known to cause gas, bloating, diarrhea, and/or constipation in susceptible people and put together a diet that was low in all of them.

FODMAP is an acronym that stands for:

  • F – fermentable carbohydrates
  • O – oligo-saccharides
  • D – di-saccharides
  • M – mono-saccharides
  • P – polyols

Of course, that statement comes under the “Aren’t you glad you asked?” category. It is meaningless to most people. A better way to understand this is to look at foods in the FODMAP category. They include:

  • gas and bloatingLactose, found in milk and milk products (especially for people who lack the enzyme lactase)
  • Fructose in high concentrations, found in foods like apples, pears, honey and agave syrup. (30-40% of individuals have problems absorbing fructose).
  • Fructans, found in foods like wheat, onions and garlic.
  • Galacto-oligosaccharides, found in foods like beans, lentils, and soybeans.
  • Polyols such as sorbitol and mannitol, found in fruits such as cherries, apricots, and apples, and as sweeteners added to many “sugar-free” foods.

These are all foods that are poorly digested or poorly absorbed, so they are fermented by intestinal bacteria. It is the fermentation of these foods by intestinal bacteria that causes the gas, bloating, and diarrhea.

Does The FODMAP Diet Work?

The evidence that the FODMAP diet is effective is pretty impressive. For example:

What Does This Mean For You?

On the surface, this seems to be a good news, bad news story.

good news bad newsThe good news is that the FODMAP diet is incredibly effective at decreasing frequent gas, bloating, abdominal discomfort, diarrhea and constipation – and it really doesn’t matter whether you have been diagnosed with IBS or IBD, or you are just someone who suffers from those symptoms more frequently than you would like.

The bad news is that the FODMAP diet is very restrictive. You can appreciate that when you look at the list of high FODMAPs foods you need to avoid. That means:

  • The diet is very difficult to stick to long term. In the follow up study described above only 30% of the participants were able to stick with the diet for the full 16 months.
  • The diet restricts so many foods that you would really need the guidance of a registered dietitian to design a nutritionally adequate diet plan.

 

The reality, however,is that very few people actually need to restrict all the high FODMAP foods to enjoy significant relief from their symptoms. Clinically, most physicians test various FODMAPs in their IBS and IBD patients and only restrict the ones that cause symptoms. You can do exactly the same thing yourself. Start by reducing groups of high FODMAP foods on the list. Once you have identified which food groups cause your symptoms, you can test foods within that group one by one.

The most important news is that the FODMAP diet concept may help many people who struggle with occasional gas, bloating, and diarrhea. Let me give you one example:

  • Let’s suppose you have discovered that foods made from wheat flour cause you g.i. problems. You have concluded that you are gluten intolerant and carefully avoid foods containing gluten, but you still have occasional gas, bloating and diarrhea. You might be sensitive to the fructans in wheat, not the gluten. If so, a quick glance at the FODMAPs list suggests a number of fructan-containing foods you may be sensitive to that you would never have expected if you just focused on avoiding gluten. For example:
  • Vegetables: garlic, onions, asparagus, artichokes and snow peas might be causing you trouble.
  • Fruits: grapefruit, nectarines, plums and watermelon could be causing you problems.
  • Processed foods: Inulin, a naturally occurring fiber, found in Jerusalem artichokes, is primarily a fructan. Inulin and several other naturally occurring fructans are added to many processed foods to increase their fiber content. These foods might also be causing you trouble.

This is just the tip of the iceberg. Most of us have probably identified one or two problem foods that we know give us gas. By using the FODMAPs list we may be able to identify other foods we should avoid.

 

The Bottom Line

  • By restricting all foods known to cause gas, bloating, diarrhea and constipation in susceptible individuals, scientists and clinicians have created something called the FODMAP diet.
  • The FODMAP diet has proven to be very effective at reducing those symptoms in people with IBS or IBD, but it is also equally effective at eliminating symptoms in individuals who simply suffer from gas, bloating, abdominal pain, diarrhea and/or constipation more frequently than they would like.
  • The low FODMAP diet is also very restrictive, but the good news is that most people don’t need to eliminate all of the foods in the diet. You can systematically test and eliminate the individual foods that cause your symptoms.
  • Most importantly, the FODMAP concept can help us identify problem foods that we might have otherwise never suspected of giving us gas. You will find an example of how this concept works in the article above.
  • Gas, bloating, abdominal pain, diarrhea and constipation can also be caused by a number of serious diseases. For that reason, you should always consult with your physician if you have severe and chronic gastrointestinal issues.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Health Tips From The Professor