Fermentable

Foods...
Trouble
I n Your
Diet By David Warmflash

S arah is a high school track star. In freshman year, she made the varsity team, and
by the end of the season, she was ranked in the top 10 in her state for pole vault-
ing. Like most of her teammates, she tried to eat healthy, with a diet rich in complex carbo-
fere with the quality
of your life and wreak
havoc on your gas-
hydrates, which are found in vegetables, potatoes, corn, rice, pasta, and cereal. trointestinal tract. If
Carbohydrates are one of the three takenly identifies parts of gluten you are an athlete, it
main categories of macronutrients— as dangerous. The immune can make it difficult to
organic compounds that you response damages the lining of train. This syndrome
need in large quantities to the small intestine, leading to is different from celiac
store energy. The other two are severe digestive symptoms disease, which is an
proteins and lipids. Athletes and a range of other effects immunologic condi-
load up on complex carbo- throughout the body. tion. If exposed to
hydrates, because carbohy- It turned out Sarah did small quantities of gluten, the immune system
drates store energy, and they not have celiac disease. of someone with celiac disease reacts in full
can be broken down easily in Instead, the doctor diag- force. Like an allergy, celiac disease is a type
the body to release energy, as nosed her with a common of hypersensitivity reaction.
needed. condition called irritable Instead, intolerance to FODMAPs depends
Often, when Sarah ate a lot bowel syndrome, and he told on the amount of FODMAPs you consume. A
of pasta, beans, and cereal, she felt her to reduce her intake of food small scoop of ice cream may be tolerated by
bloated and gassy. By the summer following containing a range of compounds called your body, but a supersize milkshake could
her freshman year, she experienced frequent fermentable oligosaccharides, disaccharides send you running to the bathroom. The same
diarrhea and occasional constipation, which and monosaccharides and polyols (FOD- quantity-based effect is true of beans, lentils,
interfered with her training. She tried a gluten- MAPs). Sarah had never heard of FODMAPs, and grains, which contain high quantities of
free diet after learning from a friend that some but it turns out that many people who are not hard-to-digest oligosaccharides.
people cannot tolerate gluten, a group of pro- sensitive to gluten are actually sensitive to By understanding what the O, D, M, and
teins found in many grains. After a few days, FODMAPs. P in FODMAPs stand for, Sarah was able to
her symptoms improved enough for her to control her diet and eat foods that contain low
keep training, but they did not disappear. amounts of each category. So let’s see what
By the end of the summer, Sarah went FODMAPs these letters stand for and how they helped
to see her doctor. Hearing about the slight Irritable bowel syndrome is a common dis- Sarah cope with her condition. Then, later, we
shutterstock; thinkstock

improvement with the gluten-free diet, the order that affects the large intestine, or colon, will discuss the F, for “fermentable,” which
doctor tested Sarah for celiac disease—a and causes abdominal pain, bloating, and refers to what happens to the Os, Ds, Ms,
disorder that comes from eating foods with diarrhea. This disorder is not life-threatening, and Ps if the small intestine does not provide
gluten, because the immune system mis- but it can be uncomfortable, and it can inter- enough of the enzymes to digest them.

10 Chemmatters | FEBRUARY/MARCH 2015 www.acs.org/chemmatters

 grains and beans fairly well, but some people
(a) (b) (c)
can tolerate large amounts, and some people
H CH2OH HO CH2OH CH OH OH cannot handle even a little bit. Also, any given
2
O
person may handle galacto-oligosaccharides
HO O H O H OH
H H and fructans completely differently.
HO H HO H H CH2OH Sarah loves hummus. She might be able to
OH OH break down the galacto-oligosaccharides in
OH H
H OH H OH hummus but not the fructans in the bread on
which she spreads it, or it could be the other
Figure 1. Chemical structures of three common monosaccharides, or simple sugars: (a) glucose;
(b) galactose; and (c) fructose way around. In either case, any undigested
oligosaccharides pass through the small intes-
tine into the colon before being eliminated
First, the O in FODMAPs OH OH
from the body. Upon reaching the large colon,
stands for “oligosaccha- they will cause discomfort, such as bloating
O and diarrhea (Fig. 4).
rides,” which are a type of
carbohydrate. Carbohy- HO Now, let’s look at the D, or
drates form a large group OH disaccharide, in FODMAPs.
OH O Disaccharides are made of car-
of organic compounds that are present in
foods and living tissues; they include sugars, bohydrate molecules that con-
O
starch, and cellulose. They contain hydrogen tain only two monosaccharides.
and oxygen in the same ratio as water (2:1) HO Like oligosaccharides, there are many
and are made up of monosaccharides, or sim- OH kinds of disaccharides, and
O enzymes break down some
ple sugars (Fig. 1), which are joined together
OH but not others. Amylase,
to form chains containing thousands of these O
HO O for instance, works well
monosaccharide units. Oligosaccharides con-
HO OH on a disaccharide called
tain only between three and 10 monosaccha-
OH maltose, which consists
rides, so they are relatively small. O
When food is digested, it goes from the OH of two glucose subunits,
OH but it will not work on
mouth to the esophagus and then to the
stomach and the small intestine. The main Figure 2. Stachyose, a type of galacto-oligosaccharide found in green other disaccharides.
beans and soybeans, is composed of four monosaccharides that are in the Maltose is found in
function of the small intestine is to absorb
following order (from top to bottom): two galactose molecules, one glucose
nutrients and minerals from food. Following molasses and malted
molecule, and one fructose molecule.
absorption, nutrients travel through the blood- drinks, and it also
stream to organs and tissues throughout the For the most part, humans can produce accumulates in foods such as sweet potatoes
body. The food parts that are not absorbed go small amounts of the enzymes needed to when they are cooked. Heat breaks the bonds
through the colon, from where they are later break up galacto-oligosaccharides and fruc- between the individual glucose building blocks
eliminated. tans into their individual subunits (Fig. 3). but generally not all of them. So, often, malt-
In the small intestine, biological catalysts Most people can handle modest amounts of ose is left behind.
called enzymes break apart the bonds con-
Rhonda Saunders, adapted from a drawing by David Warmflash; anthony fernandez; thinkstock

necting the various monosaccharide building

Fructose Fructose
blocks. For instance, pancreatic amylase Fructose
breaks apart any oligosaccharides made Fructose Fructose
Fructose
from glucose into their glucose subunits. But Fructose Fructose
certain oligosaccharides are built from other Fructose
small sugars, and amylase will not work on Fructose Enzyme
Fructose
Enzyme Fructose
these. Two important examples are galacto- Fructose Fructose
oligosaccharides and fructans. Enzyme Fructose
Galacto-oligosaccharides, which contain Fructose Fructose
galactose subunits (Fig. 2), are present in Fructose Fructose
large quantities in beans, lentils, and chick-
Fructose
peas—the legumes that are used to make
hummus. Fructans are strands of fructose
Fructose
subunits, and they are found in several grains,
especially wheat, rye, and barley, along with
Figure 3. A fructan molecule (blue) is broken down by enzymes (red) into fructose molecules, the building
certain vegetables such as onions, artichokes, blocks from which it is made. There are several types of fructans, and their building blocks
and leeks. are either fructose molecules or a mix of glucose and fructose molecules.

chemmatters | FEBRUARY/MARCH 2015 11

 Oligosaccharides Disaccharides

Salivary
amylase Maltose: sweet potatoes
Starch (made of glucose subunits)
Lactose: milk
Fructan Salivary amylase
(made of fructose subunits)
Lactose (made of glucose and galactose)

Starch: pasta
Fructans: bread Maltose (made of two glucose subunits)
Galacto-oligosaccharides: green beans

12 Chemmatters | FEBRUARY/MARCH 2015

Esophagus Esophagus

Galacto-oligosaccharide
(made of galactose subunits)

Stomach
Pancreatic duct Pancreatic duct

Stomach
Gas The particles released
by the bacteria keep
The particles released water inside the colon
by the bacteria keep
water inside the colon Pancreatic amylase
Colon
Gas Some people don’t have Water

www.acs.org/chemmatters
enough amylase, so some
Pancreatic amylase maltose goes through The particles grow
Water bigger, creating feces
the colon
The particles
Bloating due to the grow bigger, Bloating due to the
release of gas by bacteria creating feces release of gas by bacteria

Particles released by Colon Bacteria fermenting

bacteria after fermentation lactose and maltose
Small intestine

Particles released by
Bacteria fermenting
bacteria after fermentation
fructans and galacto- Small intestine
oligosaccharides Gas
Glucose subunits taken
Gas up by bloodstream
Glucose subunits taken
up by bloodstream Loose stool
Loose stool

Figure 4. Schematic representation of the digestion process for three types of oligosaccharides: Figure 5. Schematic representation of the digestion process for two common types
starch, fructans, and galacto-oligosaccharides, in the case of a person who has FODMAP of disaccharides: lactose and maltose, in the case of a person who has FODMAP
intolerance. intolerance.

Shelley A. Russell, adapted from a drawing that appeared in the Nov. 19, 2007 issue of The Washington Post
 Amylase is present in both saliva (which to foods, mints, and chewing gum because Feeling better
starts the digestion in the mouth) and secre- they taste sweet. But sorbitol, mannitol, and
xylitol are not absorbed into the bloodstream People who are sensitive to FODMAPs have
tions from the pancreas. If the quantity of
and, like undigested oligosaccharides, disac- noticed various levels of improvement when
starch is so high that not enough amylase is
charides, and monosaccharides, they pass they eliminate another ingredient from their
available to keep up with it, digestion may be
from the small intestine to the colon before diet: gluten. Why is that so, given that only
incomplete. Any maltose and other disaccha-
being eliminated. people who have celiac disease are known
rides that are undigested after passing through
to be sensitive to gluten? The reason is that
the small intestine enter the colon and have a
foods contain different compounds. Intoler-
fate similar to that of oligosaccharides (Fig. 5). That uncomfortable ance to grain-based foods, such as bread and
One commonly undigested disaccharide is
lactose, which consists of one glucose mol-
feeling pasta, is not because they contain gluten but
So what is the problem? Don’t because they also contain FODMAPs.
ecule and one galactose molecule. Lactose
these carbohydrates and polyols FODMAP intolerance is not an allergy.
digestion requires an enzyme called lactase.
just get eliminated? The problem Unlike gluten sensitivity, FODMAP intolerance
Many people make a good supply of lactase,
lies in the F in FODMAPS, the is not an immune reaction. Instead, the condi-
but at least 25% of adults are diagnosed as
letter that we have not yet dis- tion is an intolerance to certain types of food.
lactose-intolerant, because their bodies do not
cussed. It stands for “fermentable,” which This food intolerance is due to bacteria in the
make enough lactase. This condition is less
refers to the fermentation process, and this colon that ferment carbohydrates and to the
common among young children, but often,
is what causes all the trouble. presence of too much water in the colon, lead-
people make less lactase as they grow up.
You may have heard of fermentation in con- ing to diarrhea.
After learning about this sensitivity to disac-
nection with yeast. Yeast performs fermenta- Many factors can influence how people
charides, Sarah mentioned to her doctor that
tion to produce energy by converting sugar react to foods, and this is the case with Sarah.
she always ate her cereal with milk and that she
into alcohol and carbon dioxide. Fermentation She seems to have a lactose intolerance and
felt gassy an hour or so afterward. The same
turns fruit juices into wine and grain mash probably also an oligosaccharide intolerance,
thing happened after eating ice cream or pizza.
into beer or whiskey. The carbon dioxide but the good news is that the condition can
This meant that at least one component of her
produced by fermentation makes the bubbles be controlled. Taking pills with the enzyme
FODMAP intolerance was lactose intolerance.
in beer and some kinds of wine and causes lactase before eating dairy products solved
She would probably be better off avoiding the
bread to rise. This is one type of fermentation, part of the problem, and Sarah can also try
D portion of FODMAPs, her doctor explained,
but the term actually applies to a variety of enzyme pills that help break down galacto-
although she could take lactase enzyme in the
similar chemical reactions. oligosaccharides when she eats beans, lentils,
form of a pill before eating dairy foods.
Bacteria in our colon extract energy by and other legumes.
Sarah tried using lactase enzyme pills, and
fermenting carbohydrates, but the fermenta- In the meantime, Sarah has reduced, but
it helped. But that did not mean that the Os,
tion process also yields gases. In the case of not eliminated, her intake of grains. She also
Ms, and Ps were not contributing to her condi-
glucose (C6H12O6), the fermentation process has increased her intake of rice, because it
tion, as well. In fact, because her stomach was
leads to hydrogen (H2), carbon dioxide (CO2), does not contain significant amounts of fruc-
upset, not just after eating cereal but also after
and methane (CH4), according to the following tans but still contains starch, which Sarah can
eating pasta and other grains, the doctor sus-
chemical reaction: use to generate energy when she exercises.
pected that she did not tolerate fructans well.
By taking a more moderate approach, Sarah
How about the M, or
C6H12O6 + 4 H2O ➞ 2 CH3COO– + 2 HCO3– began to feel a lot better, and by the next
monosaccharides?
+ 4 H+ + 4 H2 season, she ranked nationally in high school
Although most people have
track and field. So if you, your friends, or your
no problem absorbing
relatives have symptoms similar to Sarah’s,
common monosaccharides
get ready for a new food craze—
such as glucose, some people do not absorb CH3COO– + H+ ➞ CH4 + CO2
the low-FODMAP diet.
other monosaccharides found in food. A typi-
cal example is fructose, which we can obtain In addition to accumulating gases, polyols,
from sucrose, or granulated sugar, or from monosaccharides, disaccharides, and small
Selected references
fruits, such as apples, or some processed undigested remnants of oligosaccharides
Low-FODMAP Diet—Overview. US News and World
foods, especially those that contain high-fruc- cause what is called an osmotic effect. Like Report: http://health.usnews.com/best-diet/
tose corn syrup. salt, these compounds draw water from the low-fodmap-diet [accessed Oct 2014].
The last type of compound in other side of the cells that surround the hol- The Low FODMAP Diet Approach: Dietary Triggers
FODMAPs is P, or polyols. These for IBS Symptoms. International Foundation for
low part of the colon. As a result, the stool Functional Gastrointestinal Disorders: http://
compounds, also called sugar stays more watery than it would be otherwise. www.aboutibs.org/site/treatment/low-fodmap-
alcohols, have the general for- All of this produces bloating, gas, diarrhea, diet/ [accessed Oct 2014].
mula (HOCH2[CH(OH)]n CH2OH). and pain—all of the symptoms that Sarah
Three common examples of polyols are sor- experienced and which prompted her to seek David Warmflash, M.D., is a science writer who
thinkstock

lives in Portland, Ore. This is his first article in

bitol, mannitol, and xylitol, which are added medical help. ChemMatters.

chemmatters | FEBRUARY/MARCH 2015 13