Foods Bloat - and Not Just Dairy

A fitness columnist on the Chicago Now blogs reminds us that plenty of foods can cause bloating besides just dairy. That's a good thing to remember when you look at your diet and try to determine what's causing the problems.

What are some of the typical bloaters out there in the food world?

Grease! It's quite obvious, really. Greasy burgers, fries, pizza, tots, and anything else that fits into the category of "bar food" is probably going to make you bloat. Not only that, but it's going to cause a war on your digestive track. ...

Fizzy beverages. This includes things like beer, soda, and anything carbonated. Yes, even DIET sodas are included on this list. It's quite simply really... the fizz is air. Air makes you bloat.

Sodium. Too much sodium can be a problem, and most of us eat way too much of it because it's hidden in things that we may not even realize (read your labels). You may think you are helping yourself by eating those freezer dinners, but they are packed with sodium. So, despite being low in calories, they could still be bloating you up! Limit your sodium intake. ...

Other culprits... as healthy as they are for you, veggies such as broccoli, cauliflower, asparagus, as well as legumes and beans, can also cause bloating.

Report from the LI Conference, part 5

I'm sure some professional jargonistas will come in here and challenge me, but for sheer brain-bending technical mumbo-jumbo in the medical field nothing is more opaquely baffling than the titles of papers on genetics. What would you do with a paper titled "The homeodomain protein Cdx2 regulates lactase gene promoter activity during enterocyte differentiation"?

Whatever that means, it was co-authored by the third presenter of the morning.

Cellular and Molecular Biology of Lactase
Eric Sibley, M.D., Ph.D.
Associate Professor
Division of Pediatrics-Gastroenterology
Stanford University School of Medicine

There are three types of lactose intolerance. If the lactase enzyme never develops at all, then newborns can't have any lactose. They literally starve to death unless a lactose-free formula is given to them almost immediately. This is how LI was first discovered as a medical condition, in fact. Because it exists from birth, this type is called Congenital LI.

Primary LI is the type that most of us have, the natural condition of all mammal. Lactase production declines after weaning, but we can drink milk until that time without symptoms.

A whole medical textbook of conditions - drugs, diseases, surgeries, anything that damages or shocks the intestines - can known out the lactase-making mechanism no matter what your age or status is otherwise. This type is known as Secondary LI.

Why is lactase so vulnerable to being knocked out? Sibley said:

Lactase is a brush border membrane protein produced by enterocytes, the absorptive epithelial cells of the small intestine. The human lactase protein is initially synthesized as a 210–220 kDa immature peptide. The precursor peptide is then processed by glycosylation and cleavage, and finally inserted into the brush border membrane as a mature 160 kDa subunit homodimer.

Lactase is made in the small intestine. Take a biopsy of a section of the inside of the small intestine and a whole invisible world is revealed under a microscope. The insides are covered in tiny projectiles. Imagine a piece of rolled-up shag carpeting and you have the idea. Each projection is called a villus and the outside of the villus, the part that interacts with the broken-down pieces of carbohydrates, proteins, and fats, the part that actually does the digestion, is a membrane called the brush border.

Lactase is made in the brush border, but not in all of it. Lactase is made only at the very tip of the villus. Scientists find that the other enzymes that digest sugars appear the farther you go down the side of the villus, toward the valley (known as the crypt). That's a more protected region than the top. So if anything is going to harm the inside of the intestine, lactase production will go first.

[Why? My guess is that throughout 99% of mammalian history, lactose wasn't very important as a nutrient except for that short time before weaning. Most animals, humans included, live the vast majority of their lifespan after weaning. So if anything has to be first or be most vulnerable, lactase production was the least valuable and bodies could chance that letting it go but protecting the others would lead to higher survival in the long run.]

Here's another fact with huge implications.

Postdecline, the level of lactase activity is 5–10% of childhood levels in most populations worldwide.

That's why most people can have some lactose, some dairy products, even if they are lactose malabsorbers (or lactose non-persisters or are LI in the common use of the term). Your lactase activity doesn't go to zero. It goes down a lot, but not to zero. That helps explain why any activity that helps to slow down the rate at which lactose travels through the intestines (having milk with a meal or having milks with more solids [like whole milk or chocolate milk]) will give your remaining lactose more time to work and reduce overall symptoms.

No Intolerance While Traveling. Why?

Every once in a while I receive an email like this one from Adam:

I have many digestion problems in the UK. Have done for a while irrespective of what I eat or cut out. Just returned from Thailand where I had absolutely perfect digestion the whole time. I found I could eat anything I wanted the whole time. I went there for the 1st time last year+ found the same thing. After returning to UK, same digestive problems started again. Mystery to me+ my doctor. Just wondered if u have ever heard of anything like this. My life is miserable in the uk because of this. Hope u can offer an answer or some advice.

This is almost the ultimate fantasy for those of use with lactose intolerance and other digestive problems. A place in which we can eat anything we want and not suffer any consequences. Why does it have to be so far from home and so temporary an ideal?

I have no answer. I have no clue. I can't think of any reason why lactose intolerance should behave differently anywhere in the world.

I had only one possible grasp at a thought that I could share with Adam. We do know that the bacteria that live in our colons are responsible for many of the symptoms of lactose intolerance and many additional ills. And we know that bacteria are local. We'll meet strange bacteria whenever we travel. That's the problem behind traveler's diarrhea.

But what if it also worked the other way? What if the local bacteria that you encounter every day in your water and food are the ones making you ill? Wouldn't you then feel better when you got so far away that your exposure was to a whole new set that didn't cause the same problems?

I'm grasping at straws here, I know. But it's the only faint shred of an answer I have. If you readers have any similar tales or ideas that might solve this mystery, please share them.

Reason 12,765,876,761 to Avoid Chiropractors

I know some of you out there believe in chiropractic medicine. I have friends who swear that a chiropractor has helped relieve their pain. It's high on the list of alternative medicines.

It's nuttier than a gluten-free non-dairy fruitcake.

Take this article by Stephanie Sandoval, who does the Your Health column for ABC15 News in Phoenix. Sandoval of course has no health credentials of any kind.

She interviewed Dr. Tony Rodriguez of the Infinite Healing Center, someone who insists that chiropractic "adjustments" can help with digestive diseases and allergies.

Digestion problems
In the case of digestive disorders such as acid reflux, stomach ulcers and constipation there can be a direct link to a spinal problem as the cause.

Dr. Rodriguez says in the mid back the 5th thoracic vertebra relays information to the stomach.

Adjusting a fixed or subluxated vertebra in this area can directly improve symptoms.

Additionally, the 1st lumbar vertebra connects to the large intestine, which if irritated can create diarrhea or constipation.

A second and just as important cause of digestive problems is reaction to irritants and foods.

This inflammation of the gut can lead to a whole host of problems stemming from poor gut function.

Improper digestion and absorption of food can lead to bacterial overgrowth and an inability for the gut lining to keep out bad guys.

A chiropractor can order tests that can point out irritants in foods and bacterial imbalance that may be a part of the problem.

Allergies
Allergies are estimated to affect 30 million Americans. An allergic response is an over protective response from the immune system to an allergen: pollen, dust, milk, dog or cat dander.

For most, these allergens don't create a negative response. But, for many of those that do suffer from allergies, the reaction may not directly be related to the offending allergen.

Dr. Rodriguez says in the spine, the 3rd cervical vertebra directly correlates with the sinuses.

Relieving pressure in the neck can help clear sinuses and reduce allergy symptoms. He adds, food is one of the most common types of allergies.

The guts inability to filter can create fatigue, congestion and outright allergic reactions.

This is not medicine. This is not science. Nothing in medical literature supports this.

What it is is quackery. Gibberish. Moonshine.

Alternative medicine? The alternative to medicine is crackpottery. Don't go there.

When Are "Facts" not Facts?

I don't usually comment on other blogs. Search on "lactose" and you get almost nothing back for the time and effort you expend. Every once in a while, though, I stumble over a load of such concentrated ignorance that I need to contain it before it spreads further.

The home page of dietblog appears at first glance to be a source of reasonable health information. Closer inspection reveals the hidden truth. Each entry is from anyone who registers and is only as good as the knowledge and opinions of the blogger. That means readers are likely to fall immediately into an abyss of food nonsense.

What caught my eye was a post It's Easy to Eat Right and That's a Fact! by a blogger named ej.

Everything I have said here, and everything else that I'll say on this site is fact, so don't have a go at me because none of this is my opinion - it's fact.

Did somebody wave a red flag?

Here's one of ej's "facts:"

Humans have been consuming fat since the year dot. Therefore our bodies know the fat and it can use the fat accordingly. We find it hard to eat too much fat because our bodies have an 'off switch' for fat - it detects when we have consumed enough fat and we feel full. ... Full fat milk is fine to have in moderation, as lactose is detected by the enzymes in the liver, so the body can deal with it.

What in world could ej possibly have meant by those sentences?

First, our bodies don't have an "off switch" for fat. Fat can, well, make you fat, just as sugar can. All sources of proteins, fats, and carbohydrates are broken down by the body into their components. If they can be used by the body or burned as fuel they will be. If not, they will be stored. As fat.

Lactose is, of course, not fat. It is a sugar. It is not "detected by the enzymes in the liver" whatever that means. Lactose gets digested by the enzymes in the small intestine, specifically the lactase enzyme. Those of us with lactose intolerance make little to no lactase, so we can't digest lactose. It doesn't matter in the tiniest whether that lactose is wrapped in whole milk or skim milk. The body doesn't notice, and the liver never sees it at any time, in any way.

Everybody about ej's approach to sugar is beyond odd. Take these statements:

They say there is a lot of sugar in fruit so it's bad for you. NO. Fruit has natural sugar, yes, but it also has fiber and nutrients in it that counteract the sugar when we eat it, so the sugar is still there, but our body can use it positively.

Here's one thing most of you probably don't know. Our bodies can't detect fructose...

What is the sugar in fruit? Right. It's fructose. Until the past few thousand years, the vast majority of the sugar that an adult human would encounter would be fructose. Natural honey is a physical rather than chemical combination of fructose and glucose. A few vegetables, notably sugar cane and sugar beets, are predominantly sucrose, itself a complex sugar made out of fructose and glucose, but those had limited range compared to fructose-heavy fruits.

BTW, it's fructose, not lactose, that is metabolized by the liver. The Wikipedia page on fructose has a jumble of contradictory and inconsistent statements on fructose digestion, but check Figure 6 Metabolic conversion of fructose to glycogen in the liver. Maybe this is what ej has read about once and misinterpreted. Saying our bodies "can't detect fructose" is sheer nonsense no matter how one interprets it.

No one diet is right, and by that I mean no one type of diet is right. You can lose weight on every type of diet. Empty sugars, which are sugars without good supporting nutrition, the nutrients found mainly in, um, fruit, do contribute to obesity. Too much fat also contributes. Too much food period is a cause of obesity. Cutting calories will help you lose weight when accompanied by an increase in exercise. Eating healthy, sensible foods is a must.

So is understanding a few basics about food, digestion, and nutrition. Everything poor ej doesn't know.

Science Whiz Kids Whiff on LI Answer

If there's one thing I've got to be rooting for, it's a team of math-science whiz kids. A neat article by Anne W. Semmes in the Greenwich Citizen talked about a test competition featuring a group of "rising science and math stars [getting ready] for the March 21 Northeast Science Bowl's grueling 12-hour 'Jeopardy style' competition hosted at the UConn School of Engineering at Storrs."

One of the questions in their trial was on chemistry:

"For individuals who are 'Lactose Intolerant,' the reason for their gastric distress is the production of methane, or acetic acid and nitrogen, or lactic acid and carbon monoxide or acetic acid and methane?"

"Lactic acid and carbon dioxide," one boy fired off.

Oops. Bad answer. In fact, it's the worst answer of the four possibilities.

As I've explained many times, undigested lactose that reaches the colon is fermented by bacteria that naturally live there. The result of the fermentation are a number of gases and what are called short-chain fatty acids. And those cause the distress.

The double jeopardy question therefore is: which gases and which fatty acids?

For an excruciatingly technical answer, let's turn to a technical article, Colonic Fermentation May Play a Role in Lactose Intolerance in Humans by Tao He et al. American Society for Nutrition J. Nutr. 136:58-63, January 2006.

During colonic fermentation, lactose is first hydrolyzed to glucose and galactose, which are subsequently fermented, leading to the production of a series of intermediate (e.g., lactate, formate and succinate) and end-product metabolites [i.e., acetate, propionate, and butyrate, gases (H₂, CO₂ and CH₄), and biomass].

First the gases. They are H₂, hydrogen, CO₂, carbon dioxide, and CH₄, methane. Not carbon monoxide, CO. Carbon dioxide is the common gas exhaled by the body in every breath. Carbon monoxide is deadly. I hope that no chemistry student would ever confuse the two.

Part two are the fatty acids. Technically, the list of metabolites He's team found are salts of acids. And lactate is the salt of the fatty acid that is lactic acid. However, lactate is not just one of the six salts. It is an intermediate product, not an end product. It's the end products that give us the distress. Butyric acid, from butyrate, is probably what causes the distinctive awful smell of gas produced by lactose intolerance, although propionic acid and acetic acid are also both smelly. Lactic acid isn't, which should be a giveaway.

So which of the remaining three anwers is correct? Let's take them one at a time.

Methane? Methane is a correct as one of the gases, but no fatty acid is listed.

Acetic acid and nitrogen? Acetic acid is a correct fatty acid but nitrogen is not one of the correct gases.

Acetic acid and methane? Both are part of the total picture so this has to be the answer the judges were looking for.

Remember that these are high school students. No disgrace in not knowing every answer to unusual chemical problems. I'm pretty sure most doctors would get this question wrong as well. Give the team a few more years and who knows how much they'll know.

What a pleasant antidote to the vast amount of ignorance on the internet.