I recently came across an interesting article called 14 Best and Worst Foods for Digestion by Amanda Gardner posted by CNN under their Health.com section. The article lists a variety of foods and rates them as to their digestibility.
The author sought out and quoted nutritional and medical experts which appear to represent current thinking in medical and nutritional circles. My first thought was “this sounds pretty good”. Who can argue with a preventative approach? BUT, just one problem; I disagree with 90 percent of the advice based on my own research findings. In a series of posts, I will be reviewing each of foods listed in the article.
High-fat and fried food
Ms Gardner: Worst
Both high-fat and fried food can overwhelm the stomach, resulting in acid reflux and heartburn. “The body can only handle so much at one time,” says Jessica Anderson, RD, a diabetes educator with the Texas A&M Health Science Center Coastal Bend Health Education Center, in Corpus Christi.
High-fat food also can result in pale-colored stool, a phenomenon called steatorrhea, which is essentially excess fat in the feces. A lot of people with irritable bowel syndrome need to stay away from foods high in fat, she says, including butter and cream because they can cause digestive problems.
Norm: Disagree
Fats have gotten a bad rap over the years, in obesity and heart disease (current evidence points squarely at high carbohydrates in the diet being the biggest culprit) and also in digestive health conditions, particularly acid reflux. But two studies published over ten years ago show that fats do not cause acid reflux(1,2). And that’s actually good because fats (including saturated fats) comprise a significant part of a healthy diet, and you need to eat an adequate amount of good fats (obviously, not trans-fats) to maintain your health. Fats provide both an excellent energy source, as well as building materials for cell membranes, hormones and other fatty acid-based molecules in the body.
As for steatorrhea, or fat malabsorption, this type of malabsorption is brought about not by eating fats, but by conditions that limit fat digestion. These include pancreatic enzyme (lipase) deficiency associated with pancreas problems or cystic fibrosis (the pancreatic duct becomes clogged with mucous), or following damage to the lining of the small intestine caused by conditions such as small intestinal bacterial overgrowth (SIBO), celiac or Crohn’s disease. So again, consuming fats doesn’t cause the problem, but rather, fat malabsorption is a symptom. In each case, the underlying condition needs to be addressed.
Now what about fried foods? When people think of fried foods, they tend to think that fat and grease are the enemy, likely because these foods are typically fried in oil, butter or animal fat. But the real enemy is not the oil, butter or fat, but wheat based flour or breading used to coat many fried foods. Wheat is high in resistant starch, specifically amylose starch. Amylose starch is the real culprit in fried foods. Amylose is the more resistant of the two types of starch and most subject to malabsorption. Amylopectin, the other type of starch, is easy to digest. Moderate levels of resistant starch are not a problem for most healthy people. But consuming large amounts of resistant starch, particularly for people with underlying digestive illnesses, increases the risk of starch malabsorption. This can fuel the overgrowth of bacteria in the small intestine (SIBO) leading to the vicious cycle described first by Elaine Gottschall in Breaking the Vicious Cycle and now firmly linked to a significant number of digestive health conditions.
Take home message: Fats and fried foods are not the cause of acid reflux or IBS symptoms as long as the fried foods are not breaded or battered with wheat based flour. Foods such as fried zucchini, fried steak or fried calamari minus the resistant starch are better choices.
*Sugar alcohols are not carbohydrates, but are malabsorbed and fermented by gut bacteria like the other difficult to digest carbohydrates mentioned.
Chili Peppers
Ms Gardner: Worst
This staple of spicy cuisine can irritate the esophagus and lead to heartburn pain.
This can be a particular problem for people with irritable bowel syndrome or those who already suffer from chronic heartburn, says Tim McCashland, MD, a gastroenterologist at the University of Nebraska Medical Center, in Omaha.
Norm: Disagree
While minor irritation of the esophagus could be attributable to certain spices including chili peppers, the real enemy for heartburn sufferers is the refluxing of stomach contents including acid, bile, intestinal bacteria and digestive enzymes into the esophagus. Controlling reflux is the key to symptoms relief. As a long term sufferer of acid reflux myself (now fully under control), I can’t ever recall any connection between chili peppers and my own symptoms not do I know of definitive studies showing this to be the case. The best approach might be to avoid foods that promote gut fermentation (the true cause of GERD symptoms) first. That will stop reflux and allow you to heal any esophageal damage and then feel free to eat chili peppers. As for IBS and other digestive conditions, I know of no connection between chili peppers and symptoms.
Dairy
Ms Gardner: Worst
You need calcium in your diet, and an easy way to get it is from dairy products such as milk and cheese. But, for the lactose intolerant, these can cause diarrhea, gas, and abdominal bloating and cramps.
Lactose intolerance, a common problem, occurs when people don’t make enough lactase, an enzyme that breaks down lactose (the sugar found in milk). Celiac disease, Crohn’s disease, and chemotherapy can damage the intestines, which also can lead to lactose intolerance.
If you’re lactose intolerant, staying away from dairy is probably your best bet.
Norm: Disagree
While I agree that lactose intolerance is a concern for most people in the world (besides Northern Europeans that almost never have this problem), you don’t need to toss the baby out with the bathwater. There exist healthy lactose-free or at least low-lactose dairy alternatives that are quite gut-friendly: 1. Heavy and light cream are low in lactose and a healthy source of vitamins, fat and protein. I might add that the evidence of newer well controlled studies attest to the health of lower carb, higher fat diets and the National Board of Health in Sweden is now recommending lower carb (higher fat) diets at least for diabetics. 2. Fermented dairy foods, Fermented dairy foods such as yogurt, kefir, acidophilus milk, cheese, and cottage cheese are gut friendly, because most of the lactose is already gone – consumed by hungry bacteria or yeast. Also, residual lactase enzyme from the microorganisms doing the fermenting helps us digest any remaining lactose. 3. Butter. Essentially milk fat, butter has been discouraged as it was thought to cause high cholesterol (not the case) and large amounts of something called AGEs (advanced glycation end products), capable of damaging cells. But a more careful analysis shows that the levels are actually lower than milk. See Chris Masterjohn’s Daily Lipid Blog for his excellent review of the topic. 4. Lactose-free dairy products. Even if you are lactose intolerant, you can buy milk, cheese and ice cream (Breyers new product) that are lactose free. It doesn’t get any easier than that. 5. Lactose-containing dairy product. Finally, you can actually consume dairy products that containing lactose if you take a lactase enzyme dietary supplement right before you consume your favorite dairy product containing lactose. The supplement does what your body can’t breaking the lactose down to the single sugars galactose and glucose which your body can easily digest.
Stay Tuned – Alcohol next! You might want a glass of wine for this one.
References:
1. Penagini R. Fat and gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol. 2000 Dec;12(12):1343-5.
2. Pehl C, Waizenhoefer A, Wendl B, Schmidt T, Schepp W, Pfeiffer A. Effect of low and high fat meals on lower esophageal sphincter motility and gastroesophageal reflux in healthy subjects. Am J Gastroenterol. 1999 May;94(5):1192-6.
