FODMAPs: A Hidden Cause Of Acne In Seemingly Clean Fruits And Vegetables

Day after day, week after week, the guy on the telly informs us that fruit and vegetables are the key to supersonic health…

…and for acne, they’re particularly important. I strongly recommend the old “five a day” mantra because plant foods are loaded with acne-clearing antioxidants and vitamins which are impossible to get from meat.

But there’s a catch, one that you may have experienced. Many acne patients are confused to find that these healthy foods give them unexplained bursts of acne, just like a sugar-loaded cake or milk chocolate.

At first glance there’s no explanation. A slice of fresh watermelon contains just 5 grams of sugar, no gluten, no trans-fats and certainly no additives like vegetable oil. Acne patients everywhere are scratching their heads, ultimately writing these reactions off as a simple food allergy.

But the real culprit, a secret culprit, is natural set of plant compounds that for some, may be just as dangerous as sugar.

The real culprits are FODMAPs, a group of natural carbohydrates found all across the plant kingdom. 

In this article we will cover the following topics:

• What FODMAPs are.
• The types of FODMAPs and how they impact digestion.
• How FODMAPs cause acne.
• The causes of FODMAP sensitivity.
• How to establish whether you have a sensitivity.
• What you can do about it.

 Let’s get started:

 

What are FODMAPs?

The term FODMAP stands for Fermentable Oligosaccharides, Discahherides, Monosaccharides, And Polyols. In short, FODMAPs are natural short chain carbohydrates which are poorly absorbed in the human digestive system,

Increasingly, FODMAPs are officially recognised as a insidious villain behind bowel diseases such as irritable bowel syndrome (IBS), especially over the last five years. The problems occur when FODMAPs fail to be absorbed by the gastro-intestinal tract and instead sit in your digestive system, where they meet pathogenic bacteria living in your intestine.

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This bacteria ferments the FODMAPs which, ordinarily in humans, produces only mild, barely noticeable, or even non-existent discomfort. But many people today have a FODMAP sensitivity, meaning that the fermentation produces excessive amounts of methane, carbon dioxide and by-products. The sugars gain an osmotic effect; they increase fluid movement and suck in water.

The result is the IBS-like symptoms of bloating, gas and pain. Normal people are left totally unable to eat nutritious plant foods, with no logical explanation why.

FODMAPs occur everywhere, from onions to apples, to cabbage and red kidney beans. Sensitivity may affect up to 35% of people, according to one study on Australian people. What’s more, FODMAP sensitivies are non-uniform; one person might be unable to digest oligosaccharides, another might get sick from polyols.

Study after study is flooding out; a 2010 review found that avoiding dietary FODMAPs reduced IBS bloating, pain and discomfort in 75% of patients. The scientists concluded that “the evidence base is now sufficiently strong to recommend its widespread application”.

Meanwhile, a 2014 Australian study gathered 30 IBS patients and 8 healthy volunteers and assigned them either a normal or low FODMAP diet for 21 days. The IBS low-FODMAP group had significantly reduced symptoms, proving that “a diet low in FODMAPs effectively reduced functional gastrointestinal symptoms”.

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Then there’s this 2015 study. 75 IBS patients taken from a clinic in Sweden were randomly assigned to either a low FODMAP diet or the standard IBS protocol: regular meal patterns, less fat, avoidance of certain vegetables like onions and cabbage, and smaller meals.

After 4 weeks, of the 67 patients who completed the study without getting ill, the FODMAP and traditional diets both significantly reduced IBS scores, and were roughly equal in their reduction of bloating, gas, inflammation and pain.

Five other studies were published in 2015 too, including this review, and this review which finding that a low FODMAP diet reduced IBS in 37-45% of patients.

Make no mistake, FODMAPs are one of the most under-discussed dietary villains today.

 

Types of FODMAPs explained in detail

There are many different types of FODMAPs, as the acronym suggests. 

Firstly, we have the monosaccharides, which solely includes fructose, a natural plant sugar found in varying ratios to glucose and sucrose (which itself is 50:50 glucose and fructose). Fructose is criticised by paleo people all the time as being the worst sugar on earth and a reason to banish fruit, and it does indeed cause problems such as fatty liver in excess.

Normal intakes are acne-friendly, but in FODMAP sensitive people, the gastrointestinal tract lacks an enzyme called GLUT-2, which aids the absorption of fructose from the intestine into the liver. Furthermore, foods like apples and pears have a dramatically higher fructose to glucose ratio, and in humans the digestion of glucose is a big source of GLUT-2. Without GLUT-2, the fructose gets moved along for dangerous fermentation by bacteria.

Hence, FODMAP patients are sensitive to both fructose rich foods (honey, agave nectar, corn syrup) and sugar ratios skewed in favour of fructose (apples, watermelons, blackberries, mangoes, pears).

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Next we have the disaccharides, with only one member: lactose. Lactose sensitivity is really an entirely different phenomenon to FODMAPs. The bacterial family lactase is missing, and the sugar (found in milk, yoghurt and other dairy) therefore gets fermented by other bacteria. However, you’ll almost certainly know already if you are lactose intolerant and in this article we are concerned with the other, hidden FODMAPs.

Next on the list is the oligosaccharides. Here things get more complicated; these sugars are more structurally complex and minor sensitivities are everywhere. The main oligosaccharides are raffinose, galactans, and fructans. Raffinose is a trisaccharide (containing three sugar types) composed of fructose, galactose and glucose. This is a signature FODMAP of green vegetables as opposed to fruits; raffinose is found in beans, cabbage, brussel sprouts, broccoli, asparagus, whole grains, and other vegetables.

Unlike ruminants, humans, pigs, and other animals with one stomach (monogastric) don’t have the raffinose digesting a-GAL enzyme, and hence it passes undigested to intestinal bacteria which do. By fermenting raffinose, the bacteria produces gases such as carbon dioxide, methane and hydrogen, thus causing some of the gas from FODMAPs. Most humans on earth can ferment low levels of raffinose, but some are sensitive even to tiny amounts.

Fructans are chains of fructose molecules, found in vegetables, but especially root vegetables like garlic, onions, and agave root. They are also found in leeks, asparagus, artichokes, and wheat.

Again, humans lack the correct digestive enzymes, causing bacteria to take up the mantle. Common symptoms of fructan intolerance include abdominal pain. Then there’s galactans, a combination of raffinose and stachyose and similarly indigestible. Galactans are the FODMAP superstar of beans such as lentils, chickpeas and red kidney beans.

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Finally, the FODMAP celebrity of the fruit world is the polyol. Polyols consist of natural sugar alcohols such as sorbitol, xylitol, mannitol, and maltitol. You might have witnessed “ols” being added to cakes and chocolate as low-glycaemic sugar-substitutes. Well, they occur naturally as well, and are abundant in apples, apricots, avocados, cherries, peaches, pears, watermelons, cauliflower, green peppers, mushrooms.

The first is sorbitol, slowly digested and strongly linked to abdominal pain, flatulence, and mild to severe diarrhea. Sorbitol is a proven cheerleader of irritable bowel syndrome. Common sources are corn syrup, apples, pears, peaches, apricots, avocado, lychee and prunes.

Secondly we have mannitol, a sweet tasting crystalline alcohol. Mannitol is known to have a laxative effect, like many sugar alcohols. It is found in strawberries, onions, celery, mushrooms, pumpkins, snow peas, and cauliflower.

Thirdly, there’s maltitol, the signature FODMAP of grain-based foods like rye and wheat. The classic symptoms of maltitol include excessive flatulence and abdominal pain. Luckily, rye, wheat and barley are so unhealthy that all acne patients should avoid them anyway.

Finally, we have a natural sweetener found on shelves everywhere: xylitol. This sugar alcohol originates in the fibres of numerous fruits and vegetables, but especially berries, oats, mushrooms, and sugar canes. Luckily, xylitol seems to be a relatively gentle FODMAP, though it has been linked to diarrhoea in high doses.

The key point that unites all FODMAPs is this: we humans either entirely lack the enzymes to digest them, or those with a FODMAP sensitivity have an impaired ability to digest them.

 

The link to acne

Have you even wondered why an apple breaks you out? There’s no obvious explanation, but an apple is one of the most heavily concentrated sources of FODMAPs in the world. It contains polyols, fructose in a poor ratio to glucose, and oligosaccharides such as raffinose.

FODMAPs have not been shown directly in scientific studies to cause acne yet, but the link is strong.

For instance, IBS has been linked to skin conditions such as dermatitis, and allergic reactions to many foods can trigger an onslaught of inflammatory chemicals such as histamine. Celiac disorder is arguable similar to FODMAP sensitivity syndrome. Your gastrointestinal tract cannot properly process gluten and it gets both fermented by bacteria and attacked by your immune system.

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Similarly, if your digestive system realises that it cannot tolerate apples and their FODMAPs, it may adapt, and like gluten, trigger an inflammatory response every time you eat it.

Excessive fermentation of FODMAPs fuel pathogenic gut bacteria, subsequently fuelling intestinal permeability and leaky gut syndrome. Friendly strains like lactobacilli could be crowded out, decreasing their production of nutrients like vitamin K2 and anti-inflammatory butyrate.

This 2015 study found that by restricting fermentable short-chain carbohydrates in 27 patients with IBS, total gut colonies of bacteria fell. However, beneficial strains such as Clostridium and Akkermansia muciniphila were substantially increased, while the pathogenic Ruminococcus torques retreated.

While FODMAPS are not proven to cause acne, judging by the evidence I believe that they almost certainly do. FODMAPs have a massive effect on your gut health, and your gut health has a massive effect on acne.

For years, I’ve wondered why so many internet acne patients reacted to antioxidant-packed foods like watermelon or blackberries. We now have the answer. The case of FODMAPs fits the mystery like glove.

 

What causes a FODMAP sensitivity?

As acne patients, having the full menu of antioxidants-rich foods out of bounds is a situation we simply cannot abide by. So how do you cure FODMAP sensitivities?

Chronic stress is one of the main causes. Stress is a well-known disruptor of the GLUT-2 enzyme, the transporter responsible for fructose uptake (see earlier). Stress can also warp human gut flora, helping unhealthy strains and crippling beneficial ones like lactobacilli and bifidobacterium.

Furthermore, stress reduces the variety of your gut bacteria. Why? Nobody knows for sure, but some bacteria have direct receptors for adrenaline (epinephrine) in their cell membrane. The butterflies in your stomach, a sinking feeling, or the feeling that your stomach no longer exists you get from strong emotions are all signs of the effect stress has on your digestion.

Another major factor is gut bacteria which is crippled in the first place. In the Western world, our way of life is extremely sanitised compared to Africa or poor parts of Asia. Of course, that’s a great thing because we don’t routinely die from infectious, dirty water, or infected wounds.

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However, we are also rarely exposed to varied bacterial strains from dirt, from unclean plant matter, or from live bacteria in our surroundings.

The result is that citizens of third world countries have dramatically more varied gut bacteria than westerners do. Healthy bacteria strains are the silent guardians against pathogenic ones, the same strains that cause digestive problems when fed FODMAPs.

Diet is also vital, including a high sugar diet, which feed candida and other yeasts, excessive oral antibiotic usage, and eating too many pesticides, which both which wipe out friendly bacteria.

The condition known as SIBO, small intestinal bacterial overgrowth, also interferes with the digestion of sorbitol, fructose, and other short-chain carbohydrates. In fact, SIBO is strongly linked to FODMAPs in studies and meanwhile, acne rosacea patients are ten times more likely to have SIBO (study).

The wild card is definitely genetics. For example, some of us might naturally manufacture less GLUT-2 and therefore digest fructose inefficiently, or we may be predisposed to bad bacteria taking over.

Polyol FODMAPs like xylitol and sorbitol are partially absorbed in humans; what if a genetic scale exists, ranging from greater efficiency to total failure? FODMAP sensitivity has only been popular for 5 years, so the answers should roll in very soon.

 

Is FODMAP sensitivity causing your acne?

Overall, there’s a big chance that FODMAPs are making your acne worse, and it’s something you should definitely consider.

If for example, you have already eliminated the classic acne supervillains like sugar, wheat, trans-fats, vegetable oils (not healthy at all; discussed in my eBook), yet are still getting acne outbreaks like clockwork, FODMAPs could be the culprit.

FODMAPs aren’t a niche issue either, with 35% of Australians having a sensitivity. Sensitivities exist all over the world, including Asian countries like China, Thailand, and Vietnam.

The signs and symptoms can be literally any digestive problems, including bloating, cramps, gas, pain, and discomfort. Here’s a brief guide to the FODMAP status of many foods:

Fruits high in FODMAPs – apples, apricots, blackberries, cherries, dried fruits (way too much fructose), grapes, mango, nectarines, pears, peaches, persimmon, plum, watermelon.

Fruits medium in FODMAPs – unripe banana, longon, rambutan, lychee, grapes.

Fruits low in FODMAPs – ripe banana, blueberry, cantaloupe melon, grapefruit, strawberry, raspberry, honeydew melon, kiwi fruit, lemon, lime, mandarin, orange, papaya, pineapple, rhubarb, passion fruit.

Vegetables high in FODMAPs – artichoke, cabbage, asparagus, garlic, onions, okra, leeks, Jerusalem artichoke, shallot, snow peas, sugar snap peas, radicchio.

Vegetables medium in FODMAPs – avocado, beetroot, broccoli, brussel sprouts, butternut pumpkin, cauliflower, celery, fennel bulb, green peas, mushroom, sauerkraut, guacamole.

Vegetables low in FODMAPs – alfalfa, bamboo shoots, bean sprouts, bell peppers, bok choy, carrots, cherry tomatoes, chives, cucumber, eggplant, endive, ginger root, green beans, kale, lettuce, tomato, swiss chard, spring onions, zucchini, spinach, seaweed (nori), parsnips, pickles, olives.

Almost all the foods listed are healthy and nutritious aside from the high sugar content of fruits like bananas, which won’t cause acne from one isolated consumption anyway. If any trigger acne on your face without being a full-blown, throat swelling, hospital visit allergy, then a FODMAP sensitivity is highly likely.

If you currently eat a standard American diet, your digestive issues could be caused by any ingredient. You could have a mild gluten intolerance (more widespread than the 1% who are full-blown celiacs), or you could be allergic to milk proteins like casein.

Therefore, the real killer sign is if your diet is completely clean. FODMAPs are a big reason why grain hating paleo followers often get digestive problems six months down the line.

Many are middle aged people who grew tired of obediently following traditional dietary advice, only to watch their health and vitality wither away. Then they jumped aboard the paleo train and began guzzling down more nutritious plant foods per month than they’d probably eaten during their entire life before. But their gut bacteria was so starved of prebiotics for years that it couldn’t cope with all the plant molecules such as FODMAPs now flooding in.

If that scenario fits you like a glove, then FODMAPs may be the menace behind all your problems.

If you have stress, IBS or SIBO, a FODMAP sensitivity is extra likely. If you want scientific confirmation, then good news: FODMAPs have become such a recognised medical issue that doctors now offer a breath test.

 

The strategy!

Step one is cutting your intake of FODMAPs down to as low levels as possible without compromising your acne nutrient intake.

However, many high FODMAP plant foods are otherwise terrific for acne. Garlic has potent anti-inflammatory powers, apple skins are like an armour of antioxidants, and cabbage has vitamin C.

Hence, the best approach is to cure your FODMAP sensitivity altogether. Firstly, you should eliminate all FODMAPs for approximately two months. As well as immediately relieving your acne, this will allow pathogenic strains of gut bacteria to fall and healthy ones to regenerate.

You should closely monitor your acne and digestion, to establish once and for all whether you do have a sensitivity. Keep your sugar intake low, to starve unhealthy microorganisms of fuel.

To be completely sure, you could briefly eliminate all FODMAPs for two days, and then restore them. If your acne comes roaring back like magic, then the genie will be out of the bottle.

Both during and after the two months, you enrich your friendly gut flora in other ways so that once you reintroduce them, FODMAP-rich foods will be far more digestible.

If you’re not sensitive to dairy proteins or lactose, then yoghurt, kefir, or blue cheeses are full of beneficial bacteria. Depending on your sensitivity, you can buy sauerkraut juice off the internet; cabbage is full of FODMAPs, but the bacteria consumes many of the short-chain carbohydrates during the fermentation process. The same applies to other fermented vegetables. Fermented soy such as natto and tempeh are also full of good bacteria. You need to cram in as many prebiotics as you can without setting off the FODMAP alarm.

Hence you should continue to eat a wide variety of low-FODMAP plant foods, as they contain prebiotics which help existing bacteria to grow. Dark chocolate, for instance, contains flavonoids which healthy lactobacilli love to feast on. Nuts like pistachios boost gut bacteria superbly.

Once two months are up and you’ve implemented all that, you can gradually reintroduce some moderate-FODMAP foods like broccoli, beetroot, etc. Broccoli is a simple one to test your sensitivity on. If you mysteriously no longer get acne from moderate FODMAP foods, then you can drive forwards; keep experimenting with more FODMAP foods, to see what your acne can now withstand.

If FODMAP sensitivity does have a genetic component, then you will be partially limited forever, but if it is mainly caused by our modern lifestyle, it may well be curable.

 

Conclusion

The acne threat from FODMAPs is very real. FODMAPs should take their place alongside sugar as a plant compound that acne patients suspect.

FODMAPs are not fundamentally unhealthy, because it’s a faulty digestive system that brings out the dangers in them. Nevertheless, if you’re sensitive you can improve your acne significantly by eliminating them, and then by fixing the sensitivity at its root.

What you should definitely not do is adopt a low-FODMAP diet simply because it sounds cool. Too many FODMAP-rich foods are nutritious and high in antioxidants to justify avoiding them if it’s anything but totally necessary.

NEXT: read the 167 page eBook and get the ultimate diet for acne

 

 

Thanks for reading!