黄肠运动腹泻

黄肠运动腹泻

在大便正常的颜色是棕色的任何阴影（通常是中等棕色），或褐色/绿色。当黄色/凳子出现面色苍白，而且没有明显的理由是，由于消费的食品，可能有以下疾病的人：

腹泻：腹泻是在改变粪便颜色最常见的原因。在腹泻的主要区别正常消化过程是，在腹泻的食物经过肠道如此之快，肠道细菌并没有转化为粪胆素呈现大便这是正常的棕色胆红素足够的时间。胃食管反流病（GERD）也是食物的迅速通过肠道消化过程中通过的疾病。

胆汁：在本病从肠到肝胆汁流量下降或停止。由于胆汁，粪便缺乏轻色。未消化食物颗粒可能会在凳子上。在胆汁，胆红素和胆汁酸盐可旅行进入血液，皮肤和尿液等造成黄疸，皮肤发痒和暗臭尿液进一步复杂化。胆汁淤积可能是由于内部或外部问题的肝脏。
肝病（肝内胆汁淤积症）：在肝脏受损压缩小胆汁运河是流出的胆汁从肝脏细胞的原因。凳会出现黄色/苍白由于胆汁在肠道出现减少的数额。可能的原因 是酒精性肝炎，淀粉样变性病，癌症已经扩散到肝脏（肝转移），肝硬化，淋巴瘤，结节病，干燥综合征，肺结核，病毒性肝炎呕吐，恶心和压痛/右上角腹部疼痛 是主要的一肝病的常见症状。

胆囊（胆管）疾病：在胆管梗阻（通过它从肝脏进入肠道一）胆汁的流动会造成较少的粪便胆汁的外观，造成粪便黄色，苍白，甚至灰色。可能的原因包括胆囊结石，炎症（胆管炎），肿瘤（胆管癌）。抽筋右上角腹部和右肋骨下方疼痛是常见的症状在胆囊/胆管疾病。

胰腺疾病：胆管按下了胰头的扩大，从而导致胆汁从肝脏小肠阻塞流量。胰腺炎（胰腺的炎症）和胰腺囊肿或癌症的可能会导致这种情况出现。
腹部包块：胆管按下了腹部肿瘤（如纤维），从而导致胆汁淤积和黄色大便。大的肿瘤，可以检测和手，或腹胀感觉到。

For English Version Click http://viral-gastroenteritis.blogspot.com/2009/05/yellow-bowel-movement-in-diarrhea.html

绿色大便腹泻的成因

首先是大便通常是由于吃食物的颜色，其次则是由肝脏胆汁国家编制的颜色。胆汁正常的颜色是绿色，经过适当的消化过程，原来的棕色。这一过程需要时间消化，如果消化过程没有完成，而且食物的移动速度比正常程序通过肠子，有更少的时间来胆汁化学改变。因此，它仍将绿色时排出体外。

一般来说，绿色大便，是不是恐慌。可以有绿色粪便的原因很多。第一个也是最明显的原因是吃绿色食品。谁的人主要是消费绿色，叶状蔬菜中含有叶绿素在他的饭，这是正常的，他可能有绿色大便。

含铁丰富的早餐麦片等丰富的食物，红肉，菠菜，豆类等，并与暗紫色色如人工色素，在冰淇淋，汽水，果汁，饮料或其他使用，食品，黑色甘草，蔬菜捣 烂，叶菜类蔬菜像西兰花，生菜，菠菜，白菜，麦片，牛奶制品，糖果。的Kool - Aid，冰棍和明胶（果冻），也可能导致彩虹色的粪便。

深绿颜色可能持续到5天之后，上述食品的消费。补充材料或人工色素可能导致色彩明亮的绿色大便。


在婴儿的大便颜色是绿色的第一天，刚分娩后，后来由于母乳喂养。有些婴儿奶粉也能导致有绿色的婴儿粪便。


关于明确液体“饥饿疗法在儿童疾病”可能是导致绿色水样便。


有些药物和被人为色时口服补充，如铁补充剂，缩短运输时间泻药肠道（因为），藻类，叶绿素，儿童糖浆，维生素/矿物质补充剂，或最终任何其他药物或如果它包含果糖或山梨糖醇，可能会加快蠕动，可能会绿色的粪便。


腹泻及大便松散：可能有很多原因，大便松散，包括食物中毒（贾第虫和沙门氏菌感染往往造成绿色腹泻），轮状病毒感染，食物过敏，乳糖不耐症，果糖 吸收不良，腹腔疾病，克罗恩病，溃疡性结肠炎等，胃食管反流病，甲状腺毒症（升高，血液中的甲状腺激素的水平），通常是由于自身免疫性甲状腺疾病（甲亢）

受损（通常在糖尿病）肠道神经支配。


胆汁盐的吸收主要在小肠（回肠末端的最后部分）进入血液。胆汁受损原因重新吸收是：

     *小肠炎症，主要是由于克罗恩病
     *清除手术回肠末端

当担心绿色大便？


绿色大便，没有任何下列原因，如果单是正常的，不需要采取任何行动。如果发烧等症状，腹泻，便秘，体重减轻，全身不适或发现，你应该立即联系医生，因为可能会造成严重的根本障碍。



P.S.

请记住，在互联网上所有的医疗信息，只是为信息而设计的，而不是取代你的医生。

What is Diarrhea? Normal & Loose/Excessive Bowel Movements (Diarrhea)

What Is a Diarrhea?

Diarrhea (Greek dia = through, rhein = flowing) means having more than three bowel movements, or passing more than 300g of watery stool daily (1).

NOTE: American English spelling is diarrhea, UK English spelling is diarrhoea.

What Is Not a Diarrhea?

• Ten diapers a day are usual in a 14 days old infant. Three soft bowel movements a day may be considered normal for adult on a fibre-rich diet. Stool soiling in children who are already toilet trained may be due to defective anus. Stool incontinence or mucus seeping in adults may be due to rectal inflammation, rectal prolapse, hemorrhoids, uncoordinated pelvic floor muscles, or anal muscle or nerve damage (2). In all mentioned cases, bowel movements tend to be of normal volume and consistency.
• Occasional single loose stool still isn't a diarrhea. Unripe fruits, green potatoes, spicy or hot food may all irritate the bowel. Insufficiently cooked or chewed food, a heavy sugary or fatty meal may be hard to digest. Wrong food combinations, like meat with sugar, may result in a loose stool. Food which is psychically rejected, after ingesting, might flow through the intestine quickly. Caffeine stimulates peristalsis, as can strong emotions like fear.

Normal Stool

• Stool frequency. A newborn passes its first stool in the first two days. During the first month, breast-fed babies usually have 8-10 stools per day, at one month 4 per day, at four months 2 per day, and a child at four years usually has 1 stool per day (7). Three stools per day down to 3 stools per week may be normal for children and adults on solid food.
• Stool quantity depends on the amount of ingested food and its fiber content. Two liters of mixed food yields about 200g of stool. The more fiber in the diet, the bulkier the stool.
• Stool consistency. A normal stool is semi-solid. Food fibers make stools soft as they tend to bind water. If not enough water is consumed, stools will be hard; on the other hand a lot (up to 20 liters/day) of water consumption will not result in a softer stool, since most of the water is absorbed in the intestine.
• The color of the stool in a healthy adult is any shade of brown, or even green. A green stool may originate from green vegetables, fruit juices, or iron supplements. A newborn's first stool (meconium) is greenish black. A black stool may come from licorice, iron supplements, or Pepto-Bismol. A red stool may originate from beetroot, tomato sauce, red Jelly-O, etc.
• Stool composition: 60-90% of water, the rest are fibers and other undigested substances, bacteria, shed intestinal cells, bile pigments, and minerals.

Mechanisms of Diarrhea

• Osmotic diarrhea. When a particular nutrient (solute) is not absorbed, it attracts water from blood vessels in the intestinal wall (where it is found in lower concentrations) into the intestinal hollow (with high concentrations). This process is called osmosis and occurs after ingestion of large amounts of unabsorbable solutes (e.g. sorbitol), or when nutrients stay within the intestine, because they can't be digested (in lack of digestive enzymes), or absorbed (in inflammation or surgical resection of a part of intestine).
• Secretory diarrhea. Unabsorbed fatty or bile acids trigger water secretion from colonic mucosa; toxins from some bacteria (E. coli, V. cholerae) or some drugs (quinine) have the same effect on the small intestinal mucosa. Secretory diarrhea is watery.
• Exudative diarrhea. From ulcerated intestinal mucosa (in shigellosis, amebiasis, ulcerative colitis), the blood, proteins and pus may exudate and appear in the stool. Exudative diarrhea is often of low volume.
• Motility diarrhea. In increased gut motility (psychic stress, irritant food, bacterial toxins, laxatives, hyperthyroidism) there is not enough time for adequate water and nutrient absorption, thus resulting in motility diarrhea.
• More than one mechanism is usually involved in each diarrheal event.

Diarrheal Stool

• The frequency of diarrheal stool may vary from three a day to twenty a day or more in extreme cases. Over 20 liters of water with electrolytes (potassium, sodium, magnesium) may be lost in one day in severe diarrhea. Diarrheal stool may be anything from clear liquid to soft formed mass.
• Water in diarrheal stools originates from food, unabsorbed digestive juices, or increased intestinal secretion. White diarrheal stool is from unabsorbed fats (>6g fats/day is abnormal), and yellow stool from lack of bile acids. Green diarrhea is from unabsorbed bile acids. Bloody diarrhea is from ulcerated colonic, or (rarely) small intestinal mucosa. Black colored diarrheal stool is from bleeding from the mouth, nose, throat, lungs, esophagus or stomach, or from antidiarrheal drug Pepto-Bismol. Other components of diarrheal stool: undigested substances, mucus, sugars (e.g. lactose), and microorganisms.

Is Diarrhea Harmful?

• In many cases, diarrhea is only an unpleasant event. However, a few liters of body water lost during diarrhea may lead to dehydration within 24 hours, may severely affect metabolism, muscles, nerves, heart, or consciousness, and may cause permanent damage of affected organs. About 2.2 million children die from diarrhea (mostly from dehydration) every year, mostly in countries where medical help is not easily accessible; malnourished children with lowered immunity or chronic diseases are at greatest risk (8). Repeating acute or chronic diarrhea may lead to malnutrition.

Causes of Diarrhea

Main causes of diarrhea are:

• Gastrointestinal infections: viruses (mostly Rotavirus), bacteria (e.g. Escherichia coli, Campylobacter, Salmonella, Shigella), parasites (e.g. Giardia, intestinal worms); primarily non-gastrointestinal infections (e.g. measles, tuberculosis)
• Inappropriate food (artificial sweeteners, overfeeding)
• Psychic factors
• Food intolerance: lactose intolerance, celiac disease, food allergies
• Medication: antibiotics;
• Toxins: pesticides, poisonous plants
• Intestinal disease: e.g. inflammatory bowel disease, lymphoma
• Other abdominal disease: liver, pancreatic, gallbladder disease
• Other causes: AIDS, hyperthyroidism, cystic fibrosis, competitive running, etc.

Caring for Your Child

How can you help your child cope with inflammatory bowel disease? Because of the unpredictable nature of the disease, it's easy to feel helpless. Your child will likely be fatigued, irritable, and anxious - the best way to help your child is to seek treatment as soon as symptoms appear to help relieve as much discomfort as possible.

Although it can be difficult to get any child to eat properly, a balanced diet with adequate calories becomes even more important for kids with inflammatory bowel disease. Diarrhea, loss of nutrients, and the side effects of drug treatment may all lead to malnutrition.

Encourage your child to eat small meals throughout the day to help lessen any symptoms. Pack nutritious snacks and lunches so your child won't be tempted to indulge in junk food that's high in fat and sodium, which can intensify the symptoms of the disease. Eventually, your child may be able to determine which foods provoke symptoms and learn to avoid those foods.

If your child begins to lose weight quickly, has repeated bouts of diarrhea, or complains of abdominal cramping, inflammatory bowel disease may be the cause. Call your child's doctor if you notice any of these symptoms to ensure that your child gets proper evaluation and treatment.

Inflammatory bowel disease is a serious condition, but with proper treatment and medical care, your child can enjoy a productive, normal life.

Inflammatory Bowel Disease

The digestive system is a set of organs (including the stomach, large and small intestines, rectum, and others) that convert the foods we eat into nutrients and absorb these nutrients into the bloodstream to fuel our bodies. We seldom notice its workings unless something goes wrong, as in the case of inflammatory bowel disease (IBD).

It's estimated that up to 1 million Americans have inflammatory bowel disease. It occurs most frequently in people ages 15 to 30, but it can also affect younger children and older people. And there are significantly more reported cases in western Europe and North America than in other parts of the world.

What Is Inflammatory Bowel Disease?

Inflammatory bowel disease (which is not the same thing as irritable bowel syndrome, or IBS) refers to two chronic diseases that cause inflammation of the intestines: ulcerative colitis and Crohn's diseaseCrohn's disease. Although the diseases have some features in common, there are some important differences.

Ulcerative colitis is an inflammatory disease of the large intestine, also called the colon. In ulcerative colitis, the inner lining - or mucosa - of the intestine becomes inflamed (meaning the lining of the intestinal wall reddens and swells) and develops ulcers (an ulcer is a sore, which means it's an open, painful wound). Ulcerative colitis is often the most severe in the rectal area, which can cause frequent diarrhea. Mucus and blood often appear in the stool (feces or poop) if the lining of the colon is damaged.

Crohn's disease differs from ulcerative colitis in the areas of the bowel it involves - it most commonly affects the last part of the small intestine (called the terminal ileum) and parts of the large intestine. However, Crohn's disease isn't limited to these areas and can attack any part of the digestive tract. Crohn's disease causes inflammation that extends much deeper into the layers of the intestinal wall than ulcerative colitis does. Crohn's disease generally tends to involve the entire bowel wall, whereas ulcerative colitis affects only the lining of the bowel.

What Causes It?

Medical research hasn't determined yet what causes inflammatory bowel disease. But researchers believe that a number of factors may be involved, such as the environment, diet, and possibly genetics.

Current evidence suggests that there's likely a genetic defect that affects how our immune system works and how the inflammation is turned on and off in those people with inflammatory bowel disease, in response to an offending agent, like bacteria, a virus, or a protein in food.

The problem in people with the disease is that the inflammation gets turned on, but it doesn't get turned off. Medical evidence also indicates that smoking may enhance the likelihood of developing Crohn's disease.

What Are the Signs and Symptoms?

The most common symptoms of both ulcerative colitis and Crohn's disease are diarrhea and abdominal pain. Diarrhea can range from mild to severe (as many as 20 or more trips to the bathroom a day). If the diarrhea is extreme, it can lead to dehydration, rapid heartbeat, and a drop in blood pressure. And continued loss of small amounts of blood in the stool can lead to anemia.

At times, those with inflammatory bowel disease may also have constipation. With Crohn's disease, this can happen as a result of a partial obstruction (called stricture) in the intestines. In ulcerative colitis, constipation may be a symptom of inflammation of the rectum (also known as proctitis).

Because of the loss of fluid and nutrients from diarrhea and chronic inflammation of the bowel, someone with inflammatory bowel disease may also experience fever, fatigue, weight loss, dehydration, and malnutrition. Pain usually results from the abdominal cramping, which is caused by irritation of the nerves and muscles that control intestinal contractions.

But inflammatory bowel disease can cause other health problems that occur outside the digestive system. Although medical researchers don't know why these complications happen, some people with the disease may show signs of inflammation elsewhere in the body, such as in the joints, eyes, skin, and liver. Skin tags that look like hemorrhoids or abscesses may also develop around the anus.

Inflammatory bowel disease may also cause a delay in puberty or growth problems for some kids and teens with the condition, because it can interfere with a person getting nutrients from the foods he or she eats.

How Is It Diagnosed?

Inflammatory bowel disease can be hard to diagnose because there may be no symptoms, even if the person's bowel has become increasingly damaged for years. Once symptoms do appear, they often resemble those of other conditions, which may make it difficult for doctors to diagnose.

If your child has any of the symptoms of the disease, it's important to see your child's doctor. In addition to doing a physical examination, the doctor will ask you and your child about any concerns and symptoms your child has, your child's past health, your family's health, any medications your child is taking, any allergies your child may have, and other issues. This is called the medical history.

After hearing your child's symptoms, if the doctor suspects inflammatory bowel disease, he or she may suggest certain tests. Blood tests may be done to determine if there are signs of inflammation in your child's body, which are often present with the disease. The doctor may also check for anemia and for other causes of your symptoms, like infection.

The doctor will examine your child's stool for the presence of blood. He or she may look at your child's colon with an instrument called an endoscope. Also called a colonoscope or coloscope, this instrument is a long, thin tube inserted through the anus and attached to a TV monitor. This procedure is called a colonoscopy, which allows the doctor to see inflammation, bleeding, or ulcers on the wall of your child's colon.

The doctor may also do a test called an upper endoscopy to check the esophagus, stomach, and upper small intestine for inflammation, bleeding, or ulcers. During the exam, the doctor may perform a biopsy, which involves taking a small sample of tissue from part of the colon so it can be viewed with a microscope or sent to a laboratory for other kinds of analysis.

A doctor may also order a barium study of the intestines. This procedure involves drinking a thick white solution called barium, which shows up white on an X-ray film, allowing a doctor to get a better look at what's going on in a person's intestines.

How Is It Treated?

Drug treatment is the main method for relieving the symptoms of both ulcerative colitis and Crohn's disease. Great progress is being made in the development of medications for treating inflammatory bowel disease. Your child's doctor may prescribe:

anti-inflammatory drugs (used to decrease the inflammation caused by the disease)
immunosuppressive agents (which work to restrain the immune system from attacking the body's own tissues and causing further inflammation)

If a child with inflammatory bowel disease doesn't respond to either of these medicines, your child's doctor may suggest surgery. But surgical procedures for ulcerative colitis and Crohn's disease are quite different.

With Crohn's disease, doctors make every attempt to avoid surgery because of the recurring nature of the disease. There's also a concern that an aggressive surgical approach to Crohn's disease will cause further complications, such as short bowel syndrome (which involves growth failure and a reduced ability to absorb nutrients).

In the case of ulcerative colitis, removal of the colon (large intestine) may be necessary, along with a surgical procedure called an ileoanal anastomosis (also called an ileoanal pull-through) in which doctors form a pouch from the small bowel to collect stool in the pelvis. This allows the stool to pass through the anus.

Protein-Losing Enteropathy: Gastroenterology

Introduction

Protein-losing enteropathy is characterized by the severe loss of serum proteins into the intestine. Normal protein loss in the gastrointestinal tract mainly consists of sloughed enterocytes and pancreatic and biliary secretions. Albumin loss through the gastrointestinal tract normally accounts for 2-15% of the total body degradation of albumin, but, in patients with severe protein-losing gastrointestinal disorders, the enteric protein loss may reach up to 60% of the total albumin pool.

The serum protein level reflects the balance between protein synthesis, metabolism, and protein loss. Protein-losing enteropathy is characterized by more loss of proteins via the gastrointestinal tract than synthesis leading to hypoalbuminemia. It is not a single disease, but an atypical manifestation of other diseases.

Pathophysiology

The pathophysiology of this disorder is directly related to the excessive leakage of plasma proteins into the lumen of the gastrointestinal tract. Mechanisms for gastrointestinal protein loss include lymphatic obstruction, mucosal disease with erosions, ulcerations, or increased mucosal permeability to proteins as a result of cell damage or death. Proteins entering the gastrointestinal tract are metabolized into constituent amino acids by gastric, pancreatic, and small intestinal enzymes and are reabsorbed. When the rate of gastrointestinal protein loss exceeds the body's capacity to synthesize new proteins, hypoproteinemia develops. 

Frequency in United States

The prevalence rate is not known.

International Frequency

The prevalence rate is not known.

Mortality/Morbidity

Morbidity and mortality of this condition directly relate to its cause, either primary gastrointestinal disease or a multisystem disorder.

No racial, sex, age and Clinical predilection exists.

History

• The most common presenting symptom is swelling of the legs or other areas due to peripheral edema secondary to decreased plasma oncotic pressure, with subsequent transudation of fluid from the capillary bed to the subcutaneous tissue.
• If the protein-losing gastroenteropathy is related to other systemic diseases (eg, congestive heart failure, constrictive pericarditis, connective-tissue disease, amyloidosis, protein dyscrasias), the clinical presentation may be that of the primary disease process.
• Patients with primary gastrointestinal disease present with diarrhea with or without bleeding, abdominal pain, and/or weight loss.
• Along with a loss of proteins, a significant loss of immunoglobulins and lymphocytes can also occur. This may lead to the development of an immunological deficiency, predisposing to infections.

Physical

• Physical examination reveals peripheral edema and, in rare cases, anasarca.
• Evidence of the underlying medical problem (eg, cardiac disease, amyloidosis) may exist.
• If a primary gastrointestinal etiology exists, the abdominal examination findings may be unremarkable. Hepatosplenomegaly may be present, depending on the underlying process.

Causes

Primary gastrointestinal mucosal diseases (typically ulcerative/erosive) include the following:

• Erosions or ulcerations of the esophagus, stomach, or duodenum
• Regional enteritis
• Graft versus host disease
• Pseudomembranous colitis (Clostridium difficile)
• Mucosal-based neoplasia
• Carcinoid syndrome
• Idiopathic ulcerative jejunoileitis
• Amyloidosis
• Kaposi sarcoma
• Protein dyscrasia
• Ulcerative colitis
• Neurofibromatosis
• Cytomegalovirus infection

Increased interstitial pressure or lymphatic obstruction leading to protein loss can be caused by the following:

• Tuberculosis
• Sarcoidosis
• Retroperitoneal fibrosis
• Lymphoma
• Intestinal endometriosis
• Lymphoenteric fistula
• Whipple disease
• Cardiac disease (constrictive pericarditis or congestive heart failure)
• Intestinal lymphangiectasia

Nonerosive upper gastrointestinal diseases include the following:

• Cutaneous burns
• Whipple disease
• Connective tissue disorders
• Acquired immunodeficiency syndrome (AIDS)
• Enteropathy, such as angioedema (idiopathic or hereditary) and Henoch-Schönlein purpura
• Celiac sprue
• Tropical sprue
• Allergic gastroenteritis
• Eosinophilic gastroenteritis
• Giant hypertrophic gastritis (Ménétrier disease)
• Bacterial overgrowth
• Intestinal parasites
• Microscopic colitis
• Dientamoeba fragilis

Causes of Black Colored Bowel Movement

Foods which causes black stool consist of Beets, Blueberries or blackberries in larger amounts, Licorice, uncooked red meat, or any food which contain considerable quantity of animal blood.

Bleeding: Black colored stool indicates blood passing through the stomach during digestion process. Hemoglobin iron is oxidized by stomach acid. Several stomach acids may appear in duodenum; the part of the small intestine between the stomach and the jejunum. Because of this phenomenon, if there is any bleeding arises from duodenum or above, will result in black, stinking stools that stick to the toilet. Causes of bleeding may include:

• 
  
  Internal bleeding (Gastrointestinal, Rectal, Stomach, Nose, Mouth, Lung, or Spontaneous bleeding into the gut due to trobocytopenia, hemophilia, metastases, or sepsis)
  
  


• 
  
  Stomach or duodenal inflammation (gastritis)
  
  


• 
  
  Ulcer (Peptic, or due to alcohol, smoking, strong spices, or infection with H. pylori bacteria, Colon cancer)
  
  


• 
  
  Stomach or duodenal cancer
  
  


• 
  
  Esophageal varices due to liver cirrhosis (often in alcoholics), or portal hypertension
  
  


• 
  
  Mallory-Weiss tear (a tear in the esophagus from violent vomiting)
  
  


• 
  
  Nose or para-nasal sinuses (high blood pressure, tumor, injury)
  
  


• 
  
  Mouth (tooth extraction, injury)
  
  


• 
  
  Throat (severe inflammation, cancer)
  
  

Medications: Following medications, if taken by mouth, may cause black stools:

• Charcoal


• Iron supplements


• Pepto-Bismol (bismuth subsalicylate, an anti-diarrheal drug)


• Vanadium products, often used by bodybuilders

Poisons: Some poisons like Lead may result in black stools




Other reasons: Black stool may be due to clumps of bacteria, visible as pepper-sized specks, often found in small intestinal bacterial overgrowth (SIBO).

FODMAPs - Foods to Avoid in IBS & Bowel Disorders with Bloating and Gas

Short-Chain Carbohydrates may Result in Chronic Bloating and Diarrhea

Some short-chained carbohydrates can result chronic diarrhea, abdominal bloating, gas, or other gastrointestinal indications in individuals, who already have been diagnosed:

• Dyspepsia (indigestion)
• Irritable bowel syndrome (IBS) or functional bowel disease (FBD)…

…or also a cause of:

• Celiac disease
• Dumping syndrome (rapid gastric emptying)
• Fructose malabsorption
• Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
• Lactose intolerance
• Small intestinal bacterial overgrowth (SIBO)

These carbohydrates were named FODMAPs.

What are FODMAPs?

FODMAPs (Fermentable Oligo-, Di-, and Mono-saccharides, And Polyols) are short-chain carbohydrates that are Osmotically active, and may remove water from intestinal vessels into intestinal lumen, thus resulting diarrhea and/or easily degradable (fermentable) by intestinal bacteria, and producing large amount of gases like hydrogen, carbon dioxide, or methane thus resulting in bloating

FODMAPs include:

Oligosaccharides: Fructans that are the chains of fructose with glucose molecule on the closing. Only minimum quantities of fructans are possibly absorbed in human intestine. They may intervene with fructose absorption, resulting in worsening the symptoms in fructose malabsorption. Wheat (white bread, pasta, pastries, cookies), onions, and artichokes are Fructane-rich foods. Foods like asparagus, leeks, garlic, chicory roots, and chicory based coffee substitutes contain fructanes but are not commonly problematic. Inulins are the Fructans with over 10 molecules of fructose in a chain. and those with less than 10 fructoses are referred (on food product labels) as fructo-oligosaccharide (FOS) or oligofructose. Fructans cause problems mainly in fructose malabsorption.
Galactans(like stacchyose and raffinose) are chains of fructose with galactose molecule on the end. They act much like fructans. Galactans-rich foods are legumes (soy, beans, chickpeas, lentils), cabbage, and brussel sprouts.

Disaccharides:

Lactose (milk sugar). Lactose is in dairy products, but may be also found in chocolate, and other sweets, beer, pre-prepared soups and sauces, etc. Lactose is poorly absorbed in lactose intolerance, SIBO, and in small intestinal inflammation (Crohn's disease, celiac disease).

Monosaccharides:

Fructose (fruit sugar). Fructose-rich foods are honey, dried fruits like prunes, figs, dates, or raisins, apples, pears, sweet cherries, peaches, agave syrup, watermelon, papaya, etc. Fructose is often added to commercial foods and drinks as high fructose corn syrup (HFCS). Fructose causes symptoms even in healthy people, if ingested in excess, especially in fructose malabsorption, but also in SIBO.

Polyols, also known as sugar alcohols (appearing as artificial sweeteners in commercial foods and drinks):

• Sorbitol may appear in "sugar-free chewing gum", "low calorie foods"; naturally it appears in stone fruits: peaches, apricots, plums, etc).
• Xylitolnaturally apears in some berries. A pack of chewing gum containing sorbitol or xylitol may cause symptoms in a healthy child, and especially in persons with fructose malabsorption or SIBO.
• Other polyols:mannitol, isomalt, erithrytol, arabitol, erythritol, glycol, glycerol, lactitol, ribitol, etc may be problematic in fructose malabsorption, and in SIBO.

Possible Symptoms of FODMAP-Rich Diet

Excessive FODMAPs ingestion may cause:

• Diarrhea, since they are osmotically active, so they drag water from intestinal vessels into intestine
• Bloating and flatulence, since they are broken down (fermented) by intestinal bacteria into gases like hydrogen, carbon dioxide, or methane
• Abdominal pain
• Unintentional weight loss
• Symptoms of vitamin and mineral deficiency
• Headache, lethargy, and depression.

Approach to Low-FODMAPs Diet

In unexplained chronic diarrhea or bloating, FODMAPs should be considered as a possible cause, so their amount in the diet should be LIMITED (not necessary totally excluded).

General approach is to take off as much as possible FODMAPs from the diet for six-eight weeks. If FODMAPs are the cause of the symptoms, these should lessen considerably in the first week. Additional weeks of diet bring some rest to the small intestine, and cause reduction of overgrown intestinal bacteria.

After six weeks, some foods that will least likely cause symptoms can be introduced back into the diet (diet challenge), one type of food every fourth day. For example, on the first day of the seventh week, a piece of lactose containing food like cheese can be tried, and if in the next 72 hours no symptoms appear, additional amount of cheese or other dairy can be tried, and waited 72 hours again. If still no symptoms, it's likely that dairy is not problematic food, or at least not problematic when taken in limited amount. If symptoms appear, this speaks for lactose intolerance, so dairy should be avoided and next type of foods tried. This can be some low-fructosefood like banana, then after 72 hours orange, and so on foods with increasing amount of fructose. If someone can eat 5 prunes, it's not likely that he/she has fructose malabsorption.

A registered dietitian may be needed to give instruction about introduction of the low-FODMAP diet and diet challenge.

How Long Should a Low-FOODMAP Diet Last?

When problematic FODMAPs are identified, some persons will need to strictly avoid them for life, if they wants to be symptoms free, others will be able to ingest them in limited amount after weeks of diet. General rule is: not eat FODMAPs-rich foods in great amount in one sitting, and not eat them every day.

If Low-FODMAP diet doesn't help, testing for food allergies, dumping syndrome, celiac disease, and inflammatory bowel disease (Crohn's disease) should be considered.

Can Low-FODMAP Diet be Dangerous?

Low-FODMAP diet should not be introduced by any person with diabetes, hypoglycemia or other metabolic disorders, or in malnutrition, without prior consultation with a doctor. It may be necessary to interrupt Low-FODMAP diet in any severe acute disease, after injury or surgery, and in other urgent situations.

None of FODMAPs (fructans, galactans, fructose, lactose, polyols) is essential nutrient for human though, meaning they are not necessary for life.

Foods to Avoid in IBS

Foods that irritate individuals diagnosed with IBS, differ from person to person. It was found out that in many of them FODMAPs-rich foods are the culprit (1).