This is a guest post by Seppo Puusa from AcneEinstein.com blog, which is a place for rational advice on natural and alternative acne treatments.
When it comes to acne, the web is full of opinions, nonsense and conflicting information. And it’s easy to be left with more questions than answers. That’s why he started AcneEinstein.com; to share evidence-based, rational advice on acne and how to cure it. He explains what works, what doesn’t and does his best to get your questions answered with reliable advice.
There’s no doubt that diet affects acne. Several studies have now shown the connection. But the real question is how to figure out which foods cause acne and which are safe to eat.
To that end I’m happy to introduce you to another possible dietary enemy: FODMAPs.
In this post I want to talk about what FODMAPs are and how they may affect your skin. We’ll also talk about how to figure out whether they are a problem for you and what to do if they are.
FODMAP is an acronym for Fermentable, Oligo-, Di-, Mono-saccharides and Polyols. They are poorly absorbed sugars found in many plant foods. With sugars I mean short-chain carbohydrates, and that means more than the sweet stuff usually associated with the word sugar.
FODMAPs are linked to many digestive and gut problems. Some people have trouble absorbing FODMAPs from the small intestine. As a result they are rapidly fermented by the harmful bacteria. Fermenting results in gas that bloats up small intestine which then causes abdominal pain. FODMAPs also attract water that further adds to the bloating and discomfort. This condition is called FODMAP intolerance.
I should point out that FODMAPs don’t cause these problems. Nobody absorbs FODMAPs completely, but only some people get these symptoms. The difference comes down to gut health. People who get these symptoms may have small intestine bacterial overgrowth (SIBO) or suffer from other gut abnormalities. Without bacterial overgrowth FODMAPs in the small intestine don’t cause any noticeable symptoms.
Just to give you an idea, here are some common sources:
- Many fruits and vegetables (such as apples and onions)
- Milk and dairy products, both from cows and goats. Lactose-free milks are acceptable.
- Most legumes
- Wheat and some other grains
Can FODMAPs Cause Acne?
There’s a good reason to believe skin health is linked to gut health. For example a few studies have found far higher prevalence of SIBO in acne patients as compared to healthy controls. Similarly other studies have shown clearing of acne when SIBO is treated either with antibiotics or probiotics.
Given that FODMAPs are food for the harmful bacteria residing in the gut, eating them may further aggravate SIBO and lead to leaky gut syndrome. Candida infestations in the gut also occur when the normal bacterial balance is disturbed.
The whole FODMAP concept is still fairly new and we have no studies on how it relates to skin conditions. But anything that causes further disturbance in the gut can plausibly aggravate acne. So I would definitely treat this as a possible cause for acne.
Should You Be Worried About FODMAPs?
So who should be worried about FODMAPs and how do you know if this is a problem for you?
We can’t say for sure, but I would say go with the symptoms. Nothing in the research papers I read indicates that FODMAPs are a problem in absence of digestive symptoms. Let’s keep in mind that it’s normal to have FODMAPs in the gut and everybody malabsorbs them to some degree. It’s only when pathogenic bacteria ferment them that they become a problem.
Common symptoms of FODMAP intolerance include:
- Abdominal pain
- Irregular bowel movements
- Loose stools
Again, let’s keep in mind that everybody experiences these to some degree. For example FODMAPs found in legumes are always fermented in the gut. That’s why they are sometimes called the ‘windy vegetables’. So don’t freak out if you get some digestive problems every now and then.
But if you experience those symptoms regularly and they are stronger than normal, then you may have FODMAP intolerance.
What To Do?
OK, so you suspect you may have a problem with FODMAPs. What should you do next?
For this to be more than a temporary fix you need to tackle it from 2 sides.
- You should eliminate most FODMAPs from your diet for a while, and
- Address the underlying problem in the gut.
Low FODMAP Diet
Simply reducing the amount of FODMAPs in your diet is usually enough to get rid of the symptoms. Studies have found that low FODMAP diet is better at reducing symptoms in irritable bowel syndrome (IBS) patients than normal diet recommended for IBS. About 75% of people see good results with the diet.
Before you start with the diet you may want to talk to your doctor. Breath testing can identify problems with fructose and lactose absorption. It’s optional, but if testing shows you have no problems with them then you don’t need to cut them out.
Strict elimination diet for 2 to 4 weeks may be necessary at first. After that you can start introducing the foods back to your diet in small quantities to find the levels you can tolerate.
Simply removing FODMAPs from your diet is enough to get rid of the symptoms, but it doesn’t address the underlying gut problems. Here are some suggestions for that:
- Probiotics, either as supplements or regularly eating fermented foods (preferable option).
- HCL supplementation. Low stomach acid (HCL) often precedes SIBO and other gut problems. When you don’t produce enough stomach acid food is not digested completely and that encourages the growth of pathogenic bacteria. HCL supplement before a meal can correct the problem.
- Digestive enzymes may also help to correct digestive problems.
- Stress management. Stress has hugely negative effect on gut health and is implicated as one of the causes for SIBO.
- Sufficient sleep – as with stress.
Once the gut issues have been dealt with, it’s likely that FODMAPs aren’t a problem anymore.
I wanted to write this post as an introduction of FODMAPs as possible causes of acne. That’s why I didn’t cover the nuts and bolts of low FODMAP diet. For that purpose, you can check out these resources:
- FODMAP food chart (PDF) – contains high FODMAP foods and suitable substitutes.
- Here’s a comprehensive list of FODMAP foods and substitutes.
- Lowfodmap.com for more information, recipes and cooking inspiration.
There are of course also other resources. Google is your friend here.
Conclusion and Take-Home Messages
- FODMAPs are poorly absorbed sugars and other short-chain carbohydrates found in many plant foods.
- They are rapidly fermented by harmful bacteria in the gut causing abdominal pain, bloating, gas and other digestive problems. This is known as FODMAP intolerance.
- FODMAPs may further aggravate gut issues and open the door for Candida infections.
- FODMAPs don’t cause digestive problems but simply trigger them. The underlying cause is often bacterial overgrowth in the gut.
- While there are no studies to verify this, it’s plausible FODMAPs aggravate acne.
- In absence of abnormal digestive problems this is probably nothing to worry about. There’s no evidence to say that otherwise healthy people will benefit from low FODMAP diet.
- FODMAP intolerance should be treated by reducing dietary intake and addressing the underlying gut problems.
I want to finish this by stressing that you shouldn’t panic about this needlessly. Restricting your diet for no good reason rarely leads to anything good.
Acne has a huge genetic component and there are real abnormalities in acne-prone skin. You can’t fix them with diet. And that’s why diets, no matter how strict or healthy, rarely are enough to get you completely clear. FODMAPs may be an issue for people with recurring digestive problems, but in absence of them there’s no need to put yourself through yet another restrictive diet.
I’d love to hear your thoughts on this. So please voice your questions and comments below.
- Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals?
- Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. (PDF)
- Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms