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When Superfoods and Inflammatory Diseases Are a Recipe for Trouble

Seemingly every week, a new food makes headlines for its disease-fighting properties. Unfortunately, many of these so-called "superfoods," including broccoli, kale, tomatoes, garlic and berries, can be problematic for people who have certain diseases.

"We’re discovering that with conditions like irritable bowel syndrome and even rheumatoid arthritis, changing the balance of bacteria in the gut microbiome can trigger inflammation and exacerbate a person’s symptoms," said Ryan Bober, MD, an internal medicine specialist at Cedars-Sinai.

Of course, one of the easiest ways to alter the microbiome, the trillions of microbes that reside in your intestines, is through what you eat—and what you don’t.

Here are three "healthy" food categories that may trigger inflammation in the gut, kidneys and joints for a subset of individuals:


"We’re discovering that with conditions like irritable bowel syndrome and even rheumatoid arthritis, changing the balance of bacteria in the gut microbiome can trigger inflammation and exacerbate a person’s symptoms."


FODMAPs

FODMAPs, or Fermentable Oligo-, Di-, and Monosaccharides and Polyols, are short-chain carbohydrates that ferment in the gut and feed the bacteria in the small intestine, and they can be especially problematic for people who have digestive troubles, such as irritable bowel syndrome (IBS), small bowel intestinal overgrowth (SIBO) and inflammatory bowel disease (IBD).

Studies show that three out of four IBS patients experience fewer symptoms, such as gas, bloating, constipation and diarrhea, while eating a low-FODMAP diet. High FODMAP foods include dairy, wheat, onions, garlic, brussels sprouts, cauliflower, legumes (including beans, lentils and soybeans) and fructose (including fruits, honey and high-fructose corn syrup).

What you should know: Eating a huge amount of high-FODMAP foods could cause digestive problems for almost anyone, but most people don’t have trouble digesting the amount of FODMAPs in a typical diet. In fact, high-FODMAP foods are loaded with critical nutrients, including prebiotics, which promote the growth of healthy gut bacteria.

Your best bet: "If you need to restrict FODMAPs because of IBS, IBD or some other digestive issue, don’t do it alone," cautioned Mark Pimentel, MD, a gastroenterologist at Cedars-Sinai. "Some of these diets create nutritional deficiencies because they’re so restrictive, so it’s important to consult a gastroenterologist or registered dietitian who understands FODMAPs before embarking on a low-FODMAP diet."



Oxalates

Oxalates occur naturally in all sorts of fruits and vegetables, and there’s a lot of overlap between foods that are high in FODMAPs and those laden with oxalates. Our bodies also make oxalates during the digestive process. "If you have underlying kidney issues, the salts produced by oxalates can crystallize in the urine and act as a trigger for kidney stones," said Ali Rezaie, MD, a gastroenterologist at Cedars-Sinai. Oxalates also can bind to minerals, such as calcium and magnesium, and reduce their absorption. High-oxalate foods include green leafy vegetables, soy, almonds, potatoes, tea, beets and some legumes.

What you should know: For most people, oxalates are not a problem food. Bacteria in the gut breaks them down so they can be used for energy (and won’t interfere with nutrient absorption). Unfortunately, people who have low levels of oxalate-degrading gut bacteria—and those with certain digestive disorders—may accumulate oxalates, which can lead to kidney stones. "Most urinary oxalates are produced by the body naturally, as a waste product. They don’t come from the diet," Bober said. "But reducing your intake of high-oxalate foods could still help limit the among of oxalates circulating in the kidneys." Drinking sufficient water can also help dilute the urine and prevent oxalates from building up on kidney walls.

Your best bet: If you have a family history of kidney stones or have digestive disorders that inhibit your ability to absorb nutrients, talk to your doctor about whether you should consider limiting your oxalate intake. Otherwise, eating a mix of oxalate-containing fruits and vegetables may help you meet your daily nutrient quota and stave off disease.



Nightshades

Nightshade is a family of plants that contain small amounts of a chemical called alkaloids. One particular alkaloid in nightshade fruits and vegetables, solanine, acts almost like a pesticide while the plant is growing. "Through fighting off insects, parasites, microbes and bacteria, nightshade fruits and vegetables develop complex chemicals, some of which may be inflammatory for some individuals," said Rezaie. Nightshade-containing foods include tomatoes, potatoes, bell peppers and eggplant.

What you should know: There’s no solid evidence that nightshades are unhealthy. However, people who have certain inflammatory conditions, including IBD and rheumatoid arthritis, may notice that eating nightshades amplifies existing inflammation—and if you have digestive issues, the acidic profile of peppers or tomatoes may exacerbate your symptoms.

Your best bet: "If you have a propensity for inflammation, or you have an inflammatory condition like IBD, autoimmune disease or arthritis, eliminating nightshades may improve your symptoms," Pimentel said. "But more important than avoiding nightshades is promoting a healthy microbiome since abnormal bacterial growth in the gut fuels autoimmune disease."



Bottom Line

Each person’s gut is unique, so it’s important to listen to your body. According to Rezaie, foods should not be simply classified as "good" or "bad" foods. Instead, it’s about uncovering which foods best serve your body and personal microbiome.

"The problem is that ‘normal,’ in terms of the gut microbiome, is constantly changing depending on a number of factors. So, what may be ‘healthy’ for one individual could be problematic for another," Rezaie said. "To make matters more complicated, foods you may not be able to tolerate today could pose no problems down the line, and that’s because our gut microbiome is constantly changing and adapting."

For most healthy people, each of these food categories provides key nutrients, including fiber and disease-fighting antioxidants. But if you’re concerned about meeting your nutrient needs because you can’t tolerate certain food categories, talk to your doctor or a dietitian who is skilled in inflammatory disease states.