EP.312/ Propionate and Acetate - Can These Short Chain Fatty Acids Help You Fight Endo belly?
Last week we talked about the most beneficial short chain fatty acid for endo - butyrate.
Short chain fatty acids are types of healthy fats that are produced by good gut bacteria when we eat fibre. They eat the fibre, and the process of this, known as fermentation, produces short chain fatty acids.
To get the low down on endo and short chain fatty acids overall, head to episode ep.310 and to learn about butyrate specifically, go to last week’s episode 311.
Today, we’re talking about the two other main short chain fatty acids; propionate and acetate.
These guys have less evidence behind them directly linking them to benefits for endometriosis, whereas butyrate does. For example, a mouse study showed that though levels of all three short chain fatty acids were low in mice with endo, only treatment with butyrate led to a significant reduction in endo lesions, whereas acetate and propionate showed some reduction, but the effects were modest.
However, research indicates that people with endo are often low in short chain fatty acids, and there are numerous reasons why improving these levels could potentially help us fight endo, albeit indirectly, and perhaps not as effectively as butyrate. Given that many of us are low in all three, and they have various benefits for our body and may all have effects on endo, in varying degrees, it surely makes sense to boost them all.
Here’s why:
Acetate is our most abundant short chain fatty acid, basically, we should have more of this than any of the others. Obviously when we have endo, it’s reasonable to assume we may have lower levels than your average person.
Acetate can help inhibit unhealthy bacteria and boost healthy bacteria. It can do this by altering the pH of the gut, which supports the growth of good bacteria but not bad bacteria. Bad bacteria (pathogenic) bacteria release toxins called lipolyscharrides, which have been linked to endometriosis growth, because they trigger certain inflammatory pathways that contribute to endo progression.
Research suggests that people with endo have lower levels of certain good bacteria, and higher levels of certain pathogenic bacteria, so trying to get these levels rectified is obviously important, not just for our gut health overall, but for endometriosis.
Additionally, like butyrate, acetate is also immune regulating. People with endo appear to have a dysfunctional immune system - it pumps out excessive levels of inflammatory chemicals and cells, which contributes to endo growth, and it’s not very good at clearing endo either. Trying to get the immune system in better balance, can help calm the inflammatory reactions that are furthering endo progression, and acetate helps to increase levels of anti-inflammatory t-cells, which are types of immune cells.
Whilst acetate does perform many other roles and benefits for the body overall, these are the ones I think are worth paying attention to from an endo perspective.
Now let’s look at propionate.
Propionate makes up about a quarter of our short chain fatty acids.
Propionate plays a role in helping to keep our blood sugar levels stable, which is likely one of the reasons why there is an association between with low levels of SCFA and metabolic issues like diabetes.
Endo is associated with blood sugar issues, and also, blood sugar spikes (so sharp increases in your glucose levels) leads to an inflammatory process called oxidation, which can contribute to endo progression - we don’t have research showing that blood sugar spikes increase endo development, but we know that oxidation does (though not in isolation, there are many factors involved in endo growth). To add to that, oxidation triggers an inflammatory cascade that can increase inflammatory prostaglandins, the culprits behind endo and period pain.
Propionate also has a significant anti-inflammatory effect, not so much on the gut, but mores systemically throughout the body. In fact, like butyrate, it can help inhibit inflammatory cytokines which are linked to endo progression, however, its effects are less potent.
So, given that we may be low in these beneficial SCFA, let’s look at how we get more of them. Here are four of the main fibres to include for boosting your acetate and propionate levels.
Beta-glucan is a type of soluble fibre, and one of the best sources of beta-glucan is oats. Beta-glucan, particularly from oats, has been shown to significantly increase propionate. What’s great about oats is that they are low FODMAP, so may be less likely to trigger bloating and IBS issues in some of us with endo belly and SIBO. However, always listen to your body as we’re all different. The starch content in cooked oats for me is too high, and I bloat without fail. However, when I eat raw oats, so uncooked oats, I do not bloat at all, because they are higher in resistant starch, which takes longer to break down, resulting in slow and gradual fermentation, rather than quick and excessive fermentation, which creates gas and therefore bloating.
If you have coeliac disease or a wheat allergy, go for gluten free.
Inulin is a prebiotic fibre that produces both acetate and propionate. However, inulin contains fermentable carbohydrates that ferment rapidly and many have problems with these, such as garlic and onions - but that doesn’t necessarily mean that you will.
I’ve mentioned this numerous times since discussing short chain fatty acids, but when it comes to being triggered by certain foods, often the portion size matters. For example, leeks contain inulin and at 75g are high FODMAP, so much more likely to create fermentation and bloating, whereas a smaller serving, like 14g, is low FODMAP. Of course, this means that the inulin levels are much less and not so significant for boosting SCFA, but it does help you to get in these foods and fibre types vs. just removing them entirely. Also, you don’t have to go as low as 14g, but you might find that you’re okay on 50g leeks, just not 75g.
And to be clear, I am by no means saying you should go low FODMAP or weigh every veg you eat, but what I am saying is, try smaller serving sizes of the foods which trigger you, and you might be surprised. Additionally, there are various foods that you may be able to eat more of that contain inulin at lower levels, such as chicory leaves, which are low FODMAP at 75g per serving, so you might find you do better with them vs. garlic. Again, you won’t be getting much inulin, but it’ll be a start.
Of course, the aim is to get to the root cause of your endo bloating so that you can tolerate more foods in the long run, and not have to go for smaller portion sizes - in turn, this will allow you to improve your levels of SCFAs because you’ll be able to increase these more fermentable fibre types, like inulin. However, improving your gut bacteria balance and SCFA levels with today’s suggestions is already a step towards healing your root causes, as for many of us, gut dysbiosis is one of our endo belly drivers.
To summarise, inulin containing foods include garlic, leeks, asparagus, chicory leaves and chicory root syrup, onions, bananas and Jerusalem artichokes.
Now let’s look oligosaccharides. Oligosaccharides are a group of fermentable carbohydrates, that covers a wide range foods and all produce acetate and propionate. Two of the most common types found in high FODMAP foods are fructo-oligosaccharides and galacto-oligosaccharides. Unfortunately, these are highly fermentable and contribute to a rapid and often large amount of gas production, which results in bloating and for some of us, IBS symptoms. This is why in the low FODMAP diet, these foods are often restricted or reduced.
Oligosaccharides are found in pretty much all the foods I just listed under inulin, so foods like garlic and onions, as well as beans and lentils and also some lower FODMAP foods like red cabbage, kale, pomegranates and blueberries. For those of you who are wondering how the hell cabbage can be low FODMAP, red cabbage is low FODMAP at 75g, which is almost a whole portion of cabbage (which is 80g), so it’s unlikely you’d eat more than that anyway in one typical meal!
If you eat a diet rich in the beans, lentils, fruit and veggies you tolerate, you’ll be boosting your levels of oligosaccharides, but of course, the lower the FODMAP serving or the smaller the serving size you can tolerate, the less of this type of fibre you’ll be getting, and so the less these foods will be able to boost your SCFA production. However, for now, if you have IBS or you tend to get endo belly bloating after meals, you may need to be more mindful with these foods and boost acetate and butyrate through these other fibres I list today, just until you can work out your root causes or are able to tolerate more.
Pectin is another type of fibre that helps boost both acetate and propionate. It’s found in fruits and veggies that are higher FODMAP, like apples, pears and certain beans, but it’s also found in citrus fruits like orange, which is low FODMAP when you’re eating an orange whole, not as a juice and carrots, which are low FODMAP. Additionally, pectin is found in beans, and we’ve been talking A LOT about how beneficial beans are. When it comes to trying to eat more beans without triggering an endo belly bloating situation, try canned varieties, which are lower in FODMAPS and easy to digest, because the protective coating on the beans has started to break down, and try smaller serving sizes, like 1-2 tablespoons per meal, to see how you get on. Remember, each bean is different, so just because you can’t tolerate one, doesn’t mean you won’t be able to tolerate any.
Don’t forget the other magic fibre, resistant starch, which we discussed last week. Resistant starch does contribute a little to acetate and propionate, but mainly butyrate.
So, to wrap things up, let’s look at what a day might look like of short chain fatty acid boosting meals.
Maybe you can fit oats and blueberries into your breakfast.
Kale, beans and cooked and cooled rice could work well for a lunch time salad type dish. If you can tolerate a garlic-based dressing, that could be a nice booster as well.
And dinner could be a tray bake of some sort with veggies like carrots, red cabbage and perhaps even leeks or onions in amounts you can tolerate.
Of course, I am not giving you all the details of each meal with these examples - you’ll need to ensure there’s protein, fat, fibre and complex carbs with each meal for blood sugar balance, but you can see how these foods can be peppered across your day. Additionally, you’ll need to experiment with what foods you tolerate, enjoy or simply just want to bring in more of. Just because I’ve listed all of these options, doesn’t mean you have to try and cram them all in from the get go or start painstakingly thinking about which serving sizes agree with you. An array of different fibre foods is always the goal, but you could start simply, with including more oats or citrus fruit - start with where you feel ready.
Remember, this is really about finding sources of these fibres that boost your SCFA levels in a way that feels good and doesn’t worsen symptoms, so be sure to take it slow and do what feels best.
So that’s it for this week! I’ve got another recipe to help you on your way to boosting your SCFA acid levels over on Instagram, this time it’s no bake cookie dough bars.
Show notes
SCFAs
References:
https://www.healthline.com/nutrition/short-chain-fatty-acids-101#TOC_TITLE_HDR_3
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11208329/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500332/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9962481/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198999/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735932/
https://www.healthline.com/nutrition/short-chain-fatty-acids-101#TOC_TITLE_HDR_3
https://insight.microba.com/meet-propionate-a-short-chain-fatty-acid/#:~:text=If a patient's Insight™,proportion of propionate production2.
https://pubmed.ncbi.nlm.nih.gov/22731123/
https://www.healthline.com/health/beta-glucan-heart-healthy#should-you-supplement-with-it
https://www.verywellhealth.com/short-chain-fatty-acids-5219806
https://www.healthline.com/nutrition/oligosaccharides#foods
https://www.sciencedirect.com/science/article/pii/S2772753X23000126
https://www.mdpi.com/1422-0067/21/8/2890
https://ift.onlinelibrary.wiley.com/doi/full/10.1111/1541-4337.12565
https://www.metabolismjournal.com/article/S0026-0495(18)30151-3/abstract
Endo and inflammatory markers
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956504
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859972/
Bacteria and endo
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805679/
https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(23)00221-5/fulltext
https://www.healthline.com/health-news/endometriosis-may-be-caused-by-this-bacteria
Endometriosis and blood sugar
https://pubmed.ncbi.nlm.nih.gov/37673102/
https://pubmed.ncbi.nlm.nih.gov/7918300/
https://jamanetwork.com/journals/jama/article-abstract/202670
https://pubmed.ncbi.nlm.nih.gov/20497781/
https://pubmed.ncbi.nlm.nih.gov/19088375/
https://pubmed.ncbi.nlm.nih.gov/20537326/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333061/
https://pubmed.ncbi.nlm.nih.gov/18508964/
https://pubmed.ncbi.nlm.nih.gov/12379575/
https://www.ncbi.nlm.nih.gov/books/NBK493173/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9783643/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC308109920
https://www.wildnutrition.com/blogs/our-blog/endometriosis-part-2-the-link-between-sugar-and-the-immune-system
https://pubmed.ncbi.nlm.nih.gov/11511861/
https://pubmed.ncbi.nlm.nih.gov/2010896/
https://endometriosis.net/living/diet-sugar
https://endometriosis.net/living/how-to-balance-your-blood-sugar-levels-to-reduce-endo-symptoms
LPS
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519769/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902457/
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