FODMAP

FODMAPs are short chain carbohydrates that are poorly absorbed in the small intestine. They include short chain oligo-saccharide polymers of fructose (fructans) and galactooligosaccharides (GOS, stachyose, raffinose), disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols), such as sorbitol, mannitol, xylitol and maltitol. The term FODMAP is an acronym, derived from “Fermentable Oligo-, Di-, Monosaccharides And Polyols”. Although FODMAPs are naturally present in food and the human diet, FODMAP has been found to improve bowel syndrome (IBS) and other functional gastrointestinal disorders (FGID). Prior to the training of the FODMAP concept, was used as a first line therapy for IBS and other FGID.

Over the years, there have been multiple observations that ingestion of certain short-chain carbohydrates, including lactose, fructose and sorbitol, fructans and galactooligosaccharides, induced IBS-like symptoms. These studies also showed that dietary restriction of short-chain carbohydrates was associated with symptom improvement in some people with IBS. These short-chain carbohydrates (lactose, fructose and sorbitol, fructans and GOS) are similarly in the intestine. Firstly, they are poorly absorbed or not absorbed at all, they drag the water into the intestine via osmosis. Secondly, these molecules are readily fermented by colonic bacteria, so they malabsorption in the small intestine they enter the large intestine where they generate gases (hydrogen, carbon dioxide and methane). The dual actions of these carbohydrates cause an expansion in intestinal contents, which stretches the intestinal wall and stimulates nerves in the gut. It is this ‘stretching’ that triggers the feelings of pain and discomfort that are experienced by IBS sufferers. The FODMAP concept was first published in 2005 as part of a hypothesis paper. In this paper, it was proposed that a dietary intake of all indigestible or slowly absorbed, short-chain carbohydrates would minimize stretching of the intestinal wall. This article is intended to help reduce the incidence of IBS (see below). At the time, there is no collective term for indigestible or slowly absorbed, short-chain carbohydrates, so the term ‘ FODMAP was created to improve understanding and facilitate communication of the concept. The low FODMAP diet was originally developed by a research team at Monash University in Melbourne, Australia. The Monash team undertakes the first research to investigate whether FODMAP diet improves symptom control in patients with IBS and the mechanism exerted its effect. Monash University also established a rigorous food analysis program at the FODMAP. The FODMAP composition data was generated by Monash University published in the last 2 months. As a result of this research program and FODMAP food analysis, a comprehensive and accurate database now exists describing the FODMAP content of food; A FODMAP diet improves symptom control in the diet and is a symptom control of IBS and other FGIDs (such as simple bloating).

The basis of many functional gastrointestinal disorders (FGIDs) is distension of the intestinal lumen. Such luminal distension may induce pain, sensation of bloating, abdominal distension, and motility disorders. Therapeutic approaches seek to reduce the lead to distension, particularly of the distal small and proximal large intestine. Food substances that can induce distention are those which are poorly absorbed in the proximal small intestine, osmotically active, and fermented by intestinal bacteria with hydrogen (as opposed to methane) production. The small molecule FODMAPs exhibit these characteristics.

Poor absorption of most FODMAP carbohydrates is common to everyone. Any FODMAPs that are not absorbed in the small intestine pass into the large intestine, where bacteria close them. The resulting production of gas in bloating and flatulence. Most patients do not have significant symptoms of IBS. Restriction of FODMAP intake in the latter group. Fructose malabsorption and lactose intolerance may produce IBS symptoms through the same mechanism, but with other FODMAPs, poor absorption is found only in a minority of people. Many who benefit from a low FODMAP diet need not restrict fructose gold lactose.

The significance of sources of FODMAPs varies across dietary groups as geography, ethnicity, and other factors. Commonly used FODMAPs included the following:

Sources of fructans include wheat, rye, barley, onion, garlic, Jerusalem artichoke globe, beetroot, dandelion leaves, the white part of the leeks, the white part of spring onion, brussels sprouts, savoy cabbage and prebiotics such as fructooligosaccharides (FOS), oligofructose and inulin. Asparagus, fennel, red cabbage and radicchio may contain moderate amounts.

Pulses and beans are the main dietary sources (though green beans, canned lentils, sprouted mung beans, tofu (not silken), and tempeh contain comparatively low amounts). Supplements of the alpha-galactosidase enzyme supplement may cause symptoms (if brands containing other FODMAPs are avoided).

Polyols are found naturally in some fruit, including apples, apricots, avocados, blackberries, cherries, lychees, nectarines, peaches, pears, plums, plums, watermelon and some vegetables, including cauliflower, mushrooms and peas . They are also used as bulk sweeteners and include isomalt, maltitol, mannitol, sorbitol and xylitol. Cabbage, chicory and fennel contain moderate amounts may be eaten.

People following a low-FODMAP diet may be able to tolerate moderate amounts of fructose and lactose, especially if they have lactase persistence.

Below are low-FODMAP foods categorized by group according to the Monash University “Low FODMAP Diet”.

Evidence from randomized trials indicates that a low FODMAP diet might help to treat irritable bowel syndrome in adults and in children. A comprehensive systematic review and meta-analysis supports the efficacy of this diet in the treatment of functional gastrointestinal symptoms of IBS, but the evidence is less good for constipation. There is only a little evidence of effectiveness in inflammatory bowel disease that is likely to bias. In common with other defined diets, the low FODMAP diet may be impractical to follow and risk imposing an undue financial burden and worsening malnutrition.

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