A low-FODMAP diet is a person's global restriction of consumption of all fermentable carbohydrates (FODMAPs), recommended only for a short time. A low-FODMAP diet is recommended for managing patients with irritable bowel syndrome (IBS) and can reduce digestive symptoms of IBS including bloating and flatulence. It also seems to be beneficial in fibromyalgia. If the problem lies with indigestible fiber instead, the patient may be directed to a low-residue diet.
Description Below are low-FODMAP foods categorized by group according to the Monash University low-FODMAP diet.
Vegetables: alfalfa, bean sprouts, green beans, bok choy, capsicum (bell pepper), carrot, chives, fresh herbs, choy sum, cucumber, lettuce, tomato, zucchini, the green parts of leeks and spring onions Fruits: orange, grapes, honeydew melon (not watermelon) Protein: meats, fish, chicken, eggs, tofu (not silken), tempeh Dairy: lactose-free milk, lactose-free yoghurts, hard cheese Breads and cereals: rice, crisped rice, maize or corn, potatoes, quinoa, and breads made with their flours alone; however, oats and spelt are relatively low in FODMAPs Biscuits (cookies) and snacks: made with flour of cereals listed above, without high FODMAP ingredients added (such as onion, pear, honey, or polyol artificial sweeteners) Nuts and seeds: almonds (no more than ten nuts per serving), pumpkin seeds; not cashews or pistachios Beverage options: water, coffee, tea Other sources confirm the suitability of these and suggest some additional foods.
Mechanism The basis of many functional gastrointestinal disorders is distension of the intestinal lumen. Such luminal distension may induce pain, a sensation of bloating, abdominal distension and motility disorders. Therapeutic approaches seek to reduce factors that lead to distension, particularly of the distal small and proximal large intestine. Food substances that can induce distension are those that 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. Ingestion of certain short-chain carbohydrates, including lactose, fructose and sorbitol, fructans and galactooligosaccharides, can induce gastrointestinal discomfort similar to that seen in IBS. Dietary restriction of short-chain carbohydrates is associated with improvement of symptoms. These short-chain carbohydrates (lactose, fructose and sorbitol, fructans and GOS) behave similarly in the intestine. Firstly, being small molecules and either poorly absorbed or not absorbed at all, they drag water into the intestine via osmosis. Secondly, these molecules are readily fermented by colonic bacteria, so upon 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 volume of intestinal contents, which stretches the intestinal wall and stimulates nerves in the gut. It is this 'stretching' that triggers the sensations of pain and discomfort that are commonly experienced by people with IBS.
Uses The low-FODMAP diet is sometimes used for:
Irritable bowel syndrome (IBS) Celiac disease. Inflammatory bowel diseases. Exercise-induced gastrointestinal syndrome and exercise-associated gastrointestinal symptoms. Small intestinal bacterial overgrowth. The low-FODMAP diet is intended to be used only after a full medical evaluation. This ensures correct diagnosis and treatment. Use of a low-FODMAP diet without medical advice can lead to serious health risks, including nutritional deficiencies and misdiagnosis of celiac disease. Sometimes the diet is used in phases. Firstly, FODMAPs below the threshold value are eliminated from the diet (restriction phase). The restriction phase does not usually last more than six weeks. After this stage, products that were eliminated are re-introduced into the diet one at a time. This allows for assessment of the effects of different types of FODMAP on the individual. The final stage involves creation of a long-term diet based on the evidence collected from the previous stage.
Effects
Irritable bowel syndrome There is evidence that a dietician-supervised low-FODMAP diet is the best available way to control IBS symptoms, though there is a lack of evidence on possible adverse effects. The beneficial effect of low-FODMAP for people with IBS may be related to reduced osmotic load in the gut or changes in gut-brain axis signaling. The low-FODMAP diet does not cause any significant change in the gut microbiota in people with IBS. The effectiveness of low-FODMAP diet in children with IBS is unclear. While restrictive diets like the low-FODMAP diet can help manage symptoms in patients with Irritable bowel syndrome, they pose a significant danger: they can increase the patient's risk of developing disordered eating. The initial success in symptom reduction may become a dangerous obsession with controlling food, potentially leading to conditions such as ARFID or Orthorexia nervosa. These issues severely impact clinical outcomes and quality of life, and worsen overall health. Early monitoring and intervention are crucial to catching and addressing these pathological eating patterns.
Celiac disease Since the consumption of gluten is suppressed or reduced with a low-FODMAP diet, the improvement of the digestive symptoms with this diet may not be related to the withdrawal of the FODMAPs, but of gluten, indicating the presence of an unrecognized celiac disease, avoiding its diagnosis and correct treatment, with the consequent risk of several serious health complications, including various types of cancer.
Inflammatory bowel disease There is only a little evidence of its effectiveness in treating functional symptoms in inflammatory bowel disease from small studies that are susceptible to bias. The low-FODMAP diet is not recommended for ulcerative colitis due to risk of disruption of nutritional status and insufficient evidence of beneficial effects.
Small intestinal bacterial overgrowth The low-FODMAP diet may reduce symptoms in people with small intestinal bacterial overgrowth. However, it is not recommended as a long term diet for people with small intestinal bacterial overgrowth.
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