The Low-FODMAP Diet - Its Significance and Limitations in Application

FODMAP is an abbreviation derived from the English words fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which means fermenting oligosaccharides, disaccharides, monosaccharides, and polyols (polyhydroxy alcohols). They are commonly found in the diet as natural food ingredients or may be added to food during processing. The low FODMAP diet is a method of nutrition that focuses on consuming products with low carbohydrate and polyol content, which leads to an increase in osmotic activity in the intestines, are poorly absorbed, and are susceptible to fermentation processes in both the small intestine and the large intestine. FODMAP components include fructose, which is mainly found in fruits, honey, juices, sweets, and products sweetened with fructose syrup; lactose, which comes from milk and selected dairy products; fructo- and galactooligosaccharides, which are primarily present in onion vegetables, legume seeds, and wheat; and polyols, which occur in small amounts in fruits and vegetables but are mainly added to food.

According to definition, functional bowel disorder (IBS) is a disorder of motor bowel function characterized by pain or discomfort in the abdominal cavity (mainly during defecation) and associated with a disruption of the emptying rhythm (polar, constipation, or mixed up). Dietary treatment of IBS involves the introduction of proper nutrition, which is based on the alleviation of these painful symptoms, the regulation of dysfunctional bowel rhythms, as well as the improvement of the spontaneous onset of disease. In the treatment of functional bowel disorders, various recommendations of the British institution NICE (National Institute for Health and Care Excellence) and nutrition models are used, such as a gluten-free diet, a lactose-free diet, SCD diet (specific carbohydrate diet), controlled fiber intake, or a paleo diet. However, it has been shown that one of the most effective diets for alleviating the symptoms of IBS is a low FODMAP diet. This diet is also recommended in case of other disturbances of the digestive tract such as bloating, diarrhea, constipation, allergies, and food intolerances. However, it should be noted that not all compounds contained in FODMAP lead to an exacerbation of the bothersome symptoms in IBS patients, it is a very individual matter. There are two basic mechanisms for the occurrence and exacerbation of symptoms. The first mechanism is associated with an increased secretion of fluid into the lumen of the intestine, which results from the high osmotic activity of FODMAP products. As a result, there is stretching of the intestinal wall, which causes abdominal pain. The second mechanism is based on the rapid fermentation of FODMAP by intestinal bacteria, which in turn leads to an excessive production of gases, causing pain, discomfort, and bloating.

Let's emphasize at the outset that the low FODMAP diet should be conducted under nutritional supervision to avoid unsubstantiated dietary restrictions. Another important aspect is also the careful balancing of the diet in terms of nutrient content necessary for our health, which will minimize the risk of nutritional deficiencies. The low FODMAP diet consists of two phases that allow us to accurately determine which products contribute to the development of irritable bowel syndrome. In the first phase, which usually lasts 6-8 weeks, we use an elimination diet aimed at eliminating products with high FODMAP content, such as fructose, lactose, fructans, oligosaccharides, polyols (sorbitol, mannitol, xylitol). Remember that the low FODMAP diet should not be used for an extended period of time, as this may increase the risk of intestinal dysbiosis. Too long use of this type of diet can have an impact on intestinal flora by reducing the number of probiotics. Therefore, after the 8-week elimination period, we should move on to the second phase, where we gradually and in small amounts include low FODMAP products (e.g. hard cheeses, gluten-free products, meat, fish, eggs) in the diet. During the reintroduction of high FODMAP products to the diet, we should carefully observe the body's tolerance to individual types of fermenting components.

(not advised)

(recommended) Source: own work based on Stolarczyk A., FODMAP components in nutrients, "Medical Standards" 2015, 12, 235243; Kargulewicz A., Low-FODMAP diet in the treatment of SCI (complex disorder syndrome of the stomach-intestine), "Food Forum" 2019, 1, 29, 1821.

As previously stated in the article, a low FODMAP diet is primarily recommended for individuals suffering from hypersensitive bowel syndrome and other functional gastrointestinal disorders. The application of such a restrictive diet by individuals without clinical symptoms is not advised. FODMAPs are desirable components of our daily diet, and thus, unjustified elimination of them from the diet may negatively impact our health. This can primarily lead to the occurrence of nutritional deficiencies in the body. A low FODMAP diet is characterized by a lower intake of calcium, fiber, iron, B-complex vitamins, vitamin D, and natural antioxidants. Therefore, dietary restrictions should be suitably tailored to the individual patient's tolerance, considering the progression of the disease.