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The low FODMAP diet - what it entails and why not everyone can follow it
Table of Contents
1. Understanding the low FODMAP diet
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 primarily consists of 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.2. A Low FODMAP Diet for the Treatment of Hypersensitive Bowel Syndrome
According to definition, irritable bowel syndrome (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 irritable bowel syndrome, 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.3. Fundamental principles of the low FODMAP diet
It is worth noting at the outset that the low FODMAP diet should be followed under dietary supervision to avoid unreasonable nutritional restrictions. It is also very important to carefully balance the diet in terms of nutrient content essential for our health, as this will help minimize the risk of food 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 that aims to eliminate products with high FODMAP content, such as fructose, lactose, fructans, oligosaccharides, polyols (sorbitol, mannitol, xylitol). Let's remember that the low FODMAP diet should not be used for a long time, as this may increase the risk of dysbiosis in the gut. Too long use of this type of food can affect the intestinal flora by reducing the number of probiotics. Therefore, after the 8-week elimination phase, 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.4. Products with a substantial amount of FODMAP components
(not recommended)5. Products with a low FODMAP content
(recommended) Source: self-developed based on Stolarczyk A., FODMAP constituents in food, "Medical Standards" 2015, 12, 235243; Kargulewicz A., Low-FODMAP diet in the treatment of IBS (hypersensitivity bowel disorder), "Food Forum" 2019, 1, 29, 1821.6. "Can everyone follow a low FODMAP diet?"
As previously mentioned in the article, a low FODMAP diet is primarily recommended for individuals struggling with hypersensitive bowel syndrome and other functional gastrointestinal disorders. The application of such a restrictive diet by individuals without any 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 dietary 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.
