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FODMAP

FODMAPs are types of carbohydrates-fermentable oligo-, di-, mono-saccharides and polyols found in certain foods, including wheat and beans.

FODMAP carbohydrates are poorly absorbed in the small intestine and subsequently rapidly fermented by the bacteria in the distal small and proximal large intestine.

FODMAP carbohydrates are poorly absorbed or indigestible in the small intestine and are rapidly fermented in the colon, resulting in bloating and flatulence.

These food components increase water volume in the small intestine and gas in the colon.

These are poorly absorbed short-chain carbohydrates. 

While FODMAPs can produce certain digestive discomfort in some people, not only do they not cause intestinal inflammation, but they avoid it, because they produce beneficial alterations in the intestinal flora that contribute to maintain the good health of the colon.

FODMAPs are not the cause of irritable bowel syndrome nor other functional gastrointestinal disorders.

People develop symptoms when the underlying bowel response is exaggerated or abnormal.

 A low-FODMAP diet might help to improve short-term digestive symptoms in adults with irritable bowel syndrome, but long-term can have negative effects because it causes a detrimental impact on the gut microbiota and metabolome.

FODMAPs are found in many foods and are associated with IBS problems, like diarrhea, bloating, abdominal pain, and flatulence. 

 

The following foods contain FODMAPs:

 

oligosaccharides, including fructans (in wheat, onions, garlic) and galactans (in beans, lentils, soybeans)

 

disaccharides, including lactose (in milk and other dairy products)

 

monosaccharides, including fructose (in apples, honey)

 

polyols, including sorbitol and mannitol (in some fruits, vegetables, artificial sweeteners).

Studies have shown strong links between FODMAPs and digestive symptoms like gas, bloating, stomach pain, diarrhea and constipation.

Low-FODMAP diets can provide remarkable benefits for many people with common digestive disorders.

FODMAPs are short-chain carbs that are resistant to digestion.

FODMAPS are not absorbed into the bloodstream, but reach the far end of the intestine where gut bacteria reside.

Bacteria then use these carbs for fuel, producing hydrogen gas and causing digestive symptoms in sensitive individuals.

In addition FODMAPs draw liquid into the intestine, which may cause diarrhea.

For patients with an underlying visceral hypersensitivity of IBS, foods high in FODMAPs week, onions, garlic, legumes, dairy products, mushrooms, and cauliflower can create abdominal pain, bloating, excess gas, diarrhea, and constipation.

Not everyone is sensitive to FODMAP.

Sensitivity to FODMAPS is very common among people with irritable bowel syndrome (IBS).

The FODMAPs have the same impact on the gut of people with or without IBS,, but those with IBS appreciate those effects differently, as they are more sensitive to the presence of gas.

50% to 86% of people with IBS respond well to a low-FODMAP diet. 

 

People with IBS who follow  a low-FODMAP diet for four weeks are twice as likely to have improved quality of life and lower levels of anxiety compared with those who followed a more traditional diet.

Common FODMAPs include:

Fructose: A simple sugar found in many fruits and vegetables that also makes up the structure of table sugar and most added sugars.

Lactose: A carbohydrate found in dairy products like milk.

Fructans: Found in many foods, including grains like wheat, spelt, rye and barley.

Galactans: Found in large amounts in legumes.

Polyols: Sugar alcohols like xylitol, sorbitol, maltitol and mannitol. They are found in some fruits and vegetables and often used as sweeteners.

FODMAPs are small carbs that many people cannot digest.

They are completely resistant to digestion and are categorized as a dietary fiber.

Some carbohydrates function like FODMAPs only in some individuals : lactose and fructose sensitivity to these carbs differs between people.

FODMAPs are fermented and used as fuel by gut bacteria.

Bowel bacteria tend to produce methane, whereas the bacteria that feed on FODMAPs produce hydrogen.

Hydrogen production may lead to gas, bloating, stomach cramps, pain, and constipation, and abdominal distention.

FODMAPs are also osmotically active, drawing water into the intestine and contributing to diarrhea.

About 75% of people with IBS can benefit from a low-FODMAP diet.

In a controlled trial on people with irritable bowel syndrome found that those who withdrew from the diet the foods to which they had shown an increased IgG antibody response experienced an improvement in their symptoms.

A low-FODMAP diet may also be beneficial for other functional gastrointestinal disorders.

It can be useful for people with inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis.

Common foods and ingredients that are high in FODMAPs

Fruits: Apples, applesauce, apricots, blackberries, boysenberries, cherries, canned fruit, dates, figs, pears, peaches, watermelon

Sweeteners: Fructose, honey, high fructose corn syrup, xylitol, mannitol, maltitol, and sorbitol.

Dairy products: Milk (from cows, goats and sheep), ice cream, most yogurts, sour cream, soft and fresh cheeses (cottage, ricotta, etc) and whey protein supplements

Vegetables: Artichokes, asparagus, broccoli, beetroot, Brussels sprouts, cabbage, cauliflower, garlic, fennel, leeks, mushrooms, okra, onions, peas, shallots

Legumes: Beans, chickpeas, lentils, red kidney beans, baked beans, soybeans

Wheat: Bread, pasta, most breakfast cereals, tortillas, waffles, pancakes, crackers, biscuits

Other grains: Barley and rye

Beverages: Beer, fortified wines, soft drinks with high-fructose corn syrup, milk, soy milk, fruit juices

Foods You Can Eat on a Low-FODMAP Diet

Meats, fish and eggs: well tolerated unless they have added high-FODMAP ingredients like wheat or high-fructose corn syrup

All fats and oils

Most herbs and spices

Nuts and seeds: Almonds, cashews, peanuts, macadamia nuts, pine nuts, sesame seeds ( not pistachios, which are high in FODMAPs)

Fruits: Bananas, blueberries, cantaloupe, grapefruit, grapes, kiwi, lemons, lime, mandarins, melons, oranges, passionfruit, raspberries, strawberries (except watermelon),

Sweeteners: Maple syrup, molasses, stevia and most sugar alcohols

Dairy products: Lactose-free dairy products, hard cheeses and aged softer varieties like brie and camembert

Vegetables: Alfalfa, bell peppers, bok choy, carrots, celery, cucumbers, eggplant, ginger, green beans, kale, lettuce, chives, olives, parsnips, potatoes, radishes, spinach, green spring onion, squash, sweet potatoes, tomatoes, turnips, yams, water chestnuts, zucchini

Grains: Corn, oats, rice, quinoa, sorghum, tapioca

Beverages: Water, coffee, tea

It is recommended to eliminate all high-FODMAP foods for a few weeks, then reintroduce some of them one at a time.

A low FODMAP diet is restrictive, challenging to follow and intended only as a short term intervention to identify foods that trigger IBS symptoms.
This diet is associated with the risk of becoming malnourished or impairing intestinal microbiota.
When a low FODMAP diet is used without a previous complete medical evaluation can cause serious health risks by ameliorating and masking the digestive symptoms of serious diseases, such as celiac disease, inflammatory bowel disease and colon cancer, avoiding their correct diagnosis and therapy.

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