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FODMAP

FODMAPs or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols[1] are short-chain carbohydrates that are poorly absorbed in the small intestine and ferment in the colon. They include short-chain oligosaccharide polymers of fructose (fructans) and galactooligosaccharides (GOS, stachyose, raffinose), disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols), such as sorbitol, mannitol, xylitol, and maltitol.[1][2] Most FODMAPs are naturally present in food and the human diet, but the polyols may be added artificially in commercially prepared foods and beverages.

FODMAPs cause digestive discomfort in some people. The reasons are hypersensitivity to luminal distension or a proclivity to excess water retention and gas production and accumulation, but they do not cause intestinal inflammation. Naturally occurring FODMAPs may help avert digestive discomfort for some people because they produce beneficial alterations in the gut flora.[3][4][5][6] They are not the cause of these disorders,[7] but a low-FODMAP diet, restricting FODMAPs, might help to improve digestive symptoms in adults with irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGID).[7][8][9][10][11] Avoiding all FODMAPs long-term may have a detrimental impact on the gut microbiota and metabolome.[2][9][11][12]

FODMAPs, especially fructans, are present in small amounts in gluten-containing grains and have been identified as a possible cause of symptoms in people with non-celiac gluten sensitivity.[13][14][15][16][3] They are only minor sources of FODMAPs when eaten in the usual standard quantities in the daily diet.[13] As of 2019, reviews conclude that although FODMAPs present in wheat and related grains may play a role in non-celiac gluten sensitivity, they only explain certain gastrointestinal symptoms, such as bloating, but not the extra-digestive symptoms that people with non-celiac gluten sensitivity may develop, such as neurological disorders, fibromyalgia, psychological disturbances, and dermatitis.[3][17][13] Consuming a low FODMAP diet without a previous medical evaluation could cause health risks because it can ameliorate and mask digestive symptoms of celiac disease, delaying or avoiding its correct diagnosis and therapy.[18]

  1. ^ a b Gibson PR, Shepherd SJ (June 2005). "Personal view: food for thought — western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis". Alimentary Pharmacology & Therapeutics. 21 (12): 1399–409. doi:10.1111/j.1365-2036.2005.02506.x. PMID 15948806. S2CID 20023732.
  2. ^ a b Tuck CJ, Muir JG, Barrett JS, Gibson PR (September 2014). "Fermentable oligosaccharides, disaccharides, monosaccharides and polyols: role in irritable bowel syndrome". Expert Review of Gastroenterology & Hepatology. 8 (7): 819–34. doi:10.1586/17474124.2014.917956. PMID 24830318. S2CID 28811344.
  3. ^ a b c Cite error: The named reference Verbeke2018 was invoked but never defined (see the help page).
  4. ^ Cite error: The named reference MakhariaCatassi2015 was invoked but never defined (see the help page).
  5. ^ Cite error: The named reference GreerOKeefe2015 was invoked but never defined (see the help page).
  6. ^ Cite error: The named reference AndohTsujikawa2003 was invoked but never defined (see the help page).
  7. ^ a b Cite error: The named reference GibsonShepherd2010 was invoked but never defined (see the help page).
  8. ^ Cite error: The named reference TurcoSalvatore2018 was invoked but never defined (see the help page).
  9. ^ a b Cite error: The named reference Staudacher was invoked but never defined (see the help page).
  10. ^ Cite error: The named reference MarshEslick2015 was invoked but never defined (see the help page).
  11. ^ a b Cite error: The named reference RaoYu2015 was invoked but never defined (see the help page).
  12. ^ Cite error: The named reference HeimanGreenway2016 was invoked but never defined (see the help page).
  13. ^ a b c Fasano A, Sapone A, Zevallos V, Schuppan D (May 2015). "Nonceliac gluten sensitivity". Gastroenterology (Review). 148 (6): 1195–204. doi:10.1053/j.gastro.2014.12.049. PMID 25583468. Cereals such as wheat and rye, when consumed in normal quantities, are only minor sources of FODMAPs in the daily diet. (...) Table 1. Sources of FODMAPs (...) Oligosaccharides (fructans and/or galactans). Cereals: wheat and rye when eaten in large amounts (eg, bread, pasta, couscous, crackers, biscuits)
  14. ^ Cite error: The named reference VoltaCaioQuestions was invoked but never defined (see the help page).
  15. ^ Ontiveros N, Hardy MY, Cabrera-Chavez F (2015). "Assessing of Celiac Disease and Nonceliac Gluten Sensitivity". Gastroenterology Research and Practice (Review). 2015: 1–13. doi:10.1155/2015/723954. PMC 4429206. PMID 26064097.
  16. ^ Priyanka P, Gayam S, Kupec JT (2018). "The Role of a Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyol Diet in Nonceliac Gluten Sensitivity". Gastroenterology Research and Practice. 2018: 1561476. doi:10.1155/2018/1561476. PMC 6109508. PMID 30158962.
  17. ^ Cite error: The named reference VoltaDeGiorgio2019 was invoked but never defined (see the help page).
  18. ^ Barrett JS (March 2017). "How to institute the low-FODMAP diet". Journal of Gastroenterology and Hepatology (Review). 32 (Suppl 1): 8–10. doi:10.1111/jgh.13686. PMID 28244669. Common symptoms of IBS are bloating, abdominal pain, excessive flatus, constipation, diarrhea, or alternating bowel habit. These symptoms, however, are also common in the presentation of coeliac disease, inflammatory bowel disease, defecatory disorders, and colon cancer. Confirming the diagnosis is crucial so that appropriate therapy can be undertaken. Unfortunately, even in these alternate diagnoses, a change in diet restricting FODMAPs may improve symptoms and mask the fact that the correct diagnosis has not been made. This is the case with coeliac disease where a low-FODMAP diet can concurrently reduce dietary gluten, improving symptoms, and also affecting coeliac diagnostic indices. Misdiagnosis of intestinal diseases can lead to secondary problems such as nutritional deficiencies, cancer risk, or even mortality in the case of colon cancer.

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