Maybe you're one of these people: You eat healthily and try everything to get your intestinal problems under control, but the symptoms just don't seem to get better. Fruits, vegetables and whole grains are considered healthy foods, but in some people they cause digestive problems such as gas, bloating, diarrhea or constipation. How can that be? Some of these foods contain so-called FODMAPs and these are particularly noticeable in people with irritable bowel syndrome. The deceptive thing: FODMAPs include foods that you would actually think would do something good for your health: asparagus, cauliflower, beetroot, onions, apples, bananas, avocado, spelt, buttermilk, honey. So why do healthy foods cause discomfort?
What are FODMAPs and why can they cause digestive problems?
FODMAPs are certain short-chain carbohydrates and sugar alcohols that are naturally present in many foods. FODMAPs are generally not harmful, but are part of the daily diet of health-conscious people. However, study results show that the intestines of many people with irritable bowel syndrome react sensitively to FODMAPs. (1) Incidentally, irritable bowel syndrome manifests itself differently in each person: for one person it can lead to severe diarrhea, for another it can lead to stubborn constipation or a mixture of both.
What does the word FODMAP mean?
F – Fermentable
O – Oligosaccharides
D – Disaccharides
M – monosaccharides
A – and (and)
P – Polyols.
FODMAPs is the abbreviation for fermentable oligo-, di- and monosaccharides and polyols. These can lead to digestive problems such as diarrhea, flatulence and abdominal pain. (2)
LOW-FODMAP diet – relief from irritable bowel syndrome
According to Bellini et al. (2020), a low-FODMAP diet (LFD) is a possible form of therapy to relieve symptoms typical of irritable bowel syndrome, such as diarrhea, abdominal pain and flatulence. (3) In some countries, the low-FODMAP diet has already established itself as a regular form of therapy because it delivers promising results for irritable bowel syndrome (IBS). Studies have shown that symptoms can be improved with a low-FODMAP diet in up to 70% of irritable bowel syndrome patients . (4)
It is best to change your diet together with an experienced therapist
Since a low-FODMAP diet severely restricts food choices and has an enormous impact on the intestinal flora, it should only be followed under the guidance of a nutritionist (Bellini et al., 2020). (3) Studies show that the diversity of bacterial cultures in the intestine tends to decrease as a result of a low-FODMAP diet, but species diversity is essential and crucial for a healthy intestinal microbiome. (5)
How does the low FODMAP diet work? The two phases
The low FODMAP diet consists of two phases; one Restriction phase (also elimination phase) and a gradual one Re-exposure FODMAP-rich foods. Not everyone can achieve freedom from symptoms, but the low-FODMAP diet is The currently best available treatment method for irritable bowel syndrome .
In the first phase of the low-FODMAP diet, foods high in FODMAPs are completely avoided for six to eight weeks. If it appears during this time that the symptoms improve significantly or normalize, a long-term diet without these substances may make sense. In the second phase of the diet, various FODMAP-rich foods are tested for their individual tolerance. (6)
Low-FODMAPs include fish, kale, lactose-free whipped cream and lemons.
Successes of the low-FODMAP diet in cancer therapy
But considerable success can be achieved not only in the course of irritable bowel syndrome; this diet has also proven to be extremely promising in cancer therapy.
Patients with radiation-induced enteropathy after cancer treatment show similar symptoms to patients with irritable bowel syndrome. Already in 2017, Larsen et al. investigated whether there could be a positive effect of LFD on symptoms and health-related quality of life in patients with radiation-related intestinal disease. In an open, non-controlled pilot study, the FODMAP intake of 11 patients with radiation-related RD symptoms was successfully reduced within four weeks and those symptoms significantly improved. (7)
Further research is necessary
Although a low-FODMAP diet is increasingly being proposed for the treatment of irritable bowel syndrome, controlled long-term studies are still lacking. Potential limitations and concerns regarding LFD include nutritional adequacy, cost, and difficulty of teaching and maintaining this diet. Most of these limitations can be resolved by involving a qualified nutritionist who can clearly explain the different phases of LFD and ensure nutritional adequacy and compliance.
References
- Tuck C, Barrett J. Re-challenging FODMAPs: the low FODMAP diet phase two. J Gastroenterol Hepatol. 2017 Mar;32 Suppl 1:11-15. doi: 10.1111/jgh.13687 [Titel anhand dieser DOI in Citavi-Projekt übernehmen] . PMID: 28244664
- Mehtab W, Agarwal A, Singh N, Malhotra A, Makharia GK. All that a physician should know about FODMAPs. Indian J Gastroenterol. 2019 Oct;38(5):378-390. doi: 10.1007/s12664-019-01002-0. Epub 2019 Dec 4. PMID: 31802437
- Bellini M, Tonarelli S, Barracca F, Morganti R, Pancetti A, Bertani L, de Bortoli N, Costa F, Mosca M, Marchi S, Rossi A. A Low-FODMAP Diet for Irritable Bowel Syndrome: Some Answers to the Doubts from a Long-Term Follow-Up. Nutrients. 2020 Aug 7;12(8):2360. doi: 10.3390/nu12082360
- Camilleri M, Acosta A. Re: Halmos et al, A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014 Jun;146(7):1829-30. doi: 10.1053/j.gastro.2014.01.071
- Staudacher HM, Ralph FSE, Irving PM, Whelan K, Lomer MCE. Nutrient Intake, Diet Quality, and Diet Diversity in Irritable Bowel Syndrome and the Impact of the Low FODMAP Diet. J Acad Nutr Diet. 2020 Apr;120(4):535-547. doi: 10.1016/j.jand.2019.01.017
- Dugum M, Barco K, Garg S. Managing irritable bowel syndrome: The low-FODMAP diet. Cleve Clin J Med. 2016 Sep;83(9):655-62. doi: 10.3949/ccjm.83a.14159
- Larsen, Trine & Hausken, Trygve & Ystad, Synne & Hovdenak, Nils & Mueller, Bernd & Arslan, Gulen. (2017). Does the low FODMAP diet improve symptoms of radiation-induced enteropathy? A pilot study. Scandinavian Journal of Gastroenterology. 53. 1-8. 10.1080/00365521.2017.1397186
