FODMAP

Symptoms

Ingestion of FODMAP may cause digestive disturbances:

This can trigger and aggravate symptoms of irritable bowel syndrome and inflammatory bowel disease. The complaints primarily affect people with increased sensitivity, malabsorption or intolerance. In healthy individuals, they may occur at high doses of FODMAP.

Causes

The acronym FODMAP stands for “Fermentable Oligo-, Di- and Monosaccharides And Polyols.” The term was coined in 2005 by Gibson and Shepherd at Monash University in Melbourne (Gibson, Shepherd, 2005). It is a heterogeneous group of carbohydrates and sugar alcohols (polyols):

These substances are present in many natural and processed foods, as well as in some medicines. They are generally poorly absorbed and fermented (fermented) in the large intestine by bacterial flora to short-chain fatty acids and gases such as hydrogen and methane, and they are osmotically active. At the same time, however, they also exert beneficial effects, for example by being active as prebiotics for non-pathogenic bacteria or as dietary fiber. Thus, they are not unhealthy per se, but they can trigger or aggravate symptoms in sensitive people.

Nonpharmacologic treatment

Sensitive individuals may be recommended a diet low in FODMAPs (Low FODMAP Diet). This may result in improvement of symptoms. Several clinical trials have been conducted showing positive effect of the diet, but often without control group or without blinding. After nutritional counseling, a trial of a low FODMAP diet is started. If improvement occurs, foods can subsequently be reintroduced until individual tolerance is achieved. Complete abstinence is not necessary and not desirable, since the diet should be as balanced as possible and the FODMAPs also exert positive effects, as already discussed. Lactose and fructose only need to be avoided if intolerance or malabsorption is present. A Monash University app with a traffic light system is available for assessing which foods are rich in FODMAPs.

Drug treatment

The enzyme lactase is available for the treatment of lactose intolerance, which splits lactose into its two components that can be absorbed into the bloodstream in the small intestine. In the case of fructose malabsorption, the enzyme xylose isomerase can be taken, which converts fructose into the easily absorbed glucose. Alpha-galactosidase breaks down oligosaccharides with galactose units, which are found, for example, in vegetables, beans and nuts. Other digestive enzymes are available.