Unhappy patients diagnosed with irritable bowel syndrome often have to change many medications and more than one doctor before they feel the desired relief. For some, however, diet modification is a real find. Moreover, not that medical nutrition, which is aimed only at disturbed intestinal motility, which is advised by domestic doctors, but a diet popular abroad with the restriction of FODMAPs-substances.
The acronym FODMAPs was coined to denote a whole group of fermentable sugars (oligo-, di- and monosaccharides, as well as polyols) with common properties. All of them:
- are short-chain carbohydrates;
- poorly absorbed in the small intestine;
- have high osmotic activity;
- are quickly digested by bacteria that inhabit the digestive tract.
An excess of these substances can cause heaviness and pain in the abdomen in an otherwise healthy person.
During the processing of these substances by intestinal microbes (fermentation), water and various gases are formed. Their excess causes discomfort and pain in the abdomen, bloating, rumbling, intestinal movement disorders. A large amount of FODMAPs in the diet can lead to the appearance of these symptoms in healthy individuals. In patients with irritable bowel syndrome, clinical manifestations occur with a lower content of FODMAPs-substances and these symptoms are much more intense.
FODMAPs-substances
These FODMAPs include:
- lactose;
- fructose;
- fructans;
- Galatians;
- polyols (sugar alcohols).
Lactose is a lump of milk sugar found in cow, goat, sheep, and human milk. Once in the intestines of a healthy person, it is broken down by an enzyme - lactase into glucose and galactose molecules, which are quickly absorbed. But large amounts of lactose are often a real challenge for adults.
Fructose is a carbohydrate found in honey, fruits, agave syrup, corn syrup. However, unlike lactose, fructose is not completely digested in the digestive tract due to the lack of a specific enzyme. Its absorption depends on glucose. Products in which the ratio of fructose to glucose is 1: 1 are sufficiently well absorbed and tolerated, and only those in which the content of free fructose exceeds the amount of glucose ( apples, mangoes, pears, cherries, artichokes, etc.) can be excluded. In addition, the absorption of fructose is influenced by the individual abilities of the substances participating in absorption, the rate of intestinal transit, and the presence of bacterial overgrowth in the small intestine.
Fructans are carbohydrates that do not undergo absorption (intestinal absorption) at all, since there is no enzyme in the intestines that can break down the fructose-fructose bond. Wheat, onion, and garlic are considered to be the leaders in their content.
Galatians also belong to such carbohydrates, which are practically not absorbed due to the lack of the necessary enzyme that cleaves the chemical bond between 2 galactose molecules. They are found in beans, red beans, and lentils, which are protein sources in vegetarian diets.
Polyols are found in some vegetables and fruits, mushrooms, as well as in sweeteners (xylitol, sorbitol, etc.), which can be added to chewing gums, cough drops, syrups (including medicinal ones). Their absorption is not associated with active transport but occurs through passive diffusion.
When verifying the diagnosis of irritable bowel syndrome, Western nutritionists are trying to assess the role of these substances in the development of symptoms of the disease. To assess the tolerance of these food components, they recommend that such patients exclude foods high in FODMAPs from their diet for 6-8 weeks. They are indicated in the table below.
Content of FODMAPs-components in products
| Type of products | Foods high in FODMAPs | Low FODMAPs |
| Milk and dairy products | milk of cows, sheep, goats, soy milk, condensed milk, dairy and cream soups, yoghurts from cow and soy milk, custard, curd cheese, marscapone cheeses, ricotta | almond, coconut, rice milk, hazelnut milk, lactose-free cow's milk, lactose-free kefir, coconut milk yoghurts, hard cheeses (brie, parmesan, cheddar, Swiss, etc.), moldy cheeses, mozzarella, feta, lactose-free curd cheese allowed up to 2 tablespoons / day of some cheeses (ricotta, curd cheese) |
| Dairy spices | sour cream, whipped cream | butter |
| desserts | ice cream, frozen yogurt, sorbet | lactose-free ice cream, fruit sorbet with low content of FODMAPs-substances |
| Fruit | apples, pears, cherries, raspberries, blackberries, watermelon, nectarines, peaches, apricots, plums, prunes, persimmons, mangoes, papaya, canned fruits, large portions of any fruit | bananas, blueberries, strawberries, melon, grapefruit, lemon, lime, grapes, kiwi, pineapple, rhubarb, avocado (less than ¼), dried fruits (less than 1 tablespoon). low content of FODMAPs-substances, giving preference to ripe fruit (unripe contains more fructose) |
| Vegetables | artichoke, asparagus, peas, cabbage, shallots, leeks, garlic, cauliflower, pumpkin, green peppers, mushrooms | red peppers, bean sprouts, carrots, lettuce, spinach, green onions, cucumber , tomato, eggplant, green beans, potatoes, olives, celery (less than 1 stalk), sweet potatoes, broccoli, dill, Brussels sprouts (less than 1 cup) |
| Cereals | wheat, rye, barley (in large quantities) | brown rice, oats (including oat bran), quinoa, corn, gluten-free cereals, pasta |
| Legumes | chickpeas, beans, lentils, hummus | tofu, peanuts, green peas (less than 1/3 cup) |
| Nuts and seeds | pistachios | pecans, almonds , pine nuts, walnuts, sesame seeds, sunflower seeds, pumpkin seeds. Allowable amount of nuts and seeds - 10-15 pieces or 1-2 tablespoons |
| Sweets and sweeteners | honey, agave, high fructose corn syrup, sorbitol, xylitol, mannitol, maltitol, isomaltitol | sugar, glucose, aspartame, sucrose, pure maple syrup |
| Additives | inulin, fructooligosaccharides, sugar alcohols, chicory root | |
| Alcohol | rum | wine, beer, vodka, gin |
| High protein foods | fish, chicken, turkey, eggs, meat | |
| Vegetable oils | olive and rapeseed oil |
With the correct selection of a therapeutic diet and its strict adherence, an improvement in well-being can be observed already in the first week. Then you should gradually resume the use of FODMAPs-substances. This technique allows you to identify products that provoke clinical symptoms and establish their safe amount. The introduction of one product takes 4 days. If the use of any product is accompanied by negative clinical manifestations, then its gradual introduction will take more time (2 weeks). During this period, no new foods with a large number of FODMAPs are added to the diet.
Also Read: Salt-free diet for medical reasons
Effectiveness of the diet
The efficacy of a diet low in FODMAPs in patients with irritable bowel syndrome and even in patients with inactive inflammatory bowel disease has been supported by serious scientific randomized controlled or provocative clinical trials. Subject to persistent adherence to the diet (i.e., strict adherence to it), up to 75% of patients with functional intestinal problems notice an improvement. In 50% of patients with inflammatory intestinal diseases (in remission), this original diet reduces symptoms associated with functional disorders.
However, this option of therapeutic nutrition does not bring relief to all patients. In addition, long-term restriction of FODMAPs-substances that have a positive effect on the beneficial microflora living in the intestine can negatively affect its activity. In addition, there is no conclusive evidence on the safety of a long-term diet low in FODMAPs.
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