FODMAPs: food composition, defining cutoff values and international application

Abstract

The low-FODMAP diet is a new dietary therapy for the management of irritable bowel syndrome that is gaining in popularity around the world. Developing the low-FODMAP diet required not only extensive food composition data but also the establishment of "cutoff values" to classify foods as low-FODMAP. These cutoff values relate to each particular FODMAP present in a food, including oligosaccharides (fructans and galactooligosaccharides), sugar polyols (mannitol and sorbitol), lactose, and fructose in excess of glucose. Cutoff values were derived by considering the FODMAP levels in typical serving sizes of foods that commonly trigger symptoms in individuals with irritable bowel syndrome, as well as foods that were generally well tolerated. The reliability of these FODMAP cutoff values has been tested in a number of dietary studies. The development of the techniques to quantify the FODMAP content of foods has greatly advanced our understanding of food composition. FODMAP composition is affected by food processing techniques and ingredient selection. In the USA, the use of high-fructose corn syrups may contribute to the higher FODMAP levels detected (via excess fructose) in some processed foods. Because food processing techniques and ingredients can vary between countries, more comprehensive food composition data are needed for this diet to be more easily implemented internationally.

Elevated serum interleukin‐2 after gluten correlates with symptoms and is a potential diagnostic biomarker for coeliac disease

“…The gluten challenge material included approximately 0.1 g FODMAPs, mostly as fructan, which provided “low” exposure to FODMAPs (Table S2). FODMAPs content of baker's wheat flour was similar to vital wheat gluten flour but its lower protein concentration would mean a larger amount (approximately 75 g) would be required to deliver 6 g gluten protein. This would result in “high” FODMAPs exposure (0.9 g) that would potentially contribute to irritable bowel symptoms after gluten challenge (Table S2).…”

Long‐term impact of the low‐FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome

“…Nutritional adequacy was assessed by comparison of nutrient intakes against the United Kingdom dietary reference values . Frequency data on the consumption of foods high and low in individual FODMAPs was assessed based on cutoffs . Each food frequency questionnaire food item was categorized as high‐ or low‐FODMAP and, if high, which FODMAP(s) they contained.…”

Content of Poorly Absorbed Short‐Chain Carbohydrates (FODMAP) in Enteral Homemade Diets

“…The Monash Uni Low FODMAP Diet was elaborated by nutritionists who created the term FODMAP and is constantly updated and available worldwide . This application uses as cutoff points for low, medium, and high levels of FODMAP reports of patients reporting irritable bowel syndrome with gastrointestinal symptoms presented after consumption of certain foods . Low content of FODMAP depends on the type of fermentable carbohydrate present .…”