The Low FODMAP Diet and Its Application in East and Southeast Asia

Abstract

There is growing interest in using food choice/dietary change to influence clinical outcomes in patients with irritable bowel syndrome (IBS). The low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) diet is an evidence-based approach that is gaining popularity in many Western countries. The low FODMAP diet is based on restricting dietary intake of short chain carbohydrates that are slowly absorbed or indigestible and not absorbed during passage through the small intestine. These are collectively described as "FODMAPs" and comprise oligosaccharides (mostly fructans, galacto-oligosaccharides), sugar polyols, fructose in excess of glucose, and lactose in lactose malabsorbers. The general strategy of the diet is to avoid foods high in FODMAPs and replace them with foods low in FODMAPs, with long-term restriction limited to what is required to control symptoms. The likely mechanism of action is minimisation of the stimulation of mechanoreceptors exerted by distension of the intestinal lumen with water from osmotic effects and gases from bacterial fermentation in those with visceral hypersensitivity. The success of this dietary approach greatly depends on detailed knowledge about the FODMAP composition of food commonly consumed in that country. While the content of foods associated with East and Southeast Asian cuisines has not been fully explored, major high FODMAP sources are frequently used and include onion, garlic, shallots, legumes/pulses, and wheat-based products. Thus, this dietary approach holds great promise in treating IBS patients in East and Southeast Asia. The aim of this review is to highlight how the diet is implemented, its efficacy, and troublesome ingredients frequently used in Asian dishes.

Prevalence of Fructose Malabsorption in Patients With Irritable Bowel Syndrome After Excluding Small Intestinal Bacterial Overgrowth

“…Recently, a published review article showed Korean dishes including kimchi and doenjang may have high fermentable oligo-, di-, and mono-saccharides; and polyols (FODMAP) ingredients. 31 We think that our study may be meaningful as a stepping stone to elicit the correlation between IBS symptoms and food, especially FODMAP. Interestingly, fiber intake was significantly higher in the group of participants with IBS than in the control group.…”

Irritable Bowel Syndrome and Nickel Allergy: What Is the Role of the Low Nickel Diet?

“…It proposes that specific nondigested or poorly digested carbohydrates contribute to common IBS symptoms and induce alterations in gut motility and secretion. 25 Low-FODMAP diets have been shown to reduce gastrointestinal symptoms if compared with both high-FODMAP diets 25 and National Institute for Health and Clinical Excellence standard dietary advice. 26 The efficacy of low-FODMAP diet has been questioned in a recent multi-center, parallel, single-blind RCT that showed no superiority of low-FODMAP diet compared to traditional dietary advice in improving IBS symptoms.…”

Uso de probióticos en síndrome de intestino irritable y enfermedad inflamatoria intestinal: una revisión de la literatura

“…La dieta baja en mono, di, oligosacáridos y polioles fermentables (FODMAP) consiste en el consumo dietético reducido de carbohidratos de cadena corta, difíciles de digerir o poco absorbidos en el intestino delgado (51,52) Algunos estudios sugieren que esta dieta disminuye los síntomas funcionales intestinales y contribuye al mejoramiento del estatus nutricional en personas hospitalizadas con diarrea, y en el control de los síntomas en personas con SII (53,54). El estudio danés de Pedersen y colaboradores comparó el uso de esta dieta con probióticos y dieta occidental convencional, y demostró la utilidad de las primeras 2 medidas en el control sintomático del SII (16).…”