Diet for Gut Health: The FODMAP Diet and BeyondSymposium Presentation
Manipulation of dietary carbohydrate (including dietary fiber, resistant starch and short chain carbohydrates) are key factors for overall gut health as well as prevention and control of diseases of the gastrointestinal tract. One of the most common gastrointestinal disorders to affect our community is irritable bowel syndrome (IBS). This condition is characterized by abdominal pain/discomfort, bloating and altered bowel habit. IBS affects 10-15% of the adult population. A diet therapy that restricts short chain carbohydrates, named FODMAPs, is quickly becoming a first line treatment option in the management of this condition. FODMAPs stand for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols. FODMAPs are found naturally in a wide range of foods - fructans including fructooligosaccharides (FOS) (artichoke, garlic, onions, wheat, rye), galactooligosaccharides (GOS) (pulses), lactose (in milk), fructose in excess of glucose (pears, apples and honey), and sugar polyols (stone fruits, some vegetables and artificial sweeteners). There is a high level of scientific evidence for the use of Low FODMAP diet to treat IBS. The diet is effective in 70% of patients and involves a 3-step approach that requires input from a dietitian trained in this area. The three steps include; Step 1-The low FODMAP, Step 2-Reintroduction and Step 3-Personalization phases.
The FODMAP diet should be a balanced diet and should not exclude whole food groups. The dietitan has an important role to ensure that patients find low FODMAP alternatives and do not restrict important food groups while following this diet. For example, lactose intolerant individuals should include suitable low lactose and lactose-free dairy-containing foods. The low FODMAP diet is also being used to control IBS symptoms that are often associated with other diseases – such as inflammatory bowel disease (IBD). Understanding the FODMAP composition of wheat- and gluten-containing food is also providing new insights and understanding about the worldwide phenomenon of wheat- and gluten- avoidance. FODMAP knowledge of food (that includes important prebiotics such as fructans and GOS) may also provide a key to understanding how we can use diet to favorably manipulate the gut microbiota which may ultimately hold the key to achieving optimal gut health and prevention of disease.