Who would benefit from the Low-FODMAP diet?

The Low-FODMAP diet has been shown to be very effective in Irritable Bowel Syndrome (IBS), and is a promising management option for bowel symptoms in other conditions including inflammatory bowel disease, fibromyalgia and endometriosis.

What is the Low-FODMAP diet?

The low-FODMAP diet was developed by researchers at the Monash University in Australia. It is an acronym for a group of carbohydrates: Fermentable Oligo-, Di-, Mono-saccharides, And Polyols. These carbohydrates are poorly absorbed in the small intestine and subsequently rapidly fermented in the large intestine. As a result, ingesting these carbohydrates tends to cause gas, bloating, cramps, distention, diarrhoea, and/or constipation, particularly in sensitive individuals.

FODMAP carbohydrates can be found in a wide range of fruits, vegetables, legumes, beans, nuts, dairy and grains. Examples include:

Oligosaccharides (fructans and galacto-oligosaccharides), which are found in onions, garlic, wheat, beans, nuts, fruits and vegetables.

Lactose, which is found in dairy products such as milk, soft cheese, yogurt.

Fructose in excess of glucose, which is found in honey, apples, juice, high fructose corn syrup.

Polyols, which are found in many fruits, vegetables and artificial sweeteners.

How does the low-FODMAP diet work to manage digestive symptoms?

Persons with IBS tend to have disturbances in gut motility and/or enhanced gut sensitivity. When FODMAPs are ingested, they are poorly absorbed, and ‘pull’ water into the intestines by osmosis. They are also rapidly fermented in the large intestines, generating gasses. These actions cause an increase in volume of intestinal contents, stretching the intestines and stimulating the nerves in the gut. This leads to pain and discomfort, and cause altered bowel habits such as diarrhoea and constipation.

How is the low-FODMAP diet implemented?

The low-FODMAP diet consists of three stages, and should be implemented under the strict guidance of a registered dietitian. In the first stage, lasting about 2 to 6 weeks, foods high in FODMAPs are eliminated. Once the symptoms are controlled, the client moves on to the second stage, where foods are re-introduced in a specific manner to assess tolerance to individual FODMAPs. This leads to the third stage of the diet, where the low-FODMAP diet is personalised to the individual according to her or his tolerances. This allows the consumption of a varied, balanced diet while avoiding symptoms.

Manuel Attard is a registered dietitian who received specialist training in the Low-FODMAP diet from Monash University Australia and is the first Maltese person to be listed in the Monash University FODMAP-trained Dietitians Directory.

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