Low FODMAP diets—Boon or bane for individuals with GI disorders

Abstract

The prebiotic concept speculates that consuming non-digestible carbohydrates can positively affect the human gut microbiota, providing favorable health benefits (Vandeputte & Joossens, 2020). Multiple studies have corroborated these findings, reporting a notable increase in the numbers of bacteria from the families Bifidobacteriaceae and Lactobacillaceae (Mora-Flores et al., 2023; Vandeputte & Joossens, 2020). These bacteria work by either fermenting the prebiotic components in the diet (primary degraders) or stimulating the growth of other bacterial species through the metabolization of prebiotics, thereby generating viable substrates by way of cross-feeding (You et al., 2022). Consequently, the consumption of prebiotics imparts various health benefits via multiple mechanisms, for instance, the production of short-chain fatty acids (SCFAs) (Sanders et al., 2019) and the stimulation of the microbiome resulting in an increase in the population of favorable bacteria, or a reduction in the numbers of unfavorable bacteria (such as Akkermansia muciniphila, Faecalibacterium prausnitzii) thereof (Verhoog et al., 2019). The dysbiotic microbiomes of diseased individuals, however, present a considerably different challenge altogether, stemming from the high likelihood of side effects (water retention and gas production) induced by the fermentation of non-digestible carbohydrates at various sites in the small intestine and colon and that in turn can interfere with the symptoms (e.g., bloating, gas, abdominal pain, and diarrhea) commonly attributable to chronic gastrointestinal (GI) conditions, such as irritable bowel disorder (IBD), and irritable bowel syndrome (IBS) (Halmos & Gibson, 2019). Therefore, diets low in fermentable carbohydrates emerged as a viable alternative support mechanism for patients with GI disorders such as IBS. Termed the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, the support for the strategy was reinforced by the observed symptom relief in GI disorder patients (Bellini et al., 2020), with many patients reporting improvements within 2–4 weeks of the dietary changes (Morariu et al., 2023), as well as a marked reduction in GI distress, and consequently, a significant improvement in the quality of life (Hill et al., 2017). Moreover, low-FODMAP diets involve a structured elimination and reintroduction process. They can be personalized from the perspective of individual tolerances, aiding the patients in effectively managing the symptoms through identifying trigger foods and a balanced intake (Bertin et al., 2024). Furthermore, as patients are encouraged to seek professional advice from healthcare experts, guidance and support can help prevent any adverse health outcomes commonly attributed to dietary limitations (Morariu et al., 2023).

Keywords: FODMAP, Boon, GI Disorders, Bifidobacteriaceae, Carbohydrates