All about FODMAPs: Who should avoid them and how?



FODMAP are a group of fermentable carbohydrates.


They are known to cause common digestive problems such as bloating, gas, stomach pain, diarrhea and constipation in those who are sensitive to them.


This includes a surprising number of people, particularly those with irritable bowel syndrome (IBS).


Fortunately, studies have shown that restricting foods rich in FODMAP can dramatically improve these symptoms.


This article explains what FODMAPs are and who should avoid them.


What exactly are the FODMAPs?


FODMAP It represents Fermentable ORligo-, reI-, SUBWAYono-saccharides and Poylols (1).


These terms are the scientific names given to the carbohydrate groups that can cause digestive problems in some people.


FODMAPs usually consist of short chains of linked sugars and are not completely absorbed by your body.


These two key characteristics are the reason why some people are sensitive to them (2).


Here are the main groups of FODMAPs:




  • Oligosaccharides: Carbohydrates in this group include fructans (fructooligosaccharides and inulin) and galactooligosaccharides. Key dietary sources include wheat, rye, various fruits and vegetables, legumes and legumes.


  • Disaccharides: Lactose is the main FODMAP in this group. The key dietary sources include milk, yogurt and soft cheese.


  • Monosaccharides: Fructose is the main FODMAP in this group. The key dietary sources include various fruits, honey and agave nectar.


  • Polyols: The carbohydrates in this group include sorbitol, mannitol and xylitol. The key dietary sources include various fruits and vegetables, as well as some sweeteners such as sugar-free gum.


As you can see, FODMAPs are found in a wide range of everyday foods.


Sometimes they are naturally present in food, while others are added to improve the appearance, texture or flavor of a food.


Bottom line: FODMAP means Oligo, Di, Mono-saccharides and fermentable polyols. These carbohydrates are poorly digested by humans.


How do FODMAPs cause intestinal symptoms?


FODMAP can cause intestinal symptoms in two ways: by withdrawing fluid into the intestine and through bacterial fermentation.


1. Extract fluid in the intestine


Because FODMAPs are short sugar chains, they are "osmotically active". This means that they draw water from their body tissue into their intestines (3, 4, 5, 6).


This can cause symptoms such as bloating and diarrhea in sensitive people (7, 8, 9, 10).


For example, when you eat the fructose FODMAP, you take twice as much water in your intestine as glucose, which is not a FODMAP (4).


2. Bacterial fermentation


When you eat carbohydrates, the enzymes break them down into simple sugars before they can be absorbed through the intestinal wall and used by your body.


However, humans can not produce some of the enzymes needed to break down FODMAP. This leads to undigested FODMAP traveling through the small intestine to the large intestine or colon (3, 4).


Interestingly, its large intestine harbors trillions of bacteria (11).


These bacteria rapidly ferment FODMAP, releasing gases and other chemicals that can cause digestive symptoms, such as bloating, stomach pain, and altered bowel habits in sensitive individuals (7, 8, 9, 10).


For example, studies have shown that when FODMAP inulin is ingested, it produces 70% more gas in the large intestine than glucose (4).


These two processes occur in most people when they eat FODMAP. However, not all are sensitive.


It is thought that the reason why some people have symptoms and others is not related to the sensitivity of the intestine, which is known as colonic hypersensitivity (6).


Colonic hypersensitivity is particularly common in people with IBS (12).


Bottom line: FODMAP carry water to the intestine and trigger bacterial fermentation in the large intestine. This happens in most people, but only people with sensitive bowels have a reaction.


So, who should try a low diet in FODMAP?


A diet low in FODMAP is achieved simply by avoiding foods high in these carbohydrates.


A group of researchers first suggested the concept for the management of IBS in 2005 (1).


IBS is more common than you can realize. In fact, one in 10 adults has IBS (13).


In addition, more than 30 studies have been conducted that prove the low FODMAP diet in people with IBS (9, 10, 14, 15, 16).


The results of 22 of these studies suggest that following this diet may improve the following (14):



  • General digestive symptoms

  • Abdominal pain

  • Swelling

  • Quality of life

  • Gas

  • Altered bowel habits (diarrhea and constipation)


It is worth noting that in almost all of these studies, the diet was administered by a dietitian.


In addition, the vast majority of investigations were conducted in adults. Therefore, there is limited evidence on children who follow low diets in FODMAP (17).


There is also some speculation that a diet low in FODMAP may benefit other conditions, such as diverticulitis and digestive problems induced by exercise. However, evidence of its use beyond IBS is limited (18, 19).


Bottom line: A diet low in FODMAP improves general digestive symptoms in approximately 70% of adults with IBS. However, there is not enough evidence to recommend the diet for the treatment of other conditions.


Things you should know about a low diet in FODMAP


Here are some things you should know about this diet.


It is a low diet in FODMAP, not a diet without FODMAP


Unlike food allergies, you do not need to completely eliminate FODMAP from your diet. In fact, they are beneficial for intestinal health (20).


Therefore, it is recommended that you include them in your diet, even your own personal tolerance.


A diet low in FODMAP is not gluten free


This diet is typically low in gluten by default.


This is because wheat, which is a major source of gluten, is excluded because it is high in fructans.


However, a diet low in FODMAP is not a gluten-free diet. Foods such as sourdough bread, which contains gluten, are allowed.


A diet low in FODMAP is not dairy free


Lactose FODMAP is typically found in dairy products. However, many dairy products contain low levels of lactose, which makes them low in FODMAP.


Some examples of low-fat dairy products in FODMAP include hard and aged cheeses, crème fraîche and sour cream.


The diet low in FODMAP is not a long-term diet


It is not desirable or advisable to follow this diet for more than eight weeks.


In fact, the low-diet process in FODMAP involves three steps to reintroduce FODMAP into your diet to your personal tolerance.


Information about FODMAP is not readily available


Unlike other nutrient data for vitamins and minerals, information on which foods contain FODMAP is not available to the public.


However, there are many lists of low FODMAP foods available online. However, you should keep in mind that these are secondary sources of data and that they are incomplete.


That said, full lists of foods that have been validated in studies can be purchased at both King & # 39; s College London (if you are a registered dietitian) and at Monash University.


Bottom line: The low FODMAP diet may contain some FODMAP, as well as gluten and dairy products. The diet should not be followed strictly in the long term and you should consider the accuracy of your resources.


Is a diet nutritionally balanced FODMAP low?


You can still meet your nutritional requirements on a low diet in FODMAP.


However, like any restrictive diet, you have an increased risk of nutritional deficiencies.


In particular, you should take into account your fiber and calcium intake during a low FODMAP diet (21, 22).


Fiber


Many foods that are high in fiber are also high in FODMAPs. Therefore, people often reduce their fiber intake on a diet low in FODMAP (21).


This can be avoided by replacing high-fiber FODMAP foods, such as fruits and vegetables, with low-FODMAP varieties that still provide a lot of dietary fiber.


Low fiber sources in FODMAP include oranges, raspberries, strawberries, green beans, spinach, carrots, oats, brown rice, quinoa, gluten-free wholemeal bread and flax seeds.


Calcium


Dairy products are a good source of calcium.


However, many dairy foods are restricted in a low FODMAP diet. This is why your calcium intake may decrease when you follow this diet (22).


Low sources of calcium in FODMAP include hard and aged cheeses, lactose-free milk and yogurt, canned fish with edible bones and walnuts fortified with calcium, oats and rice milks.


You can find a complete list of low-level foods in FODMAP using the following application or brochure.


Bottom line: A diet low in FODMAP can be nutritionally balanced. However, there is a risk of some nutritional deficiencies, such as fiber and calcium.


Does everyone who follows a diet low in FODMAP have to avoid lactose?


Lactose is the rei-saccharide in FOreMAPS.


It is commonly known as "milk sugar" because it is found in dairy products such as milk, soft cheese and yogurt.


Lactose intolerance occurs when your body produces insufficient amounts of breastfeeding.North American stock market, which is an enzyme that digests breast milk.ose.


This leads to digestive problems with lactose, which is osmotically active, which means that it extracts water and is fermented by intestinal bacteria.


In addition, the prevalence of lactose intolerance in people with IBS is variable, with reports varying between 20 and 80%. For this reason, lactose is restricted in a low FODMAP diet (23, 24, 25).


If you already know that you are not lactose intolerant, you do not need to restrict lactose in a diet low in FODMAP.


Bottom line: Not everyone needs to restrict lactose in a diet low in FODMAP. If you are not lactose intolerant, you can include lactose in your diet.


When you should seek medical advice


Digestive symptoms occur with many conditions.


Some conditions are harmless, such as swelling. However, others are more sinister, such as celiac disease, inflammatory bowel disease and colon cancer.


For this reason, it is important to rule out diseases before starting a low FODMAP diet. Signs of serious illness include (26):



  • Unexplained weight loss

  • Anemia (iron deficiency)

  • Rectal bleeding

  • Family history of celiac disease, intestinal cancer or ovarian cancer.

  • People over 60 who experience changes in bowel habits that last more than six weeks.


Bottom line: Digestive problems can mask underlying diseases. It is important to rule out a disease by consulting your doctor before starting a low FODMAP diet.


Bring the message home


FODMAPs are considered healthy for most people. However, a surprising number of people are sensitive to them, particularly those with IBS.


In fact, if you have IBS, there is an approximately 70% chance that your digestive symptoms will improve with a diet low in FODMAP (9, 10, 16, 21, 22).


This diet may also benefit other conditions, but research is limited.


The low FODMAP diet has been tested and is considered safe for adults. However, be sure to choose foods high in fiber and calcium, consult reputable resources and rule out underlying diseases.


Scientists are currently working on ways to predict who will respond to the diet. Meanwhile, the best way to find out if it works for you is to try it yourself.



Reference: https: //www.healthline.com/nutrition/fodmaps






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