Irritable Bowel Syndrome and FODMAP diet

Irritable Bowel Syndrome is a condition that affects about 10% of the world population and causes very unpleasant symptoms. Under medical supervision, a suggested solution might be the combination of a good probiotic with the FODMAP diet.

“Irritable Bowel Syndrome” (IBS) is a condition characterized by symptoms such as constipation, diarrhea, abdominal pain, vomiting and bloating, not attributable to organic or biochemical changes. It is estimated that about 10% of the adult population have this symptomatology, but only less than half seek medical attention.

The pathophysiology underlying IBS seems to include an alteration of the psychological sphere (anxiety, stress, hostility, phobia, paranoia) and alterations of gastrointestinal motor activity (both of the small intestine and of the pain following distension of the rectum). These factors can also be associated with excessive colic fermentation due to intestinal dysbiosis (increase in intestinal “bad” bacteria at the expense of “good” ones), alterations in the serotoninergic system and gastrointestinal inflammation.

The therapy is based on the treatment of the predominant gastrointestinal symptom and is often associated with psychological treatment and the intake of probiotics.

The effects of the diet on IBS vary from person to person and there is no single food that causes the syndrome. However, some foods may be the basis for worsening the frequency and intensity of symptoms. A diet therapy approach that has been very successful in the past is the FODMAP diet, combined with the introduction of probiotics. The FODMAP diet was proposed by researchers from Monash University in Melbourne. It traces the symptoms of IBS back to the high distension of the intestinal lumen caused by the ingestion of a group of substances united by being osmotically active and poorly absorbed in the small intestine (with subsequent fermentation in the colon). What occurs following the ingestion of these foods is an accumulation of liquids and gases, high gastrointestinal motility, alterations in the composition of the intestinal microbiota and the onset of inflammatory processes.

Substances imputed by Australian researchers include:

  • Fructans: Short chains of fructose molecules characterized by a glucose molecule as a graft. We find them in many cereals (wheat, spelled, barley and rye), vegetables (artichokes, garlic, onion, leek, shallot), fruit (peaches, persimmons, watermelon), legumes (lentils, chickpeas, beans), fibers and supplements used in many industrial foods (inulin and fructooligosaccharides);
  • Galacto-oligosaccharides: Galactose polymers with fructose and glucose at the end. We find them particularly in legumes (beans, peas, soy, chickpeas, lentils);
  • Lactose: Disaccharide formed by the union of a glucose molecule and a galactose molecule. It is found in milk (cow, goat and sheep), in its derivatives (cream, yogurt and cheeses) and in products containing dairy products;
  • Fructose: Monosaccharide very abundant in fruit (apples, pears, cherries, watermelon), vegetables (asparagus, artichokes, peas, broad beans) and sweeteners (agave, fruit concentrates, glucose-fructose syrup);
  • Polyols: Sugary substances naturally present in fruit and vegetables but also widely used as sweeteners by the food industry, thanks to their high sweetening power and low calorie intake. We find them in fruit (apples, pears, apricots, peaches, plums, blackberries and watermelon), vegetables (cabbage, broccoli, Brussels sprouts, cabbage, mushrooms), sweeteners and additives (sorbitol, mannitol, maltitol, isomalt, lactitol, xylitol and erythritol).

The dietary approach has an elimination phase of foods rich in FODMAPs (about 3-6 weeks), a reintegration phase (the most important and difficult part to manage) and a maintenance phase. Integration with high-quality probiotics is a fundamental aid in restoring the balance between “good bacteria” and “bad bacteria”. FODMAP is a sometimes restrictive approach that could lead to important nutritional deficiencies. Furthermore, it is important that the reintegration phase takes place following certain times and procedures linked to the patient himself. For this reason, we suggest that you always be followed by a nutrition expert if you decide to undertake this diet therapy program.

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