Irritable bowel syndrome affects 7-15% of the general population (1,2), is twice as frequent in women (3) and is commonly diagnosed in patients below 50 years of age (4). IBS is described as the recurrent episodes of functional gastrointestinal symptoms. The most common symptoms include bloating, abdominal pain, diarrhoea or constipation (5).
Evidence have shown that IBS may be caused by a combination of gastrointestinal motility changes, low-grade inflammation, visceral hypersensitivity, altered microbiota and food components (6-9). However, up to 70% of IBS patients associate symptom aggravation with certain foods (10-13). Therefore, a diet that can trigger or aggravate IBS symptoms are categorised as highly fermentable oligo-,di-, and monosaccharides, as well as polyols (FODMAPs) (14,15).
What is FODMAPs?
FODMAPs stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. They are a group of short-chain carbohydrates (SCCs) that are poorly absorbed in the GI tract and are rapidly fermented by gut bacteria (15-17).
What happens to our body when we consume food HIGH in FODMAPs?
When high FODMAPs enters the body, this evokes a larger production of gas such as hydrogen, methane and carbon dioxide from their fermentation (19), resulting in an increase in small bowel water content (20,21) and causes intestinal luminal distension that in turns provokes bloating, abdominal pain, flatulence and alterations in bowel habits (22).
Every individual reacts to certain groups of FODMAPs differently. A study by Böhn et al. found that 70% of surveyed patients reported to be sensitive to foods high in FODMAPs, 49% reported to be sensitive to diary products [high in lactose], 36% reported sensitivity to beans [galactans] and 23% reported sensitivity to plums [fructose + polyols] (23). While a diet with high FODMAPs triggers various IBS symptoms, it has been reported that a low FODMAPs diet can have a positive impact on IBS symptoms (24-28).
What happens to our body when we consume food LOW in FODMAPs?
Contrary to high FODMAPs, the primary mechanism of low-FODMAPs causes a reduction in small intestinal absorption of osmotically active SCCs. This action results in diminished intestinal water content and downstream effects on colonic fermentation and gas production (29,30).
Here are the list of LOW and HIGH FODMAPs:
You can get the printable PDF list here:
For more information of FOODMAPs, check out https://www.ibsdiets.org/fodmap-diet/fodmap-food-list/
The purpose of this article is not a total restriction of high FODMAPs in your lifestyle but more of understanding why certain food can make you feel discomfort after eating. Creating the awareness and being able to identify the different food that will trigger or sits well in your stomach helps you to perform better in your day to day activities without disturbances.
I hope the above gives you a clearer picture of why you feel discomfort or experience a change in bowel habits after consumption of certain food in your dietary. However, if you are experiencing severe IBS symptoms, do seek a healthcare professional for help!
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15. Barrett J.S., Gearry R.B., Muir J.G., Irving P.M., Rose R., Rosella O., Haines M.L., Shepherd S.J., Gibson P.R. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment. Pharmacol. Ther. 2010;31:874–882. doi: 10.1111/j.1365-2036.2010.04237.x.
16. Ong D.K., Mitchell S.B., Barrett J.S., Shepherd S.J., Irving P.M., Biesiekierski J.R., Smith S., Gibson P.R., Muir J.G. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J. Gastroenterol. Hepatol. 2010;25:1366–1373. doi: 10.1111/j.1440-1746.2010.06370.x.
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20. Barrett J.S., Gearry R.B., Muir J.G., Irving P.M., Rose R., Rosella O., Haines M.L., Shepherd S.J., Gibson P.R. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment. Pharmacol. Ther. 2010;31:874–882. doi: 10.1111/j.1365-2036.2010.04237.x.
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23. *Böhn L, Störsrud S, Törnblom H, Bengtsson U, Simrén M. Self-reported food-related gastrointestinal symptoms of IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol. 2013;108:634–41. This study investigates dietary food triggers using a food questionnaire in patients with IBS and their effects on gastrointestinal and psychological symptoms and quality of life.
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