The Low FODMAP Diet and Its Application in East and Southeast Asia

Abstract

There is growing interest in using food choice/dietary change to influence clinical outcomes in patients with irritable bowel syndrome (IBS). The low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) diet is an evidence-based approach that is gaining popularity in many Western countries. The low FODMAP diet is based on restricting dietary intake of short chain carbohydrates that are slowly absorbed or indigestible and not absorbed during passage through the small intestine. These are collectively described as "FODMAPs" and comprise oligosaccharides (mostly fructans, galacto-oligosaccharides), sugar polyols, fructose in excess of glucose, and lactose in lactose malabsorbers. The general strategy of the diet is to avoid foods high in FODMAPs and replace them with foods low in FODMAPs, with long-term restriction limited to what is required to control symptoms. The likely mechanism of action is minimisation of the stimulation of mechanoreceptors exerted by distension of the intestinal lumen with water from osmotic effects and gases from bacterial fermentation in those with visceral hypersensitivity. The success of this dietary approach greatly depends on detailed knowledge about the FODMAP composition of food com - monly consumed in that country. While the content of foods associated with East and Southeast Asian cuisines has not been fully explored, major high FODMAP sources are frequently used and include onion, garlic, shallots, legumes/pulses, and wheat-based products. Thus, this dietary approach holds great promise in treating IBS patients in East and Southeast Asia. The aim of this review is to highlight how the diet is implemented, its efficacy, and troublesome ingredients frequently used in Asian dishes.

Keywords: Asia; Diet; FODMAPs; Irritable bowel syndrome.

Figures

Figure 1.

Relative fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) ratings of common cereals and grains (based on a typical serve). A relative FODMAP rating is given to each ingredient tested for its FODMAP content. For each FODMAP sub-unit, fructose, lactose, fructan, galacto-oligosaccharides, and polyols, there is variability of tolerated dose levels and therefore classifying them semi-quantitatively in acceptable serving sizes as low (in green), moderate (in amber), and high (in red) is a practical approach to support the implementation and management of the diet in clinical practice.

Figure 2.

Relative fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) ratings of common Asian fruits (based on a typical serve). For each FODMAP sub-unit, fructose, lactose, fructan, galacto-oligosaccharides, and polyols, there is variability of tolerated dose levels and therefore classifying them semi-quantitatively in acceptable serving sizes as low (in green), moderate (in amber), and high (in red) is a practical approach to support the implementation and management of the diet in clinical practice.

Figure 3.

Fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) ratings of common Asian vegetables, tofu, legumes and nuts (based on a typical serve). Two examples where FODMAP content of foods/meals can change 1), although broccoli is rated low (green) for one serve (one-half of a cup or 47 g), if consumed in larger quantities, eg, 1 cup, this increases the FODMAP content in one sitting giving it a high (red) FODMAP rating. 2) As with celery, when the serving size of one-half a medium stalk or 19 g is consumed in larger quantities during one sitting, the FODMAP rating will change to high.

Figure 4.

Relative fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) ratings of commonly used condiments, herbs and spices. For each FODMAP sub-unit, fructose, lactose, fructan, galacto-oligosaccharides, and polyols, there is variability of tolerated dose levels and therefore classifying them semi-quantitatively in acceptable serving sizes as low (in green) and high (in red) is a practical approach to support the implementation and management of the diet in clinical practice.

Figure 5.

Relative fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) ratings of dairy products (based on a typical serve). For each FODMAP sub-unit, fructose, lactose, fructan, galacto-oligosaccharides, and polyols, there is variability of tolerated dose levels and therefore classifying them semi-quantitatively in acceptable serving sizes as low (in green), moderate (in amber), and high (in red) is a practical approach to support the implementation and management of the diet in clinical practice.