Rebuttal!  Question for The Low FODMAP Diet

Yoshiharu Uno, MD, PhD

I argue against the paper by Department of Pediatrics, Università Politecnica delle Marche in Italy.

The paper is as follows.

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https://www.ncbi.nlm.nih.gov/pubmed/28300773

Nutrients. 2017 Mar 16;9(3). pii: E292. doi: 10.3390/nu9030292.

The Low FODMAP Diet: Many Question Marks for a Catchy Acronym.

Catassi G, Lionetti E, Gatti S, Catassi C.

Department of Pediatrics, Università Politecnica delle Marche,

Abstract

FODMAP, "Fermentable Oligo-, Di- and Mono-saccharides And Polyols", is a heterogeneous group of highly fermentable but poorly absorbed short-chain carbohydrates and polyols. Dietary FODMAPs might exacerbate intestinal symptoms by increasing small intestinal water volume, colonic gas production, and intestinal motility. In recent years the low-FODMAP diet for treatment of irritable bowel syndrome (IBS) has gained increasing popularity. In the present review we aim to summarize the physiological, clinical, and nutritional issues, suggesting caution in the prolonged use of this dietary treatment on the basis of the existing literature. The criteria for inclusion in the FODMAPs list are not fully defined. Although the low-FODMAP diet can have a positive impact on the symptoms of IBS, particularly bloating and diarrhea, the quality of the evidence is lower than optimal, due to frequent methodological flaws, particularly lack of a proper control group and/or lack of blinding. In particular, it remains to be proven whether this regimen is superior to conventional IBS diets. The drastic reduction of FODMAP intake has physiological consequences, e.g., on the intestinal microbiome and colonocyte metabolism, which are still poorly understood. A low-FODMAP diet imposes an important restriction of dietary choices due to the elimination of some staple foods, such as wheat derivatives, lactose-containing dairy products, many vegetables and pulses, and several types of fruits. For this reason, patients may be at risk of reduced intake of fiber, calcium, iron, zinc, folate, B and D vitamins, and natural antioxidants. The nutritional risk of the low-FODMAP diet may be higher in persons with limited access to the expensive, alternative dietary items included in the low-FODMAP diet.

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The paper recognizes the effectiveness of a low FODMAP diet.

However, the authors were concerned about the two contents.

① Changes in intestinal flora

② Risk of reduced intake of fiber, calcium, iron, zinc, folate, B and D vitamins
 

What kind of disease will increase due to changes in intestinal flora?

Is there evidence?

Calcium, zinc, iron, vitamins etc can be sufficiently supplemented with other low FODMAP foods.

Japanese people did not eat high FODMAP meals until 1945.
However, since 1950 the intake of high FODMAP meals has increased.
Then, prevalence increased in many diseases.



This can be said to be the largest human experiment in history, targeting over 100 million people.