In cases of irritable bowel syndrome, a diet low in FODMAPs – these fermentable sugars present in our diet – is often beneficial, but also sometimes ineffective. A study provides an explanation: everything depends on the composition of the intestinal microbiota.
A diet low in FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides and Polyols) can improve intestinal symptoms linked to irritable bowel syndrome. FODMAPs are sugars found everywhere in our food that ferment in the intestine.
The benefit of reducing FODMAPs in cases of irritable bowel
Irritable bowel syndrome (IBS) is characterized by pain (spasms, twisting, sometimes burning) associated with bloating and transit disorders. These symptoms can significantly impact quality of life. This is why, in addition to medications (antispasmodics and transit regulators) and lifestyle adjustments, notablyrégime is prescribed by a doctor, in particular a hepato-gastroenterologist, and supervised by a dietician to limit the risk of deficiencies.
The low FODMAP diet: unpredictable effectiveness
Overall, this diet appears to improve symptoms of irritable bowel syndrome in at least half of individuals, with an effect on abdominal pain, bloating and flatulence. But it doesn’t work for everyone. For what ? A study published inThe Lancet eBioMedicinedated September 2024 reveals that the response to the low FODMAPs diet actually depends on the composition of the intestinal microbiotaspecific to each person and which can vary depending on diet, taking antibiotics, certain illnesses, etc. English researchers have found that this diet is more effective in cases of significant dysbiosis (disruption in the quantity and diversity of intestinal flora), characterized by a bacterial environment rich in bacteria. Firmicutes and poor in Bacteroidetes.
More effective in cases of unbalanced intestinal flora
To establish this observation, the authors analyzed and compared the fecal volatilome of 112 individuals, including 56 suffering from irritable bowel syndrome. The fecal volatilome is all the volatile metabolites emitted by the feces, that is to say the products of degradation of food by the bacteria of the intestinal flora. After four weeks of a low-FODMAP diet, significant reductions in short-chain fatty acids were observed only in people with IBS with dysbiosis, an indicator of a response to the diet. Around 43.8% of patients with high dysbiosis were in remission after the diet, compared to 25% of controls, with a more marked response and reduction in pain.
In current practice, this analysis of feces is not yet possible, but the authors of the study believe that the technique could quickly be deployed.
What are FODMAPs?
FODMAPs are found throughout the diet.
– The pcereal products: The types of sugars to avoid are oligosaccharides (fructo- and galacto-oligosaccharides).
Foods to limit: wheat and its derivatives, barley, rye, as well as breads containing added sugar (fructose or sorbitol).
– Lare theregreen vegetables: The types of sugars to avoid are oligosaccharides.
Foods to limit: onion, shallot, garlic, mushroom, cauliflower, Brussels sprouts, broccoli, Jerusalem artichoke, artichoke, leek, asparagus, beetroot, avocado, eggplant and dried vegetables.
– Milk and dairy products: The type of sugar involved is lactose, a disaccharide.
Foods to limit: milk, its derivatives and dairy products. They can be replaced with lactose-free or low-lactose milk.
– Fruits: Types of sugars to avoid are monosaccharides (fructose) and polyols.
Foods to limit: apple, pear, apricot, cherry, nectarine, peach, plum, blackberry, watermelon, lychee, mango, date, fig, guava, persimmon, prune, as well as oilseed fruits (pistachios and cashew nuts).
– Industrial preparations and products containing polyols: The types of sugars to avoid are polyols (sorbitol, mannitol, maltitol and xylitol), present in particular in sugar-free chewing gum.
To find out more: Irritable bowel syndrome: which strains of probiotics are recommended?
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