FODMAPs: food composition, defining cutoff values and international application

by luciano

Abstract
The low-FODMAP diet is a new dietary therapy for the management of irritable bowel syndrome that is gaining in popularity around the world. Developing the low-FODMAP diet required not only extensive food composition data but also the establishment of “cutoff values” to classify foods as low-FODMAP. These cutoff values relate to each particular FODMAP present in a food, including oligosaccharides (fructans and galacto- oligosaccharides), sugar polyols (mannitol and sorbitol), lactose, and fructose in excess of glucose. Cutoff values were derived by considering the FODMAP levels in typical serving sizes of foods that commonly trigger symptoms in individuals with irritable bowel syndrome, as well as foods that were generally well tolerated. The reliability of these FODMAP cutoff values has been tested in a number of dietary studies. The development of the techniques to quantify the FODMAP content of foods has greatly advanced our understanding of food composition. FODMAP composition is affected by food processing techniques and ingredient selection. In the USA, the use of high-fructose corn syrups may contribute to the higher FODMAP levels detected (via excess fructose) in some processed foods. Because food processing techniques and ingredients can vary between countries, more comprehensive food composition data are needed for this diet to be more easily implemented internationally.

Extrat from the study:
A – “ omissis The Monash University Department of Gastroenterology has performed extensive work for over 10 years to quantify the FODMAP composition of hundreds of foods. Foods tested for FODMAP content represent a range of categories, including fruit and vegetables; grains, cereals, pulses, nuts, and seeds; dairy products and dairy free alternatives; meat, fish, poultry, and eggs; fats and oils; beverages; and condiments and confectionary. Some of these data have been published previously (12 -14) and are summarized in Figs 1 and 2. With growing international interest in the low-FODMAP diet, our program of FODMAP food analysis is expanding to include more international foods. This paper will dis- cuss the criteria for classifying food as low in FODMAPs and the challenges encountered in analysing food for FODMAP content.

B – “omissis.. Cutoff values were initially derived by considering (based on clinical experience) the FODMAP content and typical serving size of food, consumed in a single sitting or meal, that commonly trig- gered symptoms in individuals with IBS (e.g. onion, garlic, wheat bread, and apple). Foods that were generally well tolerated were also considered. This enabled the establishment of threshold levels for each FODMAP, above which most people experience symp- toms. The levels were set conservatively to allow people to include a number of low-FODMAP foods at each sitting. Table 2 provides examples of how cutoff values are applied to individual food items, to classify them as low in FODMAPs.
The reliability of these FODMAP cutoff values was tested in a number of dietary studies (2-4) An upper limit of 0.5 g of total FODMAPs (excluding lactose) per sitting was applied to the low-FODMAP arm of these studies, and this was generally well tolerated….”

C – The coexistence of gluten and FODMAPs in grain and cereal foods is evident in Fig. 5, which shows that many gluten- containing cereal products are high in FODMAPs (mostly fructans), while most gluten-free grains are low in FODMAPs.

D – The effect of ingredients on final FODMAP content may be me- diated by food processing techniques. Food processing techniques known to affect FODMAP levels include processes that involve heating and water, which can result in water-soluble FODMAPs (such as fructans and GOS) leaching into the surrounding liquid. For instance, canned lentils are lower in FODMAP, GOS, than boiled lentils.

F – The mediating effect of food processing on final FODMAP con tent is highlighted in spelt-containing products. While spelt flour is typically lower in FODMAPs (mostly fructans) than modern wheat, the use of spelt flour does not necessarily result in a low-FODMAP product. As shown in Fig. 8, while spelt flakes and spelt pasta are high in FODMAPs, sourdough spelt bread is low in FODMAPs. It appears that the spelt flour requires additional processing to lower the oligosaccharides (fructan) content. When a traditional sourdough culture (naturally high in lactobacilli) is used, together with a long proving time, bacteria metabolize the oligosaccharides (fructan) present in the spelt flour, thereby lowering fructan levels of the final product.

Depeening
FODMAPs: food composition, defining cutoff values and international application
Jane Varney, Jacqueline Barrett, Kate Scarlata, Patsy Catsos, Peter R Gibson and Jane G Muir Journal of Gastroenterology 9 dicembre 2016