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Friend or foe? The role of dietary supplementation in low-FODMAP diets

Article-Friend or foe? The role of dietary supplementation in low-FODMAP diets

© iStock/urbazon Friend or foe? The role of dietary supplementation in low-FODMAP diets
The low-FODMAP diet has attracted attention as an intervention for functional gut disorders, such as irritable bowel syndrome (IBS). Could there be a role for dietary supplementation in this highly restrictive regime?

Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are components of a wide variety of products. Examples of high-FODMAP foods include dairy- or wheat-based products; beans and lentils; some vegetables, including artichokes, asparagus, onions, and garlic; and some fruits, including apples, cherries, pears, and peaches.

Intake of FODMAPs is thought to exacerbate gastrointestinal symptoms in people with IBS because these compounds are poorly absorbed in the small intestine, so they pass to the large intestine, where gut bacteria rapidly ferment them into short-chain fatty acids and gases.

IBS is a common gut disorder with symptoms including abdominal pain, cramping, bloating, and changes in bowel habit. Affecting 11.2% of individuals worldwide, it is often comorbid with conditions like depression and anxiety, and has a significant impact on quality of life.

Aside from FODMAPs, other common IBS diet triggers include fibre, gluten, caffeine, fat, and alcohol.

Medical approaches for managing IBS are limited in their effectiveness and so dietary interventions have attracted attention instead.

Low-FODMAP diet alleviates symptoms in 75% of IBS patients

The low-FODMAP diet, which was first developed by researchers at Australia’s Monash University in 2005, has been shown to help three in four people with IBS manage their symptoms.

It is a three-step elimination diet wherein followers stop eating all high-FODMAP foods, before slowly reintroducing them to see which ones are troublesome. Once the foods that trigger symptoms have been identified, they can be avoided or limited.

However, concerns have been raised over the nutritional adequacy of low-FODMAP diets, particularly with regards to calcium and fibre; many FODMAP compounds (fructans, α-galacto-oligosaccharides) are a part of dietary fibre, the protective effects of which are widely recognised.

Meanwhile, some demographics – such as children, adolescents, and the elderly – might be at a higher risk of deficiencies if following the diet.

As both calcium and fibre are widely under-consumed in the general population, research suggests that the low-FODMAP diet does not significantly impact on nutrition adequacy compared with standard diets.

FODMAPs may be hiding in supplement ingredient lists

Supplementation provides a potential solution to nutritional shortfall. But how can consumers be sure that these products do not themselves contain ingredients that will trigger their symptoms?

Some FODMAPs – such as inulins, lactose, or polyols – may be hidden within supplement ingredients lists, while some multivitamins contain more than 100% of the recommended intake for nutrients, which can cause problems for IBS sufferers. For example, supplements containing an excess of iron or magnesium are known to cause gastrointestinal upset.

A 2017 study assessing the gastrointestinal tolerance of three low-FODMAP oral nutrition supplements in healthy adults concluded that such supplements were well tolerated.

Functional foods feel the plumping effect

Functional foods offer an opportunity for brands to innovate when it comes to gut-friendly products.

ATP Science, an Australian brand, last year launched its Noway Minty Choc Cookie Collagen Frozen Dessert, which is claimed to be the first patent-pending collagen frozen dessert with collagen protein. While the product uses plant-based milk – it is made with coconut cream – it includes animal collagen and gelatine.

While this combination may seem contradictory, the company says it bases its ingredient choices on the belief that “all health comes from the gut”, adding that it loves collagen “because it is also gut-friendly, unlike many dairy- or legume-based proteins”.

© iStock/Marina KomrakovaFriend or foe? The role of dietary supplementation in low-FODMAP diets

Collagen peptides are an easily digestible, bioavailable form of protein – extremely helpful in the case of unhealthy guts, which often struggle to absorb nutrients from food sources, especially proteins. Two of the amino acids found in collagen, glycine and glutamine, may be particularly useful for gut health, as they are essential for rebuilding the tissue that lines the digestive tract. Glycine may also help to alleviate inflammation.

The future of FODMAP removal

A 2020 review assessing the possibility of targeted FODMAP removal from foods via bioprocessing concluded that enzymatic treatment, fermentation, and germination can be used to significantly reduce levels of galacto-oligosaccharides, fructans, and lactose.

“Implications of targeted FODMAP reduction in foods by bioprocessing should be considered in particular from nutritional, sensory, and tolerance perspectives,” the authors added.

A 2023 study exploring technological and biotechnological strategies applicable to the formulation of low-FODMAP products concluded that “much more research is needed” to inform the development and formulation of such products.

“Ingredient selection, enzymatic approach, reduction mediated by yeast, LAB fermentation, and the use of sourdough, applied alone or in combinations, have been proven to be effective methods to reduce the FODMAPs content in cereal-based products,” the authors wrote.

“A further step could be represented by the use as ingredients in low-FODMAPs products of compounds able to mitigate IBS symptoms, such as fibres (eg. ispaghula [psyllium]), polyphenols, vitamin D, and peppermint oil. However, although these compounds have been proven to be effective, no studies can be found in the literature dealing with their incorporation in low-FODMAPs food items.”