FODMAPs and carbohydrate intolerance

Carbohydrates that are slowly absorbed or indigestible are important for health in terms of laxation and supporting a healthy microbiome and colonic mucosa. However, they can also induce symptoms if consumed in high dose or if visceral hypersensitivity is present. The most important therapeutically are short-chain carbohydrates (FODMAPs), comprising fructose, polyols and non-digestible oligosaccharides and lactose (if hypolactasic). Reducing all FOMAPs in the diet has an extensive evidence base for alleviating symptoms in the majority of patients with irritable bowel syndrome. The FODMAP diet involves restriction flowed by reintroduction of individual FODMAPs and personalization into a maintenance diet. The diet has risks shared by most restrictive diets such as nutritional inadequacy, alteration of the microbiota and over-restriction, but these are minimized with education by an adequately trained dietitian. It behooves all professionals managing patients with irritable bowel syndrome to upskill in dietary carbohydrates, FODMAPs and how to safely manipulate their intake.