Dietary practices and FODMAPs in South Asia: Applicability of the low FODMAP diet to patients with irritable bowel syndrome

Abstract

The low Fermentable Oligosaccharides, Disaccharides, and Monosaccharides And Polyols (FODMAP) diet has been described, evaluated, and found efficacious for the treatment of patients with irritable bowel syndrome primarily in Western countries. The aim of this review was to address the applicability of this diet to South Asia. The high prevalence of irritable bowel syndrome in South Asia and its associated effects of quality of life and economics warrant the introduction of efficacious therapies. The considerable heterogeneity of dietary patterns and methods of food preparation across South Asian countries and a paucity of food analysis limit precision in defining foods that are high or low in FODMAPs. Spices and condiments are commonly consumed and mostly have a low FODMAP content. However, major high FODMAP sources are frequently used and include onion, garlic, shallots, legumes/pulses, and wheat‐based products, as well as coconut and milk products, offering an opportunity for dietary management to reduce the symptom load. The feasibility of instituting a restrictive diet in which foods with a high FODMAP content are replaced by foods low in FODMAPs must be addressed as a substantial proportion of the nutritional intake including energy, proteins, and micronutrients, is often obtained from FODMAP‐rich food. Furthermore, limited knowledge of health professionals together with a paucity of dietitians further challenge the practicality of introducing the diet. Thus, while the use of the low FODMAP diet in South Asia may be more limited than in westernized countries, it does offer potential therapeutic opportunities, the efficacy, and impact of which require further investigation.

Early experience with a low FODMAP diet in Asian patients with irritable bowel syndrome

“…Hewawasam et al have highlighted some of the following challenges that would be a barrier to the implementation of a low FODMAP diet in South Asia-poor knowledge of FODMAP content of local diet, potential of malnutrition with FODMAP restriction, poor labeling of packaged food ingredients, poor social acceptance of low FODMAP alternative foods, lack of dietetic expertise, poor English literacy, and lack of knowledge of the dietary literature. 24 We believe that many of these challenges are pertinent to the Malaysian scenario as well. The Malaysian diet is complex, as alluded to before, 25 and its FODMAP content has not been completely evaluated.…”

Second Asian Consensus on Irritable Bowel Syndrome

“…147 Specifically to Asian populations, the role of a low FODMAPs diet in the management of IBS requires further study as studies are lacking. 148,149 While in some communities (eg, India with high prevalence of vegetarianism) diets may be high in FODMAPs, others may traditionally be relatively low (eg, China and Japan). 48,148,149 Lactose as a FODMAP is of specific relevance to Asia as lactase deficiency is almost universal in Asians.…”

“…148,149 While in some communities (eg, India with high prevalence of vegetarianism) diets may be high in FODMAPs, others may traditionally be relatively low (eg, China and Japan). 48,148,149 Lactose as a FODMAP is of specific relevance to Asia as lactase deficiency is almost universal in Asians. 88,150 However, as the average daily consumption is relatively low, the role of lactose-containing dairy foods in Asia is uncertain.…”

Feasibility of Low Fermentable Oligosaccharide, Disaccharide, Monosaccharide, and Polyol Diet and Its Effects on Quality of Life in an Italian Cohort

“…Nonetheless, food and taste are a direct expression and consecution of local cultures, and every food culture differs from others in terms of FODMAP quality and quantity; thus increasing the complexity of the problem of the applicability and acceptability of the low FODMAP dietary plan [15].…”