FODMAP fermente edilebilir oligosakkaritler, disakkaritler, monosakkaritler ve poliollerin baş harflerinden oluşan bir terimdir. FODMAP grubunda oligosakkaritlerden fruktan ve galaktanlar, disakkaritlerden laktoz, monosakkaritlerden fruktoz, poliollerden ise sorbitol ve mannitol ele alınmaktadır. FODMAP bileşenleri, ince bağırsakta zayıf emilen, kolona ulaşabilen, kolonda bakteriler tarafından hızlı fermente edilebilen, küçük ve dolayısıyla ozmotik olarak aktif moleküllerdir. Diyetle FODMAP alımı, kolonik gaz oluşturabilmekte, fermantasyon ile birlikte ozmotik yükü arttırabilmekte, bağırsak motilitesini etkileyebilmekte ve immün aktivasyon mekanizmaları ile gastrointestinal semptomların ortaya çıkmasına yol açabilmektedir. Bu karbonhidratların özellikle irritabl bağırsak sendromunun (İBS) ve bazı gastrointestinal hastalıkların semptomlarını arttırabildiği düşünülmektedir. Düşük FODMAP diyeti ise fonksiyonel gastrointestinal semptomları azaltmaya yönelik bir diyet olup, ön aşama, kısıtlayıcı aşama ve FODMAP ile yeniden tanıştırma aşamalarından oluşmaktadır. Düşük FODMAP diyetinin İBS semptomlarını azaltabileceği gösterilmiş; Crohn hastalığı, ülseratif kolit, çölyak tanısı olmayan gluten duyarlılığı, divertikülit, fonksiyonel dispepsi, kolik ve çocukluktaki abdominal ağrı semptomları üzerinde yararlı etkiler oluşturabileceğine dair kanıtlar bulunmuştur. Buna karşın, düşük FODMAP diyetinin uzun süre uygulamalarının bağırsak mikrobiyotası üzerinde oluşturacağı olumsuz etkiler ve yetersiz posa alımının neden olacağı riskler iyi değerlendirilmelidir. Bu derlemenin amacı, FODMAP grubunda yer alan karbonhidratların gastrointestinal semptomlarla ilişkisinin incelenmesi ve düşük FODMAP diyet önerilerinin oluşturulmasıdır.
Anahtar Kelimeler: Fermente edilebilir oligosakkaritler; disakkaritler; monosakkaritler; polioller; FODMAP; diyet; gastrointestinal hastalıklar
FODMAP is a term consisting of the initials of fermentable oligosaccharides, disaccharides, monosaccharides and polyols. In the FODMAP group, fructane and galactans from oligosaccharides, lactose from disaccharides, fructose from monosaccharides, sorbitol and mannitol from polyols are discussed. FODMAP components are small, and therefore osmotically active, molecules that are poorly absorbed in the small intestine, which can reach the colon, can be quickly fermented by bacteria in the colon. Dietary FODMAP intake can produce colonic gas, increase osmotic load with fermentation, affect bowel motility, and cause immune activation mechanisms and gastrointestinal symptoms. These carbohydrates are thought to increase the symptoms of irritable bowel syndrome (IBS) and some gastrointestinal diseases. The low FODMAP diet is aimed at reducing functional gastrointestinal symptoms, consisting of the pre-stage, restrictive stage, and re-introduction to FODMAP. A low FODMAP diet has been shown to reduce IBS symptoms; evidence has been found to have beneficial effects on Crohn's disease, ulcerative colitis, gluten sensitivity without celiac diagnosis, diverticulitis, functional dispepsy, colic and abdominal pain in childhood. However, the adverse effects of longterm administration of low FODMAP diet on the intestinal microbiota and the risks of insufficient fiber intake should be well evaluated. The aim of this review is to investigate the relationship between carbohydrates in the FODMAP group and gastrointestinal symptoms and to establish low FODMAP dietary recommendations.
Keywords: Fermentable oligosaccharides; disaccharides; monosaccharides; polyols; FODMAP; diet; gastrointestinal diseases
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