Talk:FODMAP

What the hell is FGID?

Don't use an acronym or abbreviation without telling us what it stands for. Write for a lay audience. — Preceding unsigned comment added by 71.41.7.58 (talk) 19:56, 15 May 2014 (UTC)

See the second paragraph of the lede. Mutt Lunker (talk) 17:03, 18 May 2014 (UTC)

I agree with 71.41.7.58. Since the ledes and the bodies of the articles are meant to stand alone from one another, I defined the acronym in the body. Thank you, Wordreader (talk) 01:32, 4 January 2015 (UTC)

Possible error in sentence?

I'm pretty sure "gluten grains are wheat, barley and rye free" should read either "gluten free grains are wheat, barley and rye free" or "gluten grains are wheat, barley and rye" (free omitted). I'm not sure which one is appropriate, else I'd go ahead and change it. Iridium191 (talk) 01:05, 18 August 2014 (UT

Mix of grains and food products

The following sentence is a confusing mix of grains, a broadleaf seed, and one root, and products made from them. "Grains: wheat-free grains/wheat-free flours (gluten-free grains are free of wheat, barley and rye): bagels, breads, hot/cold cereals (corn flakes, cream of rice, grits, oats, etc.), crackers, noodles, pastas, quinoa, pancakes, pretzels, rice, tapioca, tortillas, waffles" I suggest the following (I am an Agronomist, not a medical/FODMAP expert) :

"Grains: Corn/maize, rice, oats (non gluten-free oats may have an occasional wheat kernel in the lot)

Seeds: Quinoa

Root crops: Manioc/cassava/yuca (tapioca)" Rick DeLoughery (talk) 16:26, 18 August 2014 (UTC)

Article problems.

ONE: I am confused. Is this meant to be an article on the short-chain FODMAP carbohydrates or the FODMAP diet? It seems to be a mash-up of both topics.

a. If it's about the carbohydrate classification, then the diet stuff needs to be expunged. More information should be inserted on the chemistry and digestion of such carbs in humans as well as in other creatures who eat them. It's light on the science of the carbs (but don't go overboard - we want laypersons to understand what they are reading).

b. If it's about the diet, then "diet" should be added to the title and there should be information about the purpose of it - as a short-term trial with an initial elimination phase of about 6-8 weeks. This is followed by a challenge phase when foods are reintroduced in order for an irritable bowel syndrome (IBS) sufferer to discover what food intolerances are specifically causing their symptoms. It was never meant to be a long-term diet. Also, there are some variations in the FODMAP-ianism of some of the foods listed. Chocolate, for example. Monash University finds that dark chocolate at 30 grams is low-FODMAP while milk and white chocolate are moderate FODMAP levels. Carob powder is high. http://www.med.monash.edu.au/cecs/gastro/fodmap/diet-updates/chocolate.html. Another example is the cabbage group. Smooth-leaved, common cabbage is allowed in the diet up to a cup-full per sitting while some other cabbages are restricted to 1/4 cup due to the amount of fructans they contain. There may be other foods where their assessment differs from your sources. With various research institutions studying IBS and FODMAPs, there are bound to be different findings between them. If the result of one researcher is listed while others vary, then it should be mentioned that FODMAP assessment varies between researchers.

- This article makes the same mistake that a lot of people do. It is not gluten that causes IBS problems: gluten is protein. People with celiac disease cannot tolerate gluten, even to the point of death if left uncontrolled. By itself, people with IBS have no problem with gluten. It is the FODMAPs in wheat, rye, and barley that cause the problems, specifically the fructans, I believe. It is coincidental that foods high in gluten are also high in fructans. http://www.med.monash.edu/cecs/gastro/fodmap/faq.html - item #4 http://www.med.monash.edu/cecs/gastro/education/2013-public-lecture.html

- NOTE: On the Monash University link you provide, they offer a gratis downloadable FODMAP diet smart phone application: http://med.monash.edu.au/cecs/gastro/fodmap/

TWO: Odd sentence - "These include short chain (oligo-) saccharide polymers of fructose (fructans) and galactose (galactans), disaccharides (lactose), monosaccharides (fructose). . ." Can the authors please explain what appears to be inconsistencies/redundancies?

THREE: References 2 & 3 are the exact same source, please combine:

- 2-Gibson, PR; Peter R Gibson and Susan J Shepherd (2010). "Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach". Journal of Gastroenterology and Hepatology 25 (2): 252–258. doi:10.1111/j.1440-1746.2009.06149.x. PMID 20136989

- 3-Gibson PR, Shepherd SJ (2010). "Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach". Journal of Gastroenterology and Hepatology 25 (10): 252–258. doi:10.1111/j.1440-1746.2009.06149.x.PMID 20136989

FOUR: Reference 6. links to a medical practice that offers information, but also enthusiastically sells books. The "Shopping Cart" is there in the right-hand column of the homepage. This article from US News & World Report seems like a reliable replacement: http://health.usnews.com/health-news/blogs/eat-run/2012/08/28/ibs-could-be-the-fodmaps , as does this page from the University of North Carolina's Center for Functional GI & Motility Disorders: http://www.med.unc.edu/ibs/news/fats-fodmaps

Thank you, Wordreader (talk) 06:30, 4 January 2015 (UTC)

If the article is currently covering what should be two articles, it ought to be split as two articles then, but material shouldn't just be deleted to make it one or the other only. There is only one mention of gluten in the article and it is not an implication of it as a cause of IBS but a note in the suggested foods section that "gluten-free grains are free of wheat, barley and rye", which is probably better-worded as as "products" rather than "grains" but true. You may regard this as superfluous or straying into WP:NOTHOWTO or something, or if you feel your misinterpretation of what is said could be reworded, have a go.

I believe I understand the sentence you find odd, so a clarification as to what you find inconsistent or redundant would be useful. I am not particularly suggesting this as an alternative wording but I understand it as: "These include fructans and galactans (which are short chain (oligo-) saccharide polymers of fructose and galactose respectively), lactose (a disaccharide), fructose (a monosaccharide), and sorbitol, mannitol, xylitol and maltitol (sugar alcohols (a class of polyol))."

The site with the shopping cart is that of the dietetic practice of the same Dr. Shepherd who is co-author of the paper in ref 2, but supplement or replace it with other refs if you feel that is required. Mutt Lunker (talk) 00:40, 5 January 2015 (UTC)

Half and half

What is meant by "half and half"? 81.170.15.209 (talk) 09:47, 10 February 2016 (UTC)

Presumably the North American definition of the term, though it would be nice if the recommendation was for the Scottish one. Mutt Lunker (talk) 11:39, 10 February 2016 (UTC)

Mandatory v discretionary restriction of different FODMAPS

The notes in sub-headings as to which FODMAPS are mandatory and which discretionary is far from a mere "diet suggestion" but a significant elaboration of matters covered in the "absorption" section above. No-one need restrict fructose or lactose if a hospital test has not indicated intolerance. To do so is not beneficial and arguably detrimental because of the added difficulties of unnecessary further dietary restriction. Mutt Lunker (talk) 13:36, 22 July 2016 (UTC)

The article should be informing on the sources of FODMAPs rather than an instruction manual how to follow a low-FODMAP diet. I would remove the "mandatory" and "discretionary" from headings. And I question whether a "hospital test" is needed. Jrfw51 (talk) 08:12, 23 July 2016 (UTC)

Thanks for your edits, which I support and regard as a clearer explanation but as they cover the same matter, not sure why you would regard their predecessor as an instruction manual. A hospital test is not "needed" but for fructose and lactose can be had, that's all; not the case for other FODMAPs, or at least not widely available, as far as I'm aware. Mutt Lunker (talk) 10:59, 23 July 2016 (UTC)

I didn't see this conversation before my last edit – apologies – but please don't revert it until we reach a consensus (to avoid edit warring). I agree with Jrfw51. The article is primarily about FODMAPs not a low-FODMAP diet, and the section in question is about sources of FODMAPs not how to avoid them. The text in parenthesis were just diet suggestions and did not fit with the content. Furthermore, they were inaccurate. Sensitivity to particular FODMAPs varies from person to person, with some people only being sensitive to one particular group, so no one group can be labelled as "mandatory" to avoid. McLerristarr | Mclay1 09:18, 24 July 2016 (UTC)

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Further reading suggestion

Simple introduction to the topic from diet angle from New Scientist https://www.newscientist.com/article/2152877-gluten-sensitive-it-may-actually-be-a-carb-making-you-ill/ I'd add this myself but I'm not using a device I can edit on properly. Please go ahead and add it if you think it suitable. 87.114.67.61 (talk) 13:10, 6 March 2019 (UTC)Istobe87.114.67.61 (talk) 13:10, 6 March 2019 (UTC)

Still unclear

What does "Depending on the choice of other foods consumed in the daily diet, cereals may be only relatively minor sources of FODMAPs" mean? If it means "if you don't eat much of x (in comparison to other things), it will be a minor source of something contained therein" surely that could equally be applied to any of the FODMAP-containing foods and is thus superfluous at best? Cereals' contribution is surely only dependent on the absolute amount of FODMAP-containing cereals one eats and the contribution of those in other foods is a separate matter. Mutt Lunker (talk) 12:33, 20 March 2019 (UTC)

If you eat a lot of other FODMAP/fructan-containing foods, then the proportion overall that comes from cereals is small, and stopping eating these cereals makes little difference to the overall amount consumed (although it will make a big difference to the amount of gluten). If there is a relatively small amount from other dietary sources, then stopping cereals will reduce them significantly too. This is relevant in the discussions regarding whether FODMAP-sensitivity is a factor in NCGS. If you can say this better than I have, please modify it to make it clearer! Jrfw51 (talk) 14:19, 20 March 2019 (UTC)

Adjusting to what the sources say, this is what we have (in fact, both reviews say the same thing, expressed in different ways):

GibsonShepherd2010: "Wheat is a major source of fructans in the diet" Table 1 "Food sources of FODMAPs (where FODMAPs are problematic based on standard serving size) and suitable alternatives Oligosaccharides (fructans and/or galactans) Cereals: wheat & rye when eaten in large amounts (e.g. bread, pasta, couscous, crackers, biscuits)

FasanoSapone2015: "Cereals such as wheat and rye, when consumed in normal quantities, are only minor sources of FODMAPs in the daily diet" "Table 1.Sources of FODMAPs. Oligosaccharides (fructans and/or galactans). Cereals: wheat and rye when eaten in large amounts (eg, bread, pasta, couscous, crackers, biscuits)" --BallenaBlanca 🐳 ♂ (Talk) 15:55, 20 March 2019 (UTC)

Microbiome research...

Regarding underrepresented lactobacilli and bifidobacteria in affected individuals and a related dysbiosis. Low FODMAP diet may support regrow of bifidobacteria. But on the long term its requiered to re-include relevant FODMAP to the diet and just cancel grain parts such as wheat - opposite to oats without gluten resp. with beta glucanes and oatmeal gruel pro intestinal mucosa. As well sourdough barley. To support regrowing of a capable biodiversity in gut resp. to build up a immune sytem modulating eubiosis in general.

https://de.wikipedia.org/wiki/FODMAP#cite_note-6
https://pubmed.ncbi.nlm.nih.gov/28416515/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6062106/#pone.0201410.ref016
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6062106/#sec005title

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390324/#B23
https://faseb.onlinelibrary.wiley.com/doi/abs/10.1096/fasebj.31.1_supplement.968.9

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848117/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848117/#B21-foods-07-00013 --Dankedaniel (talk) 13:39, 3 January 2021 (UTC)

Fungi

It would appear that the FODMAP content of edible fungi varies substantially. Mushrooms, as a general group, are mentioned in sources as being high. Not sure if and how one would note an app as a source but, the "Food Guide" listing in the Monash University FODMAP Diet app for "Mushroom, oyster/hiratake, raw" is noted as "low in FODMAPs" for servings below "1kg/2.2 lbs". Above this large amount, there are "moderate amounts of the Polyol - Sorbitol and Mannitol". The "Fungus, white back black, dried" entry states that "only trace amounts of FODMAPs were detected in this food. Eat freely...". Possibly not suitable for use in the article but it would indicate that it can't be assumed fungus, in general, are high. Mutt Lunker (talk) 17:30, 11 July 2023 (UTC)

Thanks for that research. Kind of strange that the app is giving FODMAP amounts based on totally unrealistic serving sizes, unless it's also meant for controlling FODMAPs in the diets of livestock?? Even then, I'd think they'd just go by percentages, rather than absolute values, so not sure how reliable an info source that app is, even if it would be desirable to cite it. Which of course it wouldn't be, due to the barriers to verification, etc. (And does the app present citations?)

I didn't have time to check archive.org for pre-App-supremacy versions of the Monash site, but if this info can be found there, and if those pages actually cite sources, unlike the site's current blog pages, that would certainly be preferable to creating a {{cite app}} template. Right now, the article just says "Polyols are found naturally in mushrooms", so there's no claim that the amounts are high. I was tempted to make it "fungi such as mushrooms", but along with my not having researched the amounts in truffles, etc., you were extremely hostile to even separating mushrooms from vegetables, so right now the wording is conservative. --Dan Harkless (talk) 09:27, 12 July 2023 (UTC)

My objection(/”hostility”) was to the detrimental effect on the expression of the sentence, the primary point of which was to relate foodstuffs containing polyols. The culinary/dietary focus is important in that we are concerned with edible things (be they plants or other organisms) that contain polyols, for this article. Biological classification is secondary here and inedible polyol-containing organisms irrelevant. “Vegetable” is not a scientifically-defined term, with several meanings which may arbitrarily exclude subsets or include distantly-related ones (plants, algae, fungi). That the sentence notes some of the list as fruits and some as vegetables does not strike me as having a scientific intention: one entirely consisting of plants, the other also largely so. If noting supplementary or peripheral aspects to the sentence renders it less clear, we are better to avoid doing so. I think, though, that the latest version of the sentence is well-expressed, without detriment to the primary point being made.

The note that the polyols used as artificial sweeteners were of the bulk sweetener variety, in the text prior to the intervention, secondary as it may be, was no more peripheral than the change to noting that they are sugar alcohols. It was unclear whether the change in meaning was intentional and, as neither was central to the point, I went with the status quo ante for a cited passage.

Truffles aren’t listed in the app, yet at least; presumably of a lower priority for testing than more commonly used foodstuffs. All mushrooms are listed as high in FODMAPS, save oyster mushrooms and, to a lesser extent tinned button mushrooms.

Not sure that noting that “Cabbage, chicory, and fennel contain moderate amounts, but may be eaten in a low-FODMAP diet if the advised portion size is observed” is particularly worth singling out as, though the restriction may be greater for the others in the list, they can also be included in a low-FODMAP diet.

FWIW, I can only find reference to mannitol or sorbitol and no other polyol in the plants and fungi listed, in Monash documents or other sources but the Monash source specifying the two may be an indication that they only test for, or list inclusion of, mannitol and sorbitol. Mutt Lunker (talk) 13:27, 12 July 2023 (UTC)

Well, the lead sentence in Vegetable currently reads «Vegetables are parts of plants that are consumed by humans or other animals as food», so that counts out mushrooms. And I don't see how it would be valuable to eliminate the distinction between fruits and vegetables. As a longish list of categories of foods containing FODMAPs, this categorization is helpful, not harmful. But now that I've moved mushrooms to the front of the sentence rather than the end, you're happy with it, so I guess the point is moot.

I strongly disagree that «bulk sweeteners» was just as helpful as «sugar alcohols». I guarantee you that it's a rare consumer indeed who has any idea what a "bulk sweetener" is (most would probably guess it's a sweetener sold in bulk), but many have learned that "foods sweetened with sugar alcohols – those sweeteners ending with '-ol' – may cause gastrointestinal distress" (and those same folks aren't familiar with the term "polyol").

Truffles are relatively common in the U.S. as flavorings in gourmet foods, but presumably not in quantities that'd tip the FODMAP scale appreciably. In any case, thanks for checking the app, and also glad to hear that oyster mushrooms, as my favorites, are on the low end.

Yes, lacking any further information, it wouldn't bother me if cabbage, chicory, and fennel were grouped in with the other vegetables.

The wording on that blog page certainly gave me the impression that mannitol and sorbitol are the only polyols (or only naturally occurring polyols?) they list in the app. It looks like some edible seaweeds contain other sugar alcohols, such as fucitol and mannitol. Apparently many plant tissues contain inositol, albeit in a phytate form that's not generally bioavailable to non-ruminants. And reportedly some fruits contain erythritol. Anyhow, in the absence of a good source stating that mannitol and sorbitol are the only naturally occurring ones to be concerned about, it's better not to artificially restrict the discussion to them. --Dan Harkless (talk) 07:52, 13 July 2023 (UTC)

Indeed, the point is moot but, for clarity an in case it has been missed, "Terminology" is the section of the Vegetable article that covers the potential inclusions and exclusions within the term, including fungi. There was no suggestion to remove the distinction between fruits and vegetables but a view on the intention. Mutt Lunker (talk) 11:08, 13 July 2023 (UTC)

And yes, I'd agree it's a rare consumer that would know what a bulk sweetener is. Are you asserting that, in contrast, many consumers have heard of sugar alcohols where you are? Is the implication of your quote that it is widely known? I'd be astonished if most people had even heard either term. Mutt Lunker (talk) 00:02, 14 July 2023 (UTC)

Yes, I realize the Vegetable article mentions the traditional inclusion of mushrooms within "culinary vegetables" – I was just using the lead sentence as a good example of a definition that specifically denotes plants, thus excluding fungi. Sure, hundreds of years ago mushrooms were also thought to be "plants", but since the FODMAP concept is less than 2 decades old, and has only been established by scientific testing, it seems like cognitive dissonance to be propagating (no pun intended) such outdated food classification ideas along with it.

I wasn't claiming that "sugar alcohol" is a "widely known" term among the general public, just that far more people are aware of that group name of the "-ol" sweeteners that act as laxatives (or worse). That's especially true with the ever-increasing use of sugar alcohols as sweeteners in prepackaged foods in the U.S. (not sure if that's mirrored in your neck of the woods). I recall that as of the late '80s / early '90s, I didn't used to see sugar alcohols, other than I guess sorbitol, in ingredient lists for anything other than "health food store" sugarless gum brands. Since then, I've read countless articles (including in the popular press) that mention the potential gastric risks of sugar alcohols, even for non-FODMAP-sensitive folks. "Sugar alcohol" also happens to be an eye-catching and memorable name, and far less awkward than "sugar substitutes ending with '-ol'".

BTW, I noticed that some of the Monash blog posts, unlike that "What are the Polyols?" one that's currently cited, do actually cite sources. A couple I came across while doing additional research are Update: Bananas re-tested!, which has a proper "References" section, and Retested Foods (just in time for Aussie Summer!) – Strawberries & Grapes, which doesn't, but which has inline DOI links. So looks like Internet Archive copies of pages they've removed (in favor of redirecting to their app ad, which I now see costs $9 U.S., which is unfortunate) aren't the only pages of theirs we can cite, which is good. --Dan Harkless (talk) 13:19, 14 July 2023 (UTC)

The discussion re sweeteners and the gut must be framed with different terminology between the UK and US then. I've noticed it being raised more commonly lately but with reference broadly to artificial sweeteners or specifically to the inidividual polyols but I don't recall "sugar alcohol" being used in a popular article with an expectation of being familiar with the term, let alone what such a substance is.

Yes, I get the impression that material from Monash has a rigorous basis, whether it cites that basis or not, though clearly we can only rely on the former. Mutt Lunker (talk) 13:50, 14 July 2023 (UTC)