Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Vic., Australia.
Aliment Pharmacol Ther. 2020 Jul;52(2):233-246. doi: 10.1111/apt.15818. Epub 2020 Jun 20.
Restriction of dietary FODMAP intake can alleviate symptoms in patients with irritable bowel syndrome. Because many FODMAPs have prebiotic actions, there is concern that their dietary restriction leads to dysbiosis with health consequences, and their intake is being encouraged by addition to foods and via supplements.
To examine the hazards and benefits of high and low FODMAP intake.
Current literature was reviewed and alternative hypotheses formulated.
Low FODMAP intake reduces abundance of faecal Bifidobacteria without known adverse outcomes and has no effect on diversity, but the reduction in bacterial density may potentially be beneficial to gut health. Supplementary prebiotics can markedly elevate the intake of FODMAPs over levels consumed in the background diet. While this increases the abundance of Bifidobacteria, it adversely affects gut health in animal studies by inducing colonic mucosal barrier dysfunction, mucosal inflammation and visceral hypersensitivity. Rapid colonic fermentation is central to the identified mechanisms that include injury from high luminal concentrations of short-chain fatty acids and low pH, and inflammatory effects of increased endotoxin load and glycation of macromolecules. Whether these observations translate into humans requires further study. Opposing hypotheses are presented whereby excessive intake of FODMAPs might have health benefits via prebiotic effects, but might also be injurious and contribute to the apparent increase in functional intestinal disorders.
Reduced FODMAP intake has few deleterious effects on gut microbiota. Consequences (both positive and negative) of excessive carbohydrate fermentation in the human intestines from elevated FODMAP intake require more attention.
限制饮食中的 FODMAP 可缓解肠易激综合征患者的症状。由于许多 FODMAP 具有益生元作用，人们担心其饮食限制会导致肠道菌群失调，从而产生健康后果，因此正在通过添加食物和补充剂来鼓励摄入 FODMAP。
检查高 FODMAP 和低 FODMAP 摄入的危害和益处。
综述了当前的文献，并提出了替代假设。
低 FODMAP 摄入会减少粪便双歧杆菌的丰度，但没有已知的不良后果，并且对多样性没有影响，但细菌密度的降低可能对肠道健康有益。补充益生元可以显著增加 FODMAP 的摄入量，超过背景饮食中的摄入量。虽然这增加了双歧杆菌的丰度，但它通过诱导结肠黏膜屏障功能障碍、黏膜炎症和内脏高敏性，在动物研究中对肠道健康产生不利影响。快速的结肠发酵是确定的机制的核心，这些机制包括高腔短链脂肪酸和低 pH 值引起的损伤，以及内毒素负荷增加和大分子糖化的炎症作用。这些观察结果是否转化为人类还需要进一步研究。提出了相反的假设，即 FODMAP 的过度摄入可能通过益生元作用带来健康益处，但也可能是有害的，并导致功能性肠病的明显增加。
减少 FODMAP 摄入对肠道微生物群几乎没有有害影响。需要更多地关注从 FODMAP 摄入增加导致的人类肠道中过度碳水化合物发酵的后果（包括积极和消极的后果）。
