The challenges of implementing low fermentable oligo-, di-, mono-saccharides and polyol diet in India: An analysis of available data

Background Low fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet is used in irritable bowel syndrome (IBS). However, data on the utility and challenges of implementing such a diet in India are scanty. Since dietary practices in India are different from other Asian and Western countries, the existing Indian data were analyzed. Methods This study attempted to analyze the existing Indian data on the frequency of vegetarianism, cereal (wheat vs. rice), milk/milk product consumption, and lactose malabsorption (LM). A 5-point scale (quiet easy, easy, moderately easy, not easy, difficult) for implementation of low FODMAP diet for IBS patients was proposed based on regional dietary diversity and LM in India. Results Our analysis showed that vegetarianism is high in India with regional differences in frequency. Similarly, there is regional variation in frequency of LM though it is quite high in most parts of India where data are available. While southern, eastern, and northern parts of the country have rice as the staple cereal, wheat is consumed more in other parts. We suggest that implementing a low FODMAP diet in north-eastern India may be most easy compared to northern India, where it may be most difficult. Implementing a low FODMAP diet in southern and eastern India may be easy, moderately easy in western India, and not easy in central India. Conclusions The variation in the difficulty in implementing a low FODMAP diet in India may stem from the regional food preference and differences in vegetarianism, as well as frequency of LM.