1932

Abstract

Irritable bowel syndrome (IBS) is the most prevalent of gastrointestinal (GI) conditions, affecting millions of people worldwide. Given that most IBS patients associate their GI symptoms with eating food, specific dietary manipulation has become an attractive treatment strategy. A diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) has generated the greatest level of scientific and clinical interest. Overall, 52–86% of patients report significant improvement of their IBS symptoms with elimination of dietary FODMAPs. Patients who experience symptom improvement with FODMAP elimination should undergo a structured reintroduction of foods containing individual FODMAPs to determine sensitivities and allow for personalization of the diet plan. This review discusses the literature surrounding the administration of the low-FODMAP diet and its efficacy in the treatment of IBS.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-med-050218-013625
2020-01-27
2024-04-19
Loading full text...

Full text loading...

/deliver/fulltext/med/71/1/annurev-med-050218-013625.html?itemId=/content/journals/10.1146/annurev-med-050218-013625&mimeType=html&fmt=ahah

Literature Cited

  1. 1. 
    Lovell RM, Ford AC. 2012. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin. Gastroenterol. Hepatol. 10:7712–21
    [Google Scholar]
  2. 2. 
    Everhart JE, Ruhl CE. 2009. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology 136:3741–54
    [Google Scholar]
  3. 3. 
    Agarwal N, Spiegel BM. 2011. The effect of irritable bowel syndrome on health-related quality of life and health care expenditures. Gastroenterol. Clin. North Am. 40:111–19
    [Google Scholar]
  4. 4. 
    Kim YS, Kim N. 2018. Sex-gender differences in irritable bowel syndrome. J. Neurogastroenterol. Motil. 24:4544–58
    [Google Scholar]
  5. 5. 
    Drossman DA, Hasler WL. 2016. Rome IV—functional GI disorders: disorders of gut-brain interaction. Gastroenterology 150:61257–61
    [Google Scholar]
  6. 6. 
    Chey WD, Kurlander J, Eswaran S 2015. Irritable bowel syndrome: a clinical review. JAMA 313:9949–58
    [Google Scholar]
  7. 7. 
    Houghton LA, Lea R, Agrawal A et al. 2006. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology 131:41003–10
    [Google Scholar]
  8. 8. 
    El-Serag HB, Pilgrim P, Schoenfeld P 2004. Natural history of irritable bowel syndrome. Aliment. Pharmacol. Ther. 19:8861–70
    [Google Scholar]
  9. 9. 
    Barbara G, Grover M, Bercik P et al. 2019. Rome Foundation working team report on post-infection irritable bowel syndrome. Gastroenterology 156:146–58
    [Google Scholar]
  10. 10. 
    Rahman MM, Ghoshal UC, Sultana S et al. 2018. Long-term gastrointestinal consequences are frequent following sporadic acute infectious diarrhea in a tropical country: a prospective cohort study. Am. J. Gastroenterol. 113:91363–75
    [Google Scholar]
  11. 11. 
    Lahner E, Bellentani S, Bastiani RD et al. 2013. A survey of pharmacological and nonpharmacological treatment of functional gastrointestinal disorders. United Eur. Gastroenterol. J. 1:5385–93
    [Google Scholar]
  12. 12. 
    Bohn L, Storsrud S, Tornblom H et al. 2013. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am. J. Gastroenterol. 108:5634–41
    [Google Scholar]
  13. 13. 
    Eswaran S, Tack J, Chey WD 2011. Food: the forgotten factor in the irritable bowel syndrome. Gastroenterol. Clin. North Am. 40:1141–62
    [Google Scholar]
  14. 14. 
    Spencer M, Chey WD, Eswaran S 2014. Dietary renaissance in IBS: Has food replaced medications as a primary treatment strategy. ? Curr. Treat. Opt. Gastroenterol. 12:4424–40
    [Google Scholar]
  15. 15. 
    Salvioli B, Serra J, Azpiroz F, Malagelada JR 2006. Impaired small bowel gas propulsion in patients with bloating during intestinal lipid infusion. Am. J. Gastroenterol. 101:81853–57
    [Google Scholar]
  16. 16. 
    Varney J, Barrett J, Scarlata K et al. 2017. FODMAPs: food composition, defining cutoff values and international application. J. Gastroenterol. Hepatol. 32:Suppl. 153–61
    [Google Scholar]
  17. 17. 
    Eswaran S. 2017. Low FODMAP in 2017: lessons learned from clinical trials and mechanistic studies. Neurogastroenterol. Motil. 29:4e13055
    [Google Scholar]
  18. 18. 
    Eswaran S, Chey WD, Jackson K et al. 2017. A diet low in fermentable oligo-, di-, and monosaccharides and polyols improves quality of life and reduces activity impairment in patients with irritable bowel syndrome and diarrhea. Clin. Gastroenterol. Hepatol. 15:121890–99
    [Google Scholar]
  19. 19. 
    Shepherd SJ, Lomer MC, Gibson PR 2013. Short-chain carbohydrates and functional gastrointestinal disorders. Am. J. Gastroenterol. 108:5707–17
    [Google Scholar]
  20. 20. 
    Ong DK, Mitchell SB, Barrett JS et al. 2010. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J. Gastroenterol. Hepatol. 25:81366–73
    [Google Scholar]
  21. 21. 
    Pittayanon R, Lau JT, Yuan Y et al. 2019. Gut microbiota in patients with irritable bowel syndrome—a systematic review. Gastroenterology 157:197–108
    [Google Scholar]
  22. 22. 
    Ringel-Kulka T, Choi CH, Temas D et al. 2015. Altered colonic bacterial fermentation as a potential pathophysiological factor in irritable bowel syndrome. Am. J. Gastroenterol. 110:91339–46
    [Google Scholar]
  23. 23. 
    Murray K, Wilkinson-Smith V, Hoad C et al. 2014. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. Am. J. Gastroenterol. 109:1110–19
    [Google Scholar]
  24. 24. 
    Major G, Pritchard S, Murray K et al. 2017. Colon hypersensitivity to distension, rather than excessive gas production, produces carbohydrate-related symptoms in individuals with irritable bowel syndrome. Gastroenterology 152:1124–33
    [Google Scholar]
  25. 25. 
    McIntosh K, Reed DE, Schneider T et al. 2016. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut 66:71241–51
    [Google Scholar]
  26. 26. 
    Hustoft TN, Hausken T, Ystad SO et al. 2017. Effects of varying dietary content of fermentable short-chain carbohydrates on symptoms, fecal microenvironment, and cytokine profiles in patients with irritable bowel syndrome. Neurogastroenterol. Motil. 29:4e12969
    [Google Scholar]
  27. 27. 
    Staudacher HM, Lomer MC, Anderson JL et al. 2012. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J. Nutr. 142:81510–18
    [Google Scholar]
  28. 28. 
    Gibson PR. 2017. History of the low FODMAP diet. J. Gastroenterol. Hepatol. 32:Suppl. 15–7
    [Google Scholar]
  29. 29. 
    Staudacher HM, Whelan K, Irving PM, Lomer MC 2011. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J. Hum. Nutr. Diet 24:5487–95
    [Google Scholar]
  30. 30. 
    Eswaran SL, Chey WD, Han-Markey T et al. 2016. A randomized controlled trial comparing the low FODMAP diet versus modified NICE guidelines in US adults with IBS-D. Am. J. Gastroenterol. 111:121824–32
    [Google Scholar]
  31. 31. 
    de Roest RH, Dobbs BR, Chapman BA et al. 2013. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Int. J. Clin. Pract. 67:9895–903
    [Google Scholar]
  32. 32. 
    Halmos EP, Power VA, Shepherd SJ et al. 2014. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 146:167–75
    [Google Scholar]
  33. 33. 
    Zahedi MJ, Behrouz V, Azimi M 2018. Low fermentable oligo-di-mono-saccharides and polyols diet versus general dietary advice in patients with diarrhea-predominant irritable bowel syndrome: a randomized controlled trial. J. Gastroenterol. Hepatol. 33:61192–99
    [Google Scholar]
  34. 34. 
    Bohn L, Storsrud S, Liljebo T et al. 2015.Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology 149:61399–407.e2
  35. 35. 
    Deleted in proof
  36. 36. 
    Staudacher HM, Irving PM, Lomer MCE, Whelan K 2017. The challenges of control groups, placebos and blinding in clinical trials of dietary interventions. Proc. Nutr. Soc. 76:3203–12
    [Google Scholar]
  37. 37. 
    Staudacher HM, Lomer MCE, Farquharson FM et al. 2017. Diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and probiotic restores Bifidobacterium species: a randomized controlled trial. Gastroenterology 153:4936–47
    [Google Scholar]
  38. 38. 
    Peters SL, Yao CK, Philpott H et al. 2016. Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Aliment. Pharmacol. Ther. 44:5447–59
    [Google Scholar]
  39. 39. 
    Schumann D, Langhorst J, Dobos G, Cramer H 2018. Randomised clinical trial: yoga versus a low-FODMAP diet in patients with irritable bowel syndrome. Aliment. Pharmacol. Ther. 47:2203–11
    [Google Scholar]
  40. 40. 
    Eswaran S, Dolan R, Ball S et al. 2019. The impact of a 4-week low FODMAP and mNICE diet on nutrient intake in a sample of US adults with IBS-D. J. Acad. Nutr. Diet. In press
    [Google Scholar]
  41. 41. 
    O'Keeffe M, Jansen C, Martin L et al. 2018. Long-term impact of the low-FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome. Neurogastroenterol. Motil. 30:1e13154
    [Google Scholar]
  42. 42. 
    Harvie RM, Chisholm AW, Bisanz JE et al. 2017. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World J. Gastroenterol. 23:254632–43
    [Google Scholar]
  43. 43. 
    Wu GD, Chen J, Hoffmann C et al. 2011. Linking long-term dietary patterns with gut microbial enterotypes. Science 334:6052105–8
    [Google Scholar]
  44. 44. 
    Rothschild D, Weissbrod O, Barkan E et al. 2018. Environment dominates over host genetics in shaping human gut microbiota. Nature 555:7695210–15
    [Google Scholar]
  45. 45. 
    Halmos EP, Christophersen CT, Bird AR et al. 2015. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut 64:193–100
    [Google Scholar]
  46. 46. 
    Maagaard L, Ankersen DV, Vegh Z et al. 2016. Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet. World J. Gastroenterol. 22:154009–19
    [Google Scholar]
  47. 47. 
    Pedersen N, Ankersen DV, Felding M et al. 2017. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease. World J. Gastroenterol. 23:183356–66
    [Google Scholar]
  48. 48. 
    Whelan K, Martin LD, Staudacher HM, Lomer MCE 2018. The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice. J. Hum. Nutr. Diet 31:2239–55
    [Google Scholar]
  49. 49. 
    Chey WD. 2016. Food: the main course to wellness and illness in patients with irritable bowel syndrome. Am. J. Gastroenterol. 111:3366–71
    [Google Scholar]
  50. 50. 
    Whigham L, Joyce T, Harper G et al. 2015. Clinical effectiveness and economic costs of group versus one-to-one education for short-chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome. J. Hum. Nutr. Diet 28:6687–96
    [Google Scholar]
  51. 51. 
    Bennet SMP, Bohn L, Storsrud S et al. 2017. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut 67:5872–81
    [Google Scholar]
  52. 52. 
    Valeur J, Smastuen MC, Knudsen T et al. 2018. Exploring gut microbiota composition as an indicator of clinical response to dietary FODMAP restriction in patients with irritable bowel syndrome. Dig. Dis. Sci. 63:2429–36
    [Google Scholar]
  53. 53. 
    Rossi M, Aggio R, Staudacher H et al. 2018. Volatile organic compounds in feces associate with response to dietary intervention in patients with irritable bowel syndrome. Gastroenterology 16:3385–91.e1
    [Google Scholar]
  54. 54. 
    Eswaran SL, Merchant JL, Photenhauer A et al. 2017. Tryptophan hydroxylase 1 (Tph1) promoter genotype but not serum serotonin levels identify IBS-D patients more likely to benefit from the low FODMAP diet. Gastroenterology152(5, Suppl. 1):S69
    [Google Scholar]
  55. 55. 
    Huaman JW, Mego M, Manichanh C et al. 2018. Effects of prebiotics versus a diet low in FODMAPs in patients with functional gut disorders. Gastroenterology 155:41004–7
    [Google Scholar]
  56. 56. 
    Zhou Q, Verne ML, Fields JZ et al. 2019. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut 68:6996–1002
    [Google Scholar]
  57. 57. 
    Scarlata K, Wilson D. 2017. The Low-FODMAP Diet: Step by Step New York: Da Capo
  58. 58. 
    Catsos P. 2017. The IBS Elimination Diet and Cookbook: The Proven Low-FODMAP Plan for Eating Well and Feeling Great New York: Harmony Books
/content/journals/10.1146/annurev-med-050218-013625
Loading
/content/journals/10.1146/annurev-med-050218-013625
Loading

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error