Abstract
Food is often considered to be a precipitating factor of irritable bowel syndrome (IBS) symptoms. In recent years, there has been a growing interest in FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides, And Polyols), which can be found in many common foods. A low FODMAP diet (LFD) is increasingly suggested for IBS treatment. However, long-term, large, randomized controlled studies are still lacking, and certainties and doubts regarding LFDs have grown, often in a disorderly and confused manner. Some potential LFD limitations and concerns have been raised, including nutritional adequacy, cost, and difficulty in teaching the diet and maintaining it. Most of these limitations can be solved with the involvement of a skilled nutritionist, who can clearly explain the different phases of the LFD and ensure nutritional adequacy and compliance. Further studies should focus on new methods of teaching and learning the LFD and on predictors of response. Moreover, particular interest should be focused on the possible use of LFD in gastrointestinal diseases other than functional disorders and, possibly, also in non-gastrointestinal diseases. The aim of the present review was to clarify the effective and appropriate indications and limitations of an LFD and to discuss its possible future uses.
Highlights
In approximately 60% of cases, patients affected with irritable bowel syndrome (IBS) have reported eating as a precipitant of their symptoms, which deeply impacts their quality of life [1,2,3]
The restriction of FODMAPs can reduce natural prebiotics, which are “a substrate that is selectively utilized by host microorganisms conferring a health benefit”, such as FOS, GOS, and fibers, with possible changes in intestinal microbiota which lack the substrate for fermentation and for its natural metabolic activity [74,75,76,77]
An low FODMAP diet (LFD) is currently suggested as an effective treatment for IBS despite the lack long-term, randomized controlled studies on large numbers of patients
Summary
In approximately 60% of cases, patients affected with irritable bowel syndrome (IBS) have reported eating as a precipitant of their symptoms, which deeply impacts their quality of life [1,2,3]. Increasing production of gas: FODMAP fermentation a larger production of gases such by Murray et al. a recent crossover study suggested that an could lead to a as hydrogen, methane, and carbon dioxide, as detected in a trial using magnetic resonance imaging reduced production of gas through modifications of the microbiota, with a relative increase in the by Murray et al [17]. Reduced production of gas through modifications of the microbiota, with a relative increase in the Excessive production of short-chain fatty acids (SCFAs): SCFAs (propionate, butyrate, and acetate) hydrogen-consuming bacterial genus Adlercreutzia are products of bacterial dietary fiber metabolism and display many beneficial effects. Toxic from the intestinal mucosa, they favor the onset of high-amplitude propagated colonic contractions, accelerating intestinal transit [21] These phenomena, taken as a whole within the context of the visceral hypersensitivity typical of IBS patients, may provoke abdominal pain, bloating, flatulence, and alterations in bowel habits. The aim of the present review was to contribute to clarifying the effective and appropriate indications and limitations of a LFD and to discuss its possible future uses
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