The Impacts of the Low-FODMAP Diet on the Management of Irritable Bowel Syndrome Symptoms: Possibilities, Feasibility, and Alternatives

Abstract

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) condition characterized by a myriad of GI symptoms (e.g., diarrhea, nutrient malabsorption) that vary in severity. Due to its complex and individual nature, there is no known cure for IBS, but many diets have been assessed for their viability in managing symptoms. The low-FODMAP diet has recently been investigated for its potential benefits for IBS patients. FODMAPs, or Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols are short- and medium-chain carbohydrates that are poorly absorbed in the small intestine and are prone to absorb water and ferment in the colon. Consumption of these FODMAPs correlates with increasing severity of IBS symptoms. The purpose of this randomized controlled trial systematic review was to compile various evidence-based dietary recommendations for the low-FODMAP diet for adult patients suffering from IBS from randomized controlled and clinical trials. The possibilities, feasibilities, and potential alternatives are proposed to determine if there is sufficient evidence to recommend the low-FODMAP diet for this patient population. Over 1,000 studies were screened and 6 were reviewed to determine the benefits of this diet. It was found that the low-FODMAP diet has demonstrated efficacy in delivering IBS symptom relief by changing patients’ metabolomes, microbiomes, and physiology. Specifically, this diet showed a greater overall decrease in abdominal pain, bloating, stool consistency, frequency, and urgency. Greater diversity of actinobacteria was found in the stool samples of these patients. Nociceptive neurons were also shown to be less sensitive and GI gas production was also markedly decreased. Despite these benefits, the low-FODMAP diet is more recommended for acute flare-ups due to its difficult adherence and attrition. Instead, we conclude that the balanced Mediterranean diet contains aspects of the traditional Mediterranean and low-FODMAP diet that can relieve IBS symptoms for daily life, while the low-FODMAP diet can be an effective treatment to ameliorate conditions when severe symptoms are experienced.