Review Article | Published:

Mechanisms and efficacy of dietary FODMAP restriction in IBS

Nature Reviews Gastroenterology & Hepatology volume 11, pages 256266 (2014) | Download Citation

Abstract

IBS is a debilitating condition that markedly affects quality of life. The chronic nature, high prevalence and associated comorbidities contribute to the considerable economic burden of IBS. The pathophysiology of IBS is not completely understood and evidence to guide management is variable. Interest in dietary intervention continues to grow rapidly. Ileostomy and MRI studies have demonstrated that some fermentable carbohydrates increase ileal luminal water content and breath hydrogen testing studies have demonstrated that some carbohydrates also increase colonic hydrogen production. The effects of fermentable carbohydrates on gastrointestinal symptoms have also been well described in blinded, controlled trials. Dietary restriction of fermentable carbohydrates (popularly termed the 'low FODMAP diet') has received considerable attention. An emerging body of research now demonstrates the efficacy of fermentable carbohydrate restriction in IBS; however, limitations still exist with this approach owing to a limited number of randomized trials, in part due to the fundamental difficulty of placebo control in dietary trials. Evidence also indicates that the diet can influence the gut microbiota and nutrient intake. Fermentable carbohydrate restriction in people with IBS is promising, but the effects on gastrointestinal health require further investigation.

Key points

  • The underlying pathophysiology of IBS is complex and the efficacy of medical treatment is variable

  • Prebiotic carbohydrates selectively increase numbers of specific bacteria (for example, bifidobacteria) that could influence gastrointestinal health

  • Short-chain fermentable carbohydrates (termed FODMAPs) are known to induce gastrointestinal symptoms and do so through their effects on luminal water handling and colonic gas production

  • Evidence suggests fermentable carbohydrate restriction (low FODMAP diet) is effective for IBS symptoms; however, data are limited to uncontrolled or retrospective studies, one controlled trial and three randomized, controlled trials

  • Further randomized trials are required to confirm the efficacy of fermentable carbohydrate restriction in IBS management and to further examine the effects on the gut microbiota and dietary quality

  • Placebo-controlled trials are difficult to undertake in studies of dietary advice

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Acknowledgements

H. M. Staudacher is funded by the National Institute for Health Research.

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Affiliations

  1. King's College London, School of Medicine, Diabetes and Nutritional Sciences Division, Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.

    • Heidi M. Staudacher
    •  & Kevin Whelan
  2. Guys and St Thomas NHS Foundation Trust, Department of Gastroenterology, College House, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.

    • Peter M. Irving
    •  & Miranda C. E. Lomer

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H. M. Staudacher and K. Whelan researched data for and wrote the article. All authors made equal contributions to discussion of content and reviewing/editing the manuscript before submission.

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https://doi.org/10.1038/nrgastro.2013.259

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