Skip to content
2000
Volume 5, Issue 1
  • ISSN: 0250-6882
  • E-ISSN: 0250-6882
side by side viewer icon HTML

Abstract

Irritable bowel syndrome (IBS) is a debilitating, complex, chronic disorder with a multifactorial etiopathogenesis, pathophysiology and clinical phenotype. IBS is the most common disorder of gut-brain interaction (DGBI), with a prevalence ranging from 7% to 23% globally. The burden of IBS on patients is considerable in terms of reduced quality of life. Furthermore, the costs to healthcare systems and society are substantial as IBS accounts for billions of dollars in direct and indirect medical costs. Common symptoms of IBS are bloating, reoccurring episodes of abdominal pain, excessive flatus, constipation, diarrhea or alternating bowel habits. Many IBS patients have associated ingestion of specific foods with GI symptoms onset or exacerbation and have therefore, attempted dietary therapy for the treatment and control of their GI symptoms. The low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP) diet is currently the most evidence-based and internationally accepted viable first-line dietary therapy for IBS. FODMAPs are short-chain carbohydrates that are poorly or incompletely absorbed in the small intestine and subsequently fermented by the colonic microbiota, leading to the production of gases, such as hydrogen, carbon dioxide, and methane. There is a recognized need to elucidate how FODMAPs induce GI symptoms and to understand how the 3-phase (restriction, re-introduction and personalization) FODMAP diet works. Hence, the objective of this review article is to elucidate the pathophysiological central and peripheral gut-related mechanisms through which FODMAPs cause GI- symptoms, to expound the implementation of the FODMAP diet and to highlight and confute concerns around the safety and risks of the FODMAP diet long-term.

This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Loading

Article metrics loading...

/content/journals/nemj/10.2174/0102506882269342231212064600
2024-01-26
2025-01-31
Loading full text...

Full text loading...

/deliver/fulltext/nemj/5/1/NEMJ-5-E02506882269342.html?itemId=/content/journals/nemj/10.2174/0102506882269342231212064600&mimeType=html&fmt=ahah

References

  1. DrossmanD.A. Functional gastrointestinal disorder and the Rome IV process.Functional gastrointestinal disorders. Disorders of brain-gut interaction.4th ed. DrossmanD.A. ChangL. CheyW.D. Raleigh, NCRome Foundation2016113210.24890/gb.01
    [Google Scholar]
  2. SoaresR.L.S. Irritable bowel syndrome: A clinical review.World J. Gastroenterol.20142034121441216010.3748/wjg.v20.i34.1214425232249
    [Google Scholar]
  3. SoaresR.L.S. Irritable bowel syndrome, food intolerance and non- celiac gluten sensitivity. A new clinical challenge.Arq. Gastroenterol.201855441742210.1590/s0004‑2803.201800000‑8830785529
    [Google Scholar]
  4. BlackC.J. FordA.C. Best management of irritable bowel syndrome.Frontline Gastroenterol.202112430331510.1136/flgastro‑2019‑10129834249316
    [Google Scholar]
  5. ManningL.P. YaoC.K. BiesiekierskiJ.R. Therapy of IBS: Is a Low FODMAP diet the answer?Front. Psychiatry20201186510.3389/fpsyt.2020.0086533110411
    [Google Scholar]
  6. PortincasaP. BonfrateL. de BariO. LemboA. BallouS. Irritable bowel syndrome and diet.Gastroenterol. Rep.201751111910.1093/gastro/gow04728110300
    [Google Scholar]
  7. ReddelS. PutignaniL. Del ChiericoF. The impact of low- FODMAPs, gluten-free, and ketogenic diets on gut microbiota modulation in pathological conditions.Nutrients201911237310.3390/nu1102037330759766
    [Google Scholar]
  8. SperberA.D. DumitrascuD. FukudoS. GersonC. GhoshalU.C. GweeK.A. HunginA.P.S. KangJ.Y. MinhuC. SchmulsonM. BolotinA. FrigerM. FreudT. WhiteheadW. The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: A Rome Foundation working team literature review.Gut20176661075108210.1136/gutjnl‑2015‑31124026818616
    [Google Scholar]
  9. VarjúP. FarkasN. HegyiP. GaramiA. SzabóI. IllésA. SolymárM. VinczeÁ. BalaskóM. PárG. BajorJ. SzűcsÁ. HuszárO. PécsiD. CzimmerJ. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies.PLoS One2017128e018294210.1371/journal.pone.018294228806407
    [Google Scholar]
  10. WerlangM.E. PalmerW.C. LacyB.E. Irritable bowel syndrome and dietary interventions.Gastroenterol. Hepatol.2019151162630899204
    [Google Scholar]
  11. SultanN. VarneyJ.E. HalmosE.P. BiesiekierskiJ.R. YaoC.K. MuirJ.G. GibsonP.R. TuckC.J. How to Implement the 3-Phase FODMAP diet into gastroenterological practice.J. Neurogastroenterol. Motil.202228334335610.5056/jnm2203535799231
    [Google Scholar]
  12. LiuJ. CheyW.D. HallerE. EswaranS. Low-FODMAP Diet for Irritable Bowel Syndrome: What We Know and What We Have Yet to Learn.Annu. Rev. Med.202071130331410.1146/annurev‑med‑050218‑01362531986083
    [Google Scholar]
  13. RejA. AveryA. AzizI. BlackC.J. BowyerR.K. BuckleR.L. SeamarkL. ShawC.C. ThompsonJ. TrottN. WilliamsM. SandersD.S. Diet and irritable bowel syndrome: An update from a UK consensus meeting.BMC Med.202220128710.1186/s12916‑022‑02496‑w36096789
    [Google Scholar]
  14. MayerE.A. NanceK. ChenS. The gut–brain axis.Annu. Rev. Med.202273143945310.1146/annurev‑med‑042320‑01403234669431
    [Google Scholar]
  15. CashBD Irritable bowel syndrome: diagnosis and treatment.Gastroenterol Endoscopy news.2017
    [Google Scholar]
  16. BarrettJ.S. How to institute the low-FODMAP diet.J. Gastroenterol. Hepatol.201732S181010.1111/jgh.1368628244669
    [Google Scholar]
  17. YanR. AndrewL. MarlowE. KunaratnamK. DevineA. DunicanI.C. ChristophersenC.T. Dietary fibre intervention for gut microbiota, sleep, and mental health in adults with irritable bowel syndrome: A scoping review.Nutrients2021137215910.3390/nu1307215934201752
    [Google Scholar]
  18. BöhnL StorsrudS LiljeboT CollinL LindforsP TornblomH SimrenM Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: A randomized controlled trial.Gastroenterology201514961399140710.1053/j.gastro.2015.07.054
    [Google Scholar]
  19. FedewaA. RaoS.S.C. Dietary fructose intolerance, fructan intolerance and FODMAPs.Curr. Gastroenterol. Rep.201416137010.1007/s11894‑013‑0370‑024357350
    [Google Scholar]
  20. AltobelliE. Del NegroV. AngelettiP. LatellaG. Low-FODMAP diet improves irritable bowel syndrome symptoms: A meta-analysis.Nutrients20179994010.3390/nu909094028846594
    [Google Scholar]
  21. MitchellH. PorterJ. GibsonP.R. BarrettJ. GargM. Review article: Implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research.Aliment. Pharmacol. Ther.201949212413910.1111/apt.1507930589971
    [Google Scholar]
  22. SanderB.Q. CoelhoA.T. OliveiraR.E.M. AvanceA.D. MeladoC.F. MarquesJ.M. VeríssimoA.E. Fodmap’s restricted diet in patients with irritable gut syndrome: A systematic review.Acad J Gastroenterol Hepatol202124000545
    [Google Scholar]
  23. SpectorT. The Diet Myth. The real science behind what we eat.2nd ed.London, UKWeidenfeld and Nicolson2020
    [Google Scholar]
  24. van LanenA.S. de BreeA. GreylingA. Correction to: Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: A systematic review and meta-analysis.Eur. J. Nutr.2021606352310.1007/s00394‑021‑02620‑133585949
    [Google Scholar]
  25. WangJ. YangP. ZhangL. HouX. A Low-FODMAP diet improves the global symptoms and bowel habits of adult ibs patients: A systematic review and meta-analysis.Front. Nutr.2021868319110.3389/fnut.2021.68319134490319
    [Google Scholar]
  26. ChawlaA. Stress a trigger for irritable bowel syndrome.2014Available from:https://gulfnews.com/uae/health/stress-a-trigger-for-irritable-bowel-syndrome-1.1429513 (Accessed on: December 20, 2014.)
    [Google Scholar]
  27. BuonoJ.L. CarsonR.T. FloresN.M. Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea.Health Qual. Life Outcomes20171513510.1186/s12955‑017‑0611‑228196491
    [Google Scholar]
  28. CheyW.D. KeeferL. WhelanK. GibsonP.R. Behavioral and diet therapies in integrated care for patients with irritable bowel syndrome.Gastroenterology20211601476210.1053/j.gastro.2020.06.09933091411
    [Google Scholar]
  29. ChongP.P. ChinV.K. LooiC.Y. WongW.F. MadhavanP. YongV.C. The microbiome and irritable bowel syndrome - a review on the pathophysiology, current research and future therapy.Front. Microbiol.201910113610.3389/fmicb.2019.0113631244784
    [Google Scholar]
  30. GearryR. SkidmoreP. O’BrienL. WilkinsonT. NanayakkaraW. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date.Clin. Exp. Gastroenterol.2016913114210.2147/CEG.S8679827382323
    [Google Scholar]
  31. O’KeeffeM. JansenC. MartinL. WilliamsM. SeamarkL. StaudacherH.M. IrvingP.M. WhelanK. LomerM.C. Long-term impact of the low-FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome.Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc.201820181315410.1111/nmo.13154
    [Google Scholar]
  32. BelliniM. TonarelliS. NagyA. PancettiA. CostaF. RicchiutiA. de BortoliN. MoscaM. MarchiS. RossiA. Low FODMAP Diet: Evidence, doubts, and hopes.Nutrients202012114810.3390/nu1201014831947991
    [Google Scholar]
  33. Bootz-MaozH. PearlA. MelzerE. MalnickS. SharonE. BennetY. TsentsarevskyR. AbuchatzeraS. AmidrorS. AretzE. AzrielS. Gam Ze LetovaC. NaamaM. ShovalI. YaronO. Karako-LampertS. BelS. YissacharN. Diet-induced modifications to human microbiome reshape colonic homeostasis in irritable bowel syndrome.Cell Rep.202241711165710.1016/j.celrep.2022.11165736384106
    [Google Scholar]
  34. StaudacherH.M. Nutritional, microbiological and psychosocial implications of the low FODMAP diet.J. Gastroenterol. Hepatol.201732S1161910.1111/jgh.1368828244658
    [Google Scholar]
  35. VervierK. MossS. KumarN. Two microbiota subtypes identified in irritable bowel syndrome with distinct responses to the low FODMAP diet.Gut202134810234
    [Google Scholar]
  36. HarperA. NaghibiM. GarchaD. The role of bacteria, probiotics and diet in irritable bowel syndrome.Foods2018721310.3390/foods702001329373532
    [Google Scholar]
  37. TuckC.J. VannerS.J. Dietary therapies for functional bowel symptoms: Recent advances, challenges, and future directions.Neurogastroenterol. Motil.2018301e1323810.1111/nmo.1323829094792
    [Google Scholar]
  38. NaseriK. DabiriH. Rostami-NejadM. YadegarA. HouriH. OlfatifarM. SadeghiA. SaadatiS. CiacciC. IovinoP. ZaliM.R. Influence of low FODMAP-gluten free diet on gut microbiota alterations and symptom severity in Iranian patients with irritable bowel syndrome.BMC Gastroenterol.202121129210.1186/s12876‑021‑01868‑534261437
    [Google Scholar]
  39. HillP. MuirJ.G. GibsonP.R. Controversies and recent developments of the Low-FODMAP Diet.Gastroenterol. Hepatol.2017131364528420945
    [Google Scholar]
  40. WilsonB. WhelanK. Prebiotic inulin-type fructans and galacto-oligosaccharides: Definition, specificity, function, and application in gastrointestinal disorders.J. Gastroenterol. Hepatol.201732S1646810.1111/jgh.1370028244671
    [Google Scholar]
  41. MarascoG. CremonC. BarbaroM.R. StanghelliniV. BarbaraG. Gut microbiota signatures and modulation in irritable bowel syndrome.Microbiome Research Reports202211110.20517/mrr.2021.12
    [Google Scholar]
  42. KastiA. PetsisK. LambrinouS. KatsasK. NikolakiM. PapanikolaouI.S. HatziagelakiE. TriantafyllouK. A combination of mediterranean and Low-FODMAP Diets for Managing IBS symptoms? ask your gut!Microorganisms202210475110.3390/microorganisms1004075135456802
    [Google Scholar]
  43. HalmosEP PowerVA ShepherdSJ A diet low in FODMAPs reduces symptoms of irritable bowel syndrome.Gastroenterology2014146677510.1053/j.gastro.2013.09.046
    [Google Scholar]
  44. BelliniM RossiA. Is a low FODMAP diet dangerous?Tech Coloproctol20182285697110.1007/s10151‑018‑1835‑9
    [Google Scholar]
  45. HalmosE.P. Diet in functional gastro intestinal disorders.Functional gastrointestinal disorders: A biopsychosocial approach. KnowlesS.R. SternJ. HebbardG. LondonRoutledge, Taylor & Francis Group20187179
    [Google Scholar]
  46. HalmosE.P. GibsonP.R. Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome.J. Gastroenterol. Hepatol.20193471134114210.1111/jgh.1465030945376
    [Google Scholar]
  47. StaudacherH.M. WhelanK. The low FODMAP diet: Recent advances in understanding its mechanisms and efficacy in IBS.Gut20176681517152710.1136/gutjnl‑2017‑31375028592442
    [Google Scholar]
  48. VarneyJ. BarrettJ. ScarlataK. CatsosP. GibsonP.R. MuirJ.G. FODMAPs: Food composition, defining cutoff values and international application.J. Gastroenterol. Hepatol.201732S1536110.1111/jgh.1369828244665
    [Google Scholar]
  49. GibsonP.R. History of the low FODMAP diet.J. Gastroenterol. Hepatol.201732S15710.1111/jgh.1368528244673
    [Google Scholar]
  50. HalmosE.P. ChristophersenC.T. BirdA.R. ShepherdS.J. GibsonP.R. MuirJ.G. Diets that differ in their FODMAP content alter the colonic luminal microenvironment.Gut20156419310010.1136/gutjnl‑2014‑30726425016597
    [Google Scholar]
  51. WhelanK. MartinL.D. StaudacherH.M. LomerM.C.E. 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.201831223925510.1111/jhn.1253029336079
    [Google Scholar]
  52. O’KeeffeM LomerMCE Who should deliver the low FODMAP diet and what educational methods are optimal: A review.J Gastroenterol Hepatol201732236
    [Google Scholar]
  53. GibsonP.R. HalmosE.P. SoD. YaoC.K. VarneyJ.E. MuirJ.G. Diet as a therapeutic tool in chronic gastrointestinal disorders: Lessons from the FODMAP journey.J. Gastroenterol. Hepatol.202237464465210.1111/jgh.1577234994019
    [Google Scholar]
  54. TuckC.J. MuirJ.G. BarrettJ.S. GibsonP.R. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols: Role in irritable bowel syndrome.Expert Rev. Gastroenterol. Hepatol.20148781983410.1586/17474124.2014.91795624830318
    [Google Scholar]
  55. StaudacherH.M. LomerM.C.E. FarquharsonF.M. LouisP. FavaF. FranciosiE. ScholzM. TuohyK.M. LindsayJ.O. IrvingP.M. WhelanK. A Diet Low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and a probiotic restores bifidobacterium species: A randomized controlled trial.Gastroenterology2017153493694710.1053/j.gastro.2017.06.01028625832
    [Google Scholar]
  56. MajorG PritchardS MurrayK AlappadanJP HoadCL MarcianiL Colon hypersensitivity to distension, rather than excessive gas production, produces carbohydrate-related symptoms in individuals with irritable bowel syndrome.Gastroenterology201715211243310.1053/j.gastro.2016.09.062
    [Google Scholar]
  57. HarvieR.M. ChisholmA.W. BisanzJ.E. BurtonJ.P. HerbisonP. SchultzK. SchultzM. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs.World J. Gastroenterol.201723254632464310.3748/wjg.v23.i25.463228740352
    [Google Scholar]
  58. TuckC. BarrettJ. Re-challenging FODMAPs: The low FODMAP diet phase two.J. Gastroenterol. Hepatol.201732S1111510.1111/jgh.1368728244664
    [Google Scholar]
  59. LenhartA. CheyW.D. A systematic review of the effects of polyols on gastrointestinal health and irritable bowel syndrome.Adv. Nutr.20178458759610.3945/an.117.01556028710145
    [Google Scholar]
  60. CatassiG. LionettiE. GattiS. CatassiC. The Low FODMAP Diet: Many question marks for a catchy acronym.Nutrients20179329210.3390/nu903029228300773
    [Google Scholar]
  61. BennetS.M.P. BohnL. StorsrudS. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs.Gut201711010.1136/gutjnl‑2016‑31312828416515
    [Google Scholar]
  62. McIntoshK. ReedD.E. SchneiderT. DangF. KeshteliA.H. De PalmaG. MadsenK. BercikP. VannerS. FODMAPs alter symptoms and the metabolome of patients with IBS: A randomised controlled trial.Gut20176671241125110.1136/gutjnl‑2015‑31133926976734
    [Google Scholar]
  63. HustoftT.N. HauskenT. YstadS.O. ValeurJ. BrokstadK. HatlebakkJ.G. LiedG.A. 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.2017294e1296910.1111/nmo.1296927747984
    [Google Scholar]
  64. ValdesA.M. WalterJ. SegalE. SpectorT.D. Role of the gut microbiota in nutrition and health.BMJ2018361k217910.1136/bmj.k217929899036
    [Google Scholar]
  65. CarlsonJ.L. EricksonJ.M. LloydB.B. SlavinJ.L. Health effects and sources of prebiotic dietary fiber.Curr. Dev. Nutr.201823nzy00510.1093/cdn/nzy00530019028
    [Google Scholar]
  66. RoberfroidM. GibsonG.R. HoylesL. McCartneyA.L. RastallR. RowlandI. WolversD. WatzlB. SzajewskaH. StahlB. GuarnerF. RespondekF. WhelanK. CoxamV. DaviccoM.J. LéotoingL. WittrantY. DelzenneN.M. CaniP.D. NeyrinckA.M. MeheustA. Prebiotic effects: Metabolic and health benefits.Br. J. Nutr.2010104S2S1S6310.1017/S000711451000336320920376
    [Google Scholar]
  67. JamesS. FraserK. YoungW. Gut microbial metabolites and biochemical pathways involved in irritable bowel syndrome: Effects of diet and nutrition on the microbiome.J. Nutr.20192019nxz30210.1093/jn/nxz30231891398
    [Google Scholar]
  68. MorrisonD.J. PrestonT. Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism.Gut Microbes20167318920010.1080/19490976.2015.113408226963409
    [Google Scholar]
  69. RowlandI. GibsonG. HeinkenA. ScottK. SwannJ. ThieleI. TuohyK. Gut microbiota functions: Metabolism of nutrients and other food components.Eur. J. Nutr.201857112410.1007/s00394‑017‑1445‑828393285
    [Google Scholar]
  70. HolscherH.D. Dietary fiber and prebiotics and the gastrointestinal microbiota.Gut Microbes20178217218410.1080/19490976.2017.129075628165863
    [Google Scholar]
  71. ThomasA. ThomasA. Butler-SanchezM. Dietary modification for the restoration of gut microbiome and management of symptoms in irritable bowel syndrome.Am. J. Lifestyle Med.202216560862110.1177/1559827621101296836072680
    [Google Scholar]
  72. BlachierF. BeaumontM. AndriamihajaM. DavilaA.M. LanA. GrausoM. ArmandL. BenamouzigR. ToméD. Changes in the luminal environment of the colonic epithelial cells and physiopathological consequences.Am. J. Pathol.2017187347648610.1016/j.ajpath.2016.11.01528082121
    [Google Scholar]
  73. SelvarajS.M. WongS.H. SerH.L. LeeL.H. Role of low FODMAP diet and probiotics on gut microbiome in Irritable Bowel Syndrome (IBS).Prog Microbes ; Mol Biol202031a000006910.36877/pmmb.a0000069
    [Google Scholar]
  74. NordinE. HellströmP.M. DicksvedJ. PelveE. LandbergR. BruniusC. Effects of FODMAPs and gluten on gut microbiota and their association with the metabolome in irritable bowel syndrome: A double-blind, randomized, cross-over intervention study.Nutrients20231513304510.3390/nu1513304537447371
    [Google Scholar]
  75. El-SalhyM. HatlebakkJ.G. HauskenT. Diet in Irritable Bowel Syndrome (IBS): Interaction with gut microbiota and gut hormones.Nutrients2019118182410.3390/nu1108182431394793
    [Google Scholar]
  76. Yaser AsaadN. Walid BallanM. ShalabiH.Y.A.L. HossainA. Gut microbiome and insomnia: A mini-review.Emir. Med. J.202341e22112221109810.2174/04666221122085900
    [Google Scholar]
  77. GibsonP.R. HalmosE.P. MuirJ.G. Review article: FODMAPS, prebiotics and gut health-the FODMAP hypothesis revisited.Aliment. Pharmacol. Ther.202052223324610.1111/apt.1581832562590
    [Google Scholar]
  78. SoD. LoughmanA. StaudacherH.M. Effects of a low FODMAP diet on the colonic microbiome in irritable bowel syndrome: A systematic review with meta-analysis.Am. J. Clin. Nutr.2022116494395210.1093/ajcn/nqac17635728042
    [Google Scholar]
/content/journals/nemj/10.2174/0102506882269342231212064600
Loading
/content/journals/nemj/10.2174/0102506882269342231212064600
Loading

Data & Media loading...

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
Please enter a valid_number test