Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach.
OBJECTIVE
Functional gastrointestinal symptoms are common and their management is often a difficult clinical problem. The link between food intake and symptom induction is recognized. This review aims to describe the evidence base for restricting rapidly fermentable, short-chain carbohydrates (FODMAPs) in controlling such symptoms.


METHODS
The nature of FODMAPs, their mode of action in symptom induction, results of clinical trials and the implementation of the diet are described.


RESULTS
FODMAPs are widespread in the diet and comprise a monosaccharide (fructose), a disaccharide (lactose), oligosaccharides (fructans and galactans), and polyols. Their ingestion increases delivery of readily fermentable substrate and water to the distal small intestine and proximal colon, which are likely to induce luminal distension and induction of functional gut symptoms. The restriction of their intake globally (as opposed to individually) reduces functional gut symptoms, an effect that is durable and can be reversed by their reintroduction into the diet (as shown by a randomized placebo-controlled trial). The diet has a high compliance rate. However it requires expert delivery by a dietitian trained in the diet. Breath hydrogen tests are useful to identify individuals who can completely absorb a load of fructose and lactose so that dietary restriction can be less stringent.


CONCLUSIONS
The low FODMAP diet provides an effective approach to the management of patients with functional gut symptoms. The evidence base is now sufficiently strong to recommend its widespread application.
Monash University Department of Medicine, Box Hill Hospital, Box Hill, Victoria, Australia. peter.gibson@med.monash.edu.au
Peter R
PR
Gibson
Susan J
SJ
Shepherd
D001944:Breath Tests; D050528:Diet, Carbohydrate-Restricted; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D004045:Dietary Services; D019317:Evidence-Based Medicine; D005285:Fermentation; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000178:diet therapy* / Q000209:etiology; D006801:Humans; D010349:Patient Compliance; D016896:Treatment Outcome
D004040:Dietary Carbohydrates