Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome.
OBJECTIVE
Reduction of short-chain poorly absorbed carbohydrates (FODMAPs) in the diet reduces symptoms of irritable bowel syndrome (IBS). In the present study, we aimed to compare the patterns of breath hydrogen and methane and symptoms produced in response to diets that differed only in FODMAP content.


METHODS
Fifteen healthy subjects and 15 with IBS (Rome III criteria) undertook a single-blind, crossover intervention trial involving consuming provided diets that were either low (9 g/day) or high (50 g/day) in FODMAPs for 2 days. Food and gastrointestinal symptom diaries were kept and breath samples collected hourly over 14 h on day 2 of each diet.


RESULTS
Higher levels of breath hydrogen were produced over the entire day with the high FODMAP diet for healthy volunteers (181 +/- 77 ppm.14 h vs 43 +/- 18; mean +/- SD P < 0.0001) and patients with IBS (242 +/- 79 vs 62 +/- 23; P < 0.0001), who had higher levels during each dietary period than the controls (P < 0.05). Breath methane, produced by 10 subjects within each group, was reduced with the high FODMAP intake in healthy subjects (47 +/- 29 vs 109 +/- 77; P = 0.043), but was not different in patients with IBS (126 +/- 153 vs 86 +/- 72). Gastrointestinal symptoms and lethargy were significantly induced by the high FODMAP diet in patients with IBS, while only increased flatus production was reported by healthy volunteers.


CONCLUSIONS
Dietary FODMAPs induce prolonged hydrogen production in the intestine that is greater in IBS, influence the amount of methane produced, and induce gastrointestinal and systemic symptoms experienced by patients with IBS. The results offer mechanisms underlying the efficacy of the low FODMAP diet in IBS.
Ong
Derrick K
DK
Department of Medicine, Eastern Health Clinical School, Monash University, Victoria, Australia.
Mitchell
Shaylyn B
SB
Barrett
Jacqueline S
JS
Shepherd
Sue J
SJ
Irving
Peter M
PM
Biesiekierski
Jessica R
JR
Smith
Stuart
S
Gibson
Peter R
PR
Muir
Jane G
JG
D015746:Abdominal Pain / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000368:Aged; D001944:Breath Tests; D018592:Cross-Over Studies; D015930:Diet Records; D050528:Diet, Carbohydrate-Restricted; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D045853:Exhalation; D005260:Female; D005285:Fermentation; D005414:Flatulence / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D006859:Hydrogen / Q000378:metabolism; D007413:Intestinal Mucosa / Q000378:metabolism*; D007422:Intestines / Q000503:physiopathology; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000178:diet therapy* / Q000378:metabolism / Q000503:physiopathology; D053609:Lethargy / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008697:Methane / Q000378:metabolism; D008875:Middle Aged; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria; D055815:Young Adult
D004040:Dietary Carbohydrates; D006859:Hydrogen; D008697:Methane