Mechanisms and efficacy of dietary FODMAP restriction in IBS.
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.
King's College London, School of Medicine, Diabetes and Nutritional Sciences Division, Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
Heidi M
HM
Staudacher
Guys and St Thomas NHS Foundation Trust, Department of Gastroenterology, College House, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
Peter M
PM
Irving
Guys and St Thomas NHS Foundation Trust, Department of Gastroenterology, College House, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
Miranda C E
MC
Lomer
King's College London, School of Medicine, Diabetes and Nutritional Sciences Division, Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
Kevin
K
Whelan
D000075202:Contraindications; D004035:Diet Therapy; D050528:Diet, Carbohydrate-Restricted; D004187:Disaccharides; D006801:Humans; D006859:Hydrogen / Q000378:metabolism; D043183:Irritable Bowel Syndrome / Q000178:diet therapy* / Q000378:metabolism* / Q000503:physiopathology; D009005:Monosaccharides; D009844:Oligosaccharides; D011108:Polymers; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000502:physiology
D004187:Disaccharides; D009005:Monosaccharides; D009844:Oligosaccharides; D011108:Polymers; C024617:polyol; D006859:Hydrogen