title: The low-FODMAP diet for irritable bowel syndrome: Lights and shadows.
abstract: Irritable bowel syndrome (IBS) affects 10-15% of the western population. Drug therapy for this entity has shown limited efficacy. The low Fermentable Oligo-, Di-, Monosaccharides And Polyols (FODMAP) diet has recently emerged as an effective intervention for reducing gastrointestinal symptoms in IBS. Currently, several mechanistic studies have proven the rational basis of carbohydrate restriction. In addition, high-quality evidence (prospective studies and randomized controlled trials) from a variety of countries supports the high effectiveness of a low-FODMAP diet for IBS symptoms (70%), especially abdominal bloating, pain, and diarrhea. Importantly, this diet seems to be superior to a gluten-free diet for patients with non-celiac gluten sensitivity. The most controversial features of the low FODMAP diet are its short- and long-term limitations (a high level of restriction, the need for monitoring by an expert dietitian, potential nutritional deficiencies, significant gut microbiota reduction, lack of predictors of response), as well as the potential lack of advantage over alternative dietary, pharmacological and psychological interventions for IBS. Although liberalization of carbohydrate intake is recommended in the long-term, the reintroduction process remains to be clarified as, theoretically, global carbohydrate restriction is deemed to be necessary to avoid additive effects.
authors.affiliation: Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain. Electronic address: xavi_molina@hotmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Molina-Infante
authors.affiliation: Motility and Functional Gut Disorders Unit, University Hospital Germans Trias I Pujol, Autonomous University of Barcelona, Badalona, Spain; CIBERehd, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Serra
authors.affiliation: CIBERehd, Spain; Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandez-Bañares
authors.affiliation: Department of Gastroenterology, Centro Médico Teknon, Barcelona, Spain.
authors.forename: Fermín
authors.initials: F
authors.lastname: Mearin
mesh_terms: D004032:Diet / Q000379:methods*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000178:diet therapy*; D009005:Monosaccharides
chemical_list: D009005:Monosaccharides
keywords: Diet; Dieta; FODMAP; Gluten; Irritable bowel syndrome; Non-celiac gluten sensitivity; Sensibilidad al gluten no celiaca; Síndrome del intestino irritable