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Review
. 2024 Jan 26;16(3):370.
doi: 10.3390/nu16030370.

The Role of the FODMAP Diet in IBS

Luisa Bertin  1   2 , Miriana Zanconato  1   2 , Martina Crepaldi  1   2 , Giovanni Marasco  3   4 , Cesare Cremon  3   4 , Giovanni Barbara  3   4 , Brigida Barberio  1   2 , Fabiana Zingone  1   2 , Edoardo Vincenzo Savarino  1   2
Affiliations
Review

The Role of the FODMAP Diet in IBS

Luisa Bertin et al. Nutrients. .

Abstract

The low FODMAP (fermentable oligosaccharide, disaccharide, monosaccharide, and polyol) diet is a beneficial therapeutic approach for patients with irritable bowel syndrome (IBS). However, how the low FODMAP diet works is still not completely understood. These mechanisms encompass not only traditionally known factors such as luminal distension induced by gas and water but also recent evidence on the role of FOMAPs in the modulation of visceral hypersensitivity, increases in intestinal permeability, the induction of microbiota changes, and the production of short-chain fatty acids (SCFAs), as well as metabolomics and alterations in motility. Although most of the supporting evidence is of low quality, recent trials have confirmed its effectiveness, even though the majority of the evidence pertains only to the restriction phase and its effectiveness in relieving abdominal bloating and pain. This review examines potential pathophysiological mechanisms and provides an overview of the existing evidence on the effectiveness of the low FODMAP diet across various IBS subtypes. Key considerations for its use include the challenges and disadvantages associated with its practical implementation, including the need for professional guidance, variations in individual responses, concerns related to microbiota, nutritional deficiencies, the development of constipation, the necessity of excluding an eating disorder before commencing the diet, and the scarcity of long-term data. Despite its recognized efficacy in symptom management, acknowledging these limitations becomes imperative for a nuanced comprehension of the role of a low FODMAP diet in managing IBS. By investigating its potential mechanisms and evidence across IBS subtypes and addressing emerging modulations alongside limitations, this review aims to serve as a valuable resource for healthcare practitioners, researchers, and patients navigating the intricate landscape of IBS.

Keywords: FODMAPs; fructans; fructose; galactans; glucose; irritable bowel syndrome; lactose; nutritional status.

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Conflict of interest statement

Edoardo Vincenzo Savarino has served as speaker for Abbvie, Agave, AGPharma, Alfasigma, Aurora Pharma, CaDiGroup, Celltrion, Dr Falk, EG Stada Group, Fenix Pharma, Fresenius Kabi, Galapagos, Janssen, JB Pharmaceuticals, Innovamedica/Adacyte, Malesci, MayolyBiohealth, Omega Pharma, Pfizer, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda, Tillots, and Unifarco; as a consultant for Abbvie, Agave, Alfasigma, Biogen, Bristol-Myers Squibb, Celltrion, DiademaFarmaceutici, Dr Falk, Fenix Pharma, Fresenius Kabi, Janssen, JB Pharmaceuticals, Merck & Co, Nestlè, Reckitt Benckiser, Regeneron, Sanofi, SILA, Sofar, Synformulas GmbH, Takeda, and Unifarco; and received research support from Pfizer, Reckitt Benckiser, SILA, Sofar, Unifarco, and Zeta Farmaceutici. Giovanni Barbara has been a consultant, served on the advisory board, and received speaker’s bureau fees, honorarium, and travel support to meetings from Aboca, AB Biotics, Agave, AGPharma, Alfasigma, Arena, AstraZeneca, Bayer, Biocodex, Boeringer, Bromatech, Cadigroup, Diadema, Dr Falk, GE Healthcare, Falk Pharma, IMA, Mayloy, Malesci, Nestlè, Parmalat, Sanofi, Schwabe Pharma, Sofar, Yakult, Zespri. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Hypothesized mechanisms of FODMAP-induced symptoms in individuals. Created with Biorender.com. Last accessed: 23 January 2023.
Figure 2
Figure 2
Process of low FODMAP diet implementation. Created with Biorender.com. Last accessed: 31 December 2023.
Figure 3
Figure 3
Main recommendations of dietary treatments for IBS. Created with Biorender.com. Last accessed: 31 December 2023.
Figure 4
Figure 4
High FODMAP foods and low FODMAP alternatives. Created with Biorender.com. Last accessed: 23 January 2024.
See this image and copyright information in PMC

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