Evolution, adaptation, and new applications of the FODMAP diet

Abstract

The FODMAP diet has been a treatment of irritable bowel syndrome (IBS) for many years. Rigorous scientific evaluation and clinical application of the FODMAP diet have generated deep understanding regarding clinical efficacy, mechanisms of action, and potential adverse effects of this dietary approach. In turn, this knowledge has allowed fine-tuning of the diet to optimize treatment benefits and minimize risks, in the form of the traditional three-phase diet; the FODMAP-gentle approach, which is a less restrictive iteration; and a proposed FODMAP-modified, Mediterranean-style diet which endeavours to optimise both gastrointestinal symptoms and other health parameters. Furthermore, recognition that IBS-like symptoms feature in other conditions has seen the FODMAP diet tested in non-IBS populations, including in older adults with diarrhea and women with endometriosis. These areas represent new frontiers for the FODMAP diet and a space to watch as future research evaluates the validity of these novel clinical applications.

Keywords: diet; irritable bowel syndrome; luminal gastroenterology.

Figure 1

Proposed new five‐phase FODMAP diet framework. In this updated framework, the diet is a five‐phase approach including two newly described phases of predicting response to identify ideal candidates (Phase 0), and implementation of adjunct diet and non‐diet therapies (Phase 4).

Figure 2

Adaptation of the FODMAP diet in people with irritable bowel syndrome (IBS)—indications for a traditional three‐phase FODMAP approach, a FODMAP‐gentle approach, a FODMAP–Mediterranean approach, and non‐dietary approaches.