Fermentable oligosaccharides, disaccharides, monosaccharides and polyols: role in irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) was previously left poorly treated despite its high prevalence and cost. Over the past decade, significant research has been conducted providing new dietary strategies for IBS management. The ‘low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet’ has shown symptom improvement in 68–76% of patients. Randomized, controlled trials have now proven its efficacy. The diet, low in poorly absorbed and fermentable carbohydrates, uses dietary restriction and re-challenge to determine individual tolerance to various short-chain carbohydrates. However there may be potential detrimental effects of the diet in the long term, due to potential changes to the gastrointestinal microbiota. Appropriate dietary education and management of the diet is imperative. Future research should focus on the relevance of changes to the microbiota and ways to liberalize the dietary restrictions.

Keywords::

• abdominal pain
• carbohydrates
• diet therapy
• FODMAP
• gastrointestinal diseases
• irritable bowel syndrome

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• There are limited effective treatment strategies for irritable bowel syndrome (IBS).

• The low Fermentable, Oligosaccharides, Disaccharides, Monosaccharides And Polyols (FODMAP) diet has high-quality evidence of efficacy in patients with IBS, such that the diet can now be now considered a first-line therapy for the treatment of IBS.

• The diet should be used for short-term symptom relief followed by re-challenge to assess tolerance levels to the various FODMAP subgroups.

• Correct food composition data are critical to the use of the diet.

• Involvement with a Dietitian is ideal for the correct use of the low FODMAP diet and to ensure nutritional adequacy.

• The use of hydrogen breath testing may not provide insight into dietary triggers.

• The low FODMAP diet may result in changes in the microbiota, which requires further investigation.

• The low FODMAP diet may extend beyond use in IBS. Its use in inflammatory bowel disease shows promise.

Notes