SummaryBackgroundGrains are high in FODMAPs (Fermentable Oligo‐, Di‐, Monosaccharides And Polyols) and often considered as triggers of IBS symptoms.AimTo evaluate if rye bread low in FODMAPs would be better tolerated than regular rye bread in subjects with IBS.MethodsThe study was conducted as a randomised double blind controlled cross‐over study (n = 87). Participants were supplied with both regular rye bread and low‐FODMAP rye bread for 4 weeks. Symptoms were measured with a symptom severity scoring system (IBS‐SSS) and visual analogue scale (VAS) assessments of individual symptoms. Quality of life was monitored. Colonic fermentation was measured by the breath hydrogen test and dietary intake by food diaries.ResultsDietary fibre intake increased during both study periods compared to baseline. Many signs of IBS i.e. flatulence, abdominal pain, cramps and stomach rumbling were milder on the low‐FODMAP rye bread (P‐values: 0.04; 0.049; 0.01 and 0.001). The mean of VAS measurements was favourable towards LF bread [−3 (95% CI): −6 to −1, P = 0.02] but no differences were detected in IBS‐SSS or quality of life. The AUC of breath hydrogen values was significantly lower during the low‐FODMAP bread period (median 52.9 vs. 72.6; P = 0.01).ConclusionsLow‐FODMAP rye bread helps IBS patients to control their symptoms and reduces gastrointestinal gas accumulation. However, replacing regular rye bread by low‐FODMAP bread without concomitant broader dietary changes does not improve quality of life or IBS‐SSS. Nonetheless, inclusion of low‐FODMAP rye bread in diet might be one way that IBS patients could increase their fibre intake.

Many patients suspect wheat as being a major trigger of their irritable bowel syndrome (IBS) symptoms. Our aim was to evaluate whether sourdough wheat bread baked without baking improvers and using a long dough fermentation time (>12 h), would result in lower quantities of alpha-amylase/trypsin inhibitors (ATIs) and Fermentable, Oligo-, Di-, Mono-saccharides and Polyols (FODMAPs), and would be better tolerated than yeast-fermented wheat bread for subjects with IBS who have a poor subjective tolerance to wheat. The study was conducted as a randomised double-blind controlled 7-day study (n = 26). Tetrameric ATI structures were unravelled in both breads vs. baking flour, but the overall reduction in ATIs to their monomeric form was higher in the sourdough bread group. Sourdough bread was also lower in FODMAPs. However, no significant differences in gastrointestinal symptoms and markers of low-grade inflammation were found between the study breads. There were significantly more feelings of tiredness, joint symptoms, and decreased alertness when the participants ate the sourdough bread (p ≤ 0.03), but these results should be interpreted with caution. Our novel finding was that sourdough baking reduces the quantities of both ATIs and FODMAPs found in wheat. Nonetheless, the sourdough bread was not tolerated better than the yeast-fermented bread.

Rye bread and lactobacilli modify the colonic environment and have the potential to relieve constipation and could be a safe and convenient alternative to laxatives. The effects of rye bread and cultured buttermilk with Lactobacillus rhamnosus GG (LGG) on bowel function and colon metabolism were investigated and compared with laxatives in 51 constipated adults. They were randomized to receive whole-grain rye bread (minimum 240 g/d), LGG (2 x 10(10) colony-forming units/d), whole-grain rye bread (minimum 240 g/d) + LGG (2 x 10(10) colony-forming units/d), white wheat bread (maximum 192 g/d), or laxatives (as usual for a participant) for 3 wk. Participants recorded their dietary habits, bowel function, and gastrointestinal symptoms. Fecal weight, pH, SCFA and bacterial enzyme activities, total intestinal transit time (TITT), and breath hydrogen were determined. Rye bread, compared with white wheat bread, shortened TITT by 23% (P = 0.040), increased weekly defecations by 1.4 (P = 0.014), softened feces [odds ratio (OR) 3.98; P = 0.037], eased defecation (OR 5.08; P = 0.018), increased fecal acetic acid and butyric acid contents by 24% (P = 0.044) and 63% (P <0.001), respectively, and reduced fecal beta-glucuronidase activity by 23% (P = 0.014). Compared with laxatives, rye bread reduced TITT by 41% (P = 0.006), fecal beta-glucuronidase activity by 38% (P = 0.033), and fecal pH by 0.31 units (P = 0.006). LGG did not relieve constipation or significantly affect colonic metabolism. Gastrointestinal adverse effects did not significantly differ among the study groups. In conclusion, rye bread relieves mild constipation and improves colonic metabolism compared with white wheat bread and commonly used laxatives without increasing gastrointestinal adverse effects.

AIMTo compare the effects of regular vs low-FODMAP rye bread on irritable bowel syndrome (IBS) symptoms and to study gastrointestinal conditions with SmartPill®.METHODSOur aim was to evaluate if rye bread low in FODMAPs would cause reduced hydrogen excretion, lower intraluminal pressure, higher colonic pH, different transit times, and fewer IBS symptoms than regular rye bread. The study was a randomized, double-blind, controlled cross-over meal study. Female IBS patients (n = 7) ate study breads at three consecutive meals during one day. The diet was similar for both study periods except for the FODMAP content of the bread consumed during the study day. Intraluminal pH, transit time, and pressure were measured by SmartPill, an indigestible motility capsule.RESULTSHydrogen excretion (a marker of colonic fermentation) expressed as area under the curve (AUC)(0-630 min) was [median (range)] 6300 (1785-10800) ppm∙min for low-FODMAP rye bread and 10 635 (4215-13080) ppm∙min for regular bread (P = 0.028). Mean scores of gastrointestinal symptoms showed no statistically significant differences but suggested less flatulence after low-FODMAP bread consumption (P = 0.063). Intraluminal pressure correlated significantly with total symptom score after regular rye bread (ρ = 0.786, P = 0.036) and nearly significantly after low-FODMAP bread consumption (ρ = 0.75, P = 0.052). We found no differences in pH, pressure, or transit times between the breads. Gastric residence of SmartPill was slower than expected. SmartPill left the stomach in less than 5 h only during one measurement (out of 14 measurements in total) and therefore did not follow on par with the rye bread bolus.CONCLUSIONLow-FODMAP rye bread reduced colonic fermentation vs regular rye bread. No difference was found in median values of intraluminal conditions of the gastrointestinal tract.

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