Editorial: food for thought—the low‐FODMAP diet and IBS in perspective

Abstract

4,5 several (lactose, fructose, sorbitol and wheat) are now incorporated into a popular dietary approach: the low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet. [4][5][6] These molecules, poorly absorbed in the small intestine, are thought to generate increased, osmotically driven intraluminal volumes 7 and to be fermented by the colonic microbiota to short chain fatty acids and gases; thereby generating pain, bloating and distension in a viscerally sensitive subject. 8 Clinical trials supported this hypothesis (reviewed in reference 9); soon the low-FOD-MAP diet became a cornerstone of IBS management.The systematic review and meta-analysis by Rindom Krogsgaard and colleagues casts a cold eye on clinical trials of the low-FODMAP diet and points up a number of shortcomings: unrepresentative study population (tertiary referral rather than primary care), lack of blinding, inappropriate controls (in terms of diet or other intervention) and, most tellingly, short duration of exposure (maximum 6 weeks in a disorder that lasts a lifetime). 9 Furthermore, the reintroduction phase, fundamental to the low-FODMAP strategy, has not been subjected to critical assessment. Their analysis, indeed, leads them to conclude that much of the impact of a low-FODMAP diet may be a placebo effect.

Dietary therapies for functional bowel symptoms: Recent advances, challenges, and future directions

“…Due to the heterogeneity of functional gastrointestinal symptoms, it is unlikely that a single dietary therapy will be suitable for all patients . As such, various dietary strategies have emerged for the treatment of gastrointestinal conditions, which are being used without uniformity across centers and regions.…”

“…Due to the heterogeneity of functional gastrointestinal symptoms, it is unlikely that a single dietary therapy will be suitable for all patients. 19 As such, various dietary strategies have emerged for the treatment of gastrointestinal conditions, which are being used without uniformity across centers and regions. Table 1 outlines a range of dietary therapies available, and for each diet describes the known and/or proposed mechanisms of action, evidence of efficacy, and what clinical phenotype the diet is used for.…”

Study of the Gastrointestinal Heat Retention Syndrome in Children: From Diagnostic Model to Biological Basis

“…With the deepening of research, the importance of intestinal microbes in the gut-brain axis has gradually been recognized, thus forming the concept of "microbiotagut-brain axis" [32]. Some studies have proved that intestinal flora imbalance was related to not only gastrointestinal disorders such as inflammatory bowel disease and irritable bowel syndrome [33,34], but also mental and neurological diseases such as anxiety, depression, Alzheimer's disease, and Parkinson's disease [35][36][37][38][39].…”

Application of nutrient essentiality criteria to dietary carbohydrates

“…A maternal low-FODMAP diet has also been shown to reduce symptoms of colic in breastfed infants without gross changes in breast milk composition (195) . Although further research is needed to address the shortcomings of current trials using a low-FODMAP diet, a low-FODMAP diet is also being explored for the treatment of inflammatory bowel disease (196)(197)(198)(199)(200)(201) . Interestingly, a low-FODMAP diet improves symptoms of irritable bowel syndrome despite a decrease in carbohydrate fermentation that is generally thought to be beneficial to health and an increase in protein fermentation that is generally thought to be detrimental to health (202)(203)(204)(205) .…”