FODMAP diet modulates visceral nociception by lipopolysaccharide-mediated intestinal inflammation and barrier dysfunction

Zhou, Shi; Gillilland, Merritt; Wu, Xiaoyin; Leelasinjaroen, Pornchai; Zhang, Guanpo; Zhou, Hui Ren; Ye, Bo; Lu, Yuanxu; Owyang, Chung

doi:10.1172/jci92390

Cited by 160 publications

(150 citation statements)

References 54 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…4,9,10,43,62 Total bacterial abundance decreases in these patient populations, 9,35 but the health significance of this is unknown and possibly favorable as indicated in a study in which fecal water from patients on a low-FODMAP diet increased markers of inflammation when infused into a rat colon. 63 The putatively negative indicator for health is that a low-FODMAP diet will reduce relative abundance of specific good bacteria, including butyrate-producing and butyrate-promoting bacteria and bifidobacteria in some studies. 4,9,10,28,64 Probiotic supplementation corrected this change in one study.…”

Section: Fear-mongering Associated With a Fodmap Dietmentioning

confidence: 99%

“…Several well‐controlled studies assessing varying FODMAP intake have shown that a low‐FODMAP diet has no effects on bacterial diversity, a marker of good gut health, among patients with IBS, Crohn's disease, or healthy subjects . Total bacterial abundance decreases in these patient populations, but the health significance of this is unknown and possibly favorable as indicated in a study in which fecal water from patients on a low‐FODMAP diet increased markers of inflammation when infused into a rat colon . The putatively negative indicator for health is that a low‐FODMAP diet will reduce relative abundance of specific good bacteria, including butyrate‐producing and butyrate‐promoting bacteria and bifidobacteria in some studies .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome

Halmos

Gibson

2019

J of Gastro and Hepatol

View full text Add to dashboard Cite

Since its first trial showing evidence of efficacy for managing symptoms of irritable bowel syndrome, the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet has been gaining popularity but not without criticism. Application of the diet has changed from a rigid list of “allowed” and “not allowed” foods to a structured program of initial FODMAP restriction followed by food reintroduction and finally personalization so that patients are empowered to adjust their diet themselves to achieve good predictability of symptoms. Safety concerns of the diet have centered around its initial elimination leading to compromise of nutritional and psychological health, but careful patient assessment and management, preferably through a FODMAP‐trained dietitian, will reduce the risk of such negative health outcomes. Most negative attention for the FODMAP diet has been the notion that it will ruin the microbiota. Controlled studies have indicated that reducing FODMAP intake has no effects on bacterial diversity but will reduce total bacterial abundance, and higher FODMAP intakes will increase health‐promoting bacteria, supporting the concept of the full FODMAP program, including attaining a minimal “maintenance” level of FODMAP restriction. This review addresses all these concerns in detail and how to overcome them, including the use of a “FODMAP‐gentle” diet, describing restriction of a select few foods very concentrated in FODMAPs. This version of the diet is commonly applied in practice by experienced FODMAP‐trained dietitians but is not clearly described in literature. Careful direction and assessment of response or nonresponse will decrease the risks of over‐restriction and under‐restriction of diet.

show abstract

Section: Fear-mongering Associated With a Fodmap Dietmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome

Halmos

Gibson

2019

J of Gastro and Hepatol

View full text Add to dashboard Cite

show abstract

“…11 Serum pro-inflammatory cytokines, IL-6 and IL-8, were reduced in patients with IBS following a low-FODMAP diet (P < 0.01). 57 Following 4 wk of a low-FODMAP diet, based on SCFA production, proteolytic fermentation was increased and saccharolytic fermentation decreased in patients with IBS. 57 Following 4 wk of a low-FODMAP diet, based on SCFA production, proteolytic fermentation was increased and saccharolytic fermentation decreased in patients with IBS.…”

Section: All Fodmaps Combinedmentioning

confidence: 99%

Review article: biological mechanisms for symptom causation by individual FODMAP subgroups ‐ the case for a more personalised approach to dietary restriction

Wang

Camilleri

Vanner

et al. 2019

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Background: Due to the paucity of targeted therapy for irritable bowel syndrome (IBS), many patients turn to dietary modifications for symptom management. The combination of five subgroups of poorly absorbed and rapidly fermented carbohydrates-fructans, galacto-oligosaccharides, lactose, excess fructose and polyolsare thought to trigger gastrointestinal symptoms and are referred to collectively as "FODMAPs". Aims:To examine the biological plausibility and mechanisms by which foods high in specific FODMAP subgroups cause symptoms, and to use this information to explore the possibility of targeting select dietary components to allow for a more personalised approach to dietary adjustment Methods: Recent literature was analysed via search databases including Medline, PubMed and Scopus.Results: Lactose, fructans and galacto-oligosaccharides have strong biologic plausibility for symptom generation due to lack of hydrolases resulting in distention from osmosis and rapid fermentation. However, excess fructose and polyols may only cause symptoms in specific individuals when consumed in high doses, but this remains to be established. There is evidence to suggest that certain patient characteristics such as ethnicity may predict response to lactose, but differentiation of other subgroups is difficult prior to dietary manipulation. Conclusions:While some clear mechanisms of action for symptom generation have been established, further research is needed to understand which patients will respond to specific FODMAP subgroup restriction. We suggest that clinicians consider in some patients a tailored, personalised "bottom-up" approach to the low-FODMAP diet, such as dietary restriction relevant to the patients' ethnicity, symptom profile and usual dietary intake.

show abstract

“…An important feature of functional gastrointestinal disorders such as irritable bowel syndrome is the heightened sensitivity of these patients to gut stimulation or distention, a condition termed visceral hypersensitivity . Short‐chain fatty acids in luminal contents have been shown create visceral hypersensitivity in animal studies . Low FODMAP diets are associated with a decrease in liposaccharides (a complex of fat and polysaccharides) in the luminal content of the colon .…”

Section: Introductionmentioning

confidence: 99%

Dietary Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) and Gastrointestinal Disease

Vakil

2018

Nut in Clin Prac

View full text Add to dashboard Cite

FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Dietary modification of FODMAPs has been shown to have significant effects on the physiology of the gastrointestinal tract and improves symptoms of abdominal pain, distention, and bloating in patients with irritable bowel syndrome. Structured withdrawal and reintroduction of FODMAPs supervised by a dietitian is the optimal practice for dietary FODMAP modification in irritable bowel syndrome. FODMAPs are present in enteral feeding formulas and may have a role in diarrhea and bloating in tube-fed patients. Emerging areas of research include the effects of dietary modification of FODMAPs on the microbiome, micronutrient absorption, and caloric intake. FODMAP dietary modification is an emerging area in other gastrointestinal disorders and is of relevance to all practicing dietitians.

show abstract

FODMAP diet modulates visceral nociception by lipopolysaccharide-mediated intestinal inflammation and barrier dysfunction

Cited by 160 publications

References 54 publications

Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome

Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome

Review article: biological mechanisms for symptom causation by individual FODMAP subgroups ‐ the case for a more personalised approach to dietary restriction

Dietary Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) and Gastrointestinal Disease

Contact Info

Product

Resources

About