Gastrointestinal effects of diets low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols

Abstract

Purpose of review Food ingestion is an exacerbator of gastrointestinal symptoms, regardless of origin. Sufferers mistakenly assume that they have suffered an allergic reaction to a given food. Although classical IgE-mediated allergic reactions are rarely culpable, evidence for a role for intolerance to certain carbohydrates in irritable bowel syndrome (IBS) and related conditions increases. This review assesses the status of a commonly implicated group of poorly absorbed carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides and polyols – FODMAPs) in gastrointestinal pathophysiology. Recent findings Although evidence of efficacy for low FODMAP diets in IBS accumulates, the magnitude of this effect has declined in recent studies. Comparisons to other dietary approaches have revealed conflicting results; some suggest superiority, others find parity. Concerns had been raised regarding long-term nutritional, psychological and microbiological impacts of FODMAP restriction; providing that the diet is administered in the recommended manner, these do not appear to be clinically important. The mechanisms whereby FODMAPs cause gastrointestinal symptoms continue to be explored. Summary FODMAPS induce gastrointestinal symptoms in susceptible individuals and their restriction provides clinical benefits. The magnitude of these benefits, the superiority of FODMAP restriction over other dietary approaches and the mechanisms of its effects continue to be defined.

DOMINO trial post hoc analysis: evaluation of the diet effects on symptoms in IBS subtypes

“… 3 Moreover, the low FODMAP diet is very restrictive, needs the close follow-up of an experienced dietitian and the compliance is variable. 18 , 19 In addition, it has been shown that it could negatively affect the microbiome by reducing levels of Bifidobacteria spp. and short-chain fatty acids (SCFAs) production.…”