How to Implement the 3-Phase FODMAP Diet Into Gastroenterological Practice

Sultan, Nessmah; Varney, Jane; Halmos, Emma P; Biesiekierski, Jessica R; Yao, Chu K; Muir, Jane G.; Tuck, Caroline J

doi:10.5056/jnm22035

Cited by 23 publications

(44 citation statements)

References 108 publications

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“…The emphasis on low‐FODMAP diets as elimination diets particularly in patients with IBS, the problem with devising and implementing these diets in culturally diverse regions, the lack of knowledge of FODMAP contents in many non‐Western food items, and suggested approaches to overcome these problems using staged interventions have been detailed in a recent review from Australia 23 . Our study offers an alternative approach to elimination diets.…”

Section: Discussionmentioning

confidence: 99%

Self‐reported food intolerances in an Indian population: Need for individualization rather than a universal low‐FODMAP diet

Abraham,

Dhoble,

Desai

et al. 2023

JGH Open

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Background and AimLow‐fermentable oligo‐, di‐, and monosaccharides and polyol (FODMAP) diets have been recommended for individuals with food intolerance and irritable bowel syndrome (IBS). Individual food intolerances may, however, not correspond to the FODMAP content alone.MethodsWe conducted a survey on self‐reported intolerance to articles of food commonly identified as high FODMAP in 400 healthy Indian subjects (median age 40 years; 69% men) and 204 consecutive consenting patients with IBS (median age 36 years; 58% men).ResultsOne‐hundred seventy‐nine (44.8%) healthy subjects and 147 (72.1%) patients with IBS reported some food intolerance (P < 0.00001); the latter reported intolerance to all items (except nuts) more frequently than healthy subjects. The prevalence, however, varied from 2.5 to 32%. Milk intolerance was reported equally commonly by healthy subjects and patients (23% vs 29.9%). Twenty‐three (11.3%) patients and no healthy subjects reported wheat sensitivity. The IBS diarrhea subgroup reported intolerance to milk, pulses, capsicum, cauliflower, leafy vegetables, and dry fruits more frequently than the constipation subgroup.ConclusionFrom among a list of high‐FODMAP items, individuals' intolerance varied widely, suggesting that individuals should be the final judge in deciding their elimination diets rather than devise them based on the FODMAP content alone. As in the West, food intolerance was reported more commonly by patients with IBS, especially those with diarrhea, than by healthy individuals. Also noteworthy is the low prevalence of milk intolerance in a subcontinent labeled as high in lactose intolerance. Unlike in the West, wheat intolerance was not reported by any healthy individual.

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Section: Discussionmentioning

confidence: 99%

Self‐reported food intolerances in an Indian population: Need for individualization rather than a universal low‐FODMAP diet

Abraham,

Dhoble,

Desai

et al. 2023

JGH Open

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“…Along with the growing understanding of FODMAP mechanisms and food composition, 20 efficacy data developed. Studies showing symptom benefit have now been conducted across five continents 21 . While adaptations are required, sufficient FODMAP reduction to achieve symptom response appears possible across cultures 21 .…”

Section: Evolution Of the Traditional Three‐phase Fodmap Diet: Fine‐t...mentioning

confidence: 99%

Evolution, adaptation, and new applications of the FODMAP diet

O'Brien,

Kasti,

Halmos

et al. 2024

JGH Open

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The FODMAP diet has been a treatment of irritable bowel syndrome (IBS) for many years. Rigorous scientific evaluation and clinical application of the FODMAP diet have generated deep understanding regarding clinical efficacy, mechanisms of action, and potential adverse effects of this dietary approach. In turn, this knowledge has allowed fine‐tuning of the diet to optimize treatment benefits and minimize risks, in the form of the traditional three‐phase diet; the FODMAP‐gentle approach, which is a less restrictive iteration; and a proposed FODMAP‐modified, Mediterranean‐style diet which endeavours to optimise both gastrointestinal symptoms and other health parameters. Furthermore, recognition that IBS‐like symptoms feature in other conditions has seen the FODMAP diet tested in non‐IBS populations, including in older adults with diarrhea and women with endometriosis. These areas represent new frontiers for the FODMAP diet and a space to watch as future research evaluates the validity of these novel clinical applications.

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“…The low FODMAPs (LFD) diet is an elimination protocol based on a temporary limitation of the consumption of strongly fermenting substances such as: fructooligosaccharides, oligosaccharides, disaccharides, monosaccharides and polyols [ 119 ]. Limiting the consumption of these ingredients significantly reduces fermentation in the intestine, reduces the inflow of water to the intestine and reduces gas production.…”

Section: Nutrition—what Is Beyond the Obvious?mentioning

confidence: 99%

Small Intestinal Bacterial Overgrowth and Non-Alcoholic Fatty Liver Disease: What Do We Know in 2023?

Gudan

Kozłowska-Petriczko

Bodnarczuk³

et al. 2023

Nutrients

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Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with the pathological accumulation of lipids inside hepatocytes. Untreated NAFL can progress to non-alcoholic hepatitis (NASH), followed by fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). The common denominator of the above-mentioned metabolic disorders seems to be insulin resistance, which occurs in NAFLD patients. Obesity is the greatest risk factor for lipid accumulation inside hepatocytes, but a part of the NAFLD patient population has a normal body weight according to the BMI index. Obese people with or without NAFLD have a higher incidence of small intestinal bacterial overgrowth (SIBO), and those suffering from NAFLD show increased intestinal permeability, including a more frequent presence of bacterial overgrowth in the small intestine (SIBO). The health consequences of SIBO are primarily malabsorption disorders (vitamin B12, iron, choline, fats, carbohydrates and proteins) and bile salt deconjugation. Undetected and untreated SIBO may lead to nutrient and/or energy malnutrition, thus directly impairing liver function (e.g., folic acid and choline deficiency). However, whether SIBO contributes to liver dysfunction, decreased intestinal barrier integrity, increased inflammation, endotoxemia and bacterial translocation is not yet clear. In this review, we focus on gut–liver axis and discuss critical points, novel insights and the role of nutrition, lifestyle, pre- and probiotics, medication and supplements in the therapy and prevention of both SIBO and NAFLD.

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How to Implement the 3-Phase FODMAP Diet Into Gastroenterological Practice

Cited by 23 publications

References 108 publications

Self‐reported food intolerances in an Indian population: Need for individualization rather than a universal low‐FODMAP diet

Self‐reported food intolerances in an Indian population: Need for individualization rather than a universal low‐FODMAP diet

Evolution, adaptation, and new applications of the FODMAP diet

Small Intestinal Bacterial Overgrowth and Non-Alcoholic Fatty Liver Disease: What Do We Know in 2023?

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