Low-FODMAP vs regular rye bread in irritable bowel syndrome: Randomized SmartPill^® study

Abstract

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.

Effects of Sourdough on FODMAPs in Bread and Potential Outcomes on Irritable Bowel Syndrome Patients and Healthy Subjects

“…Another study has shown that low-FODMAPs rye breads, approximately 30% reduction of mannitol and fructans, caused less gastrointestinal symptoms, as abdominal pain, flatulence, stomach rum- and intestinal cramps ( Laatikainen et al, 2016 ). A third study conducted by Pirkola et al (2018) demonstrated that low-FODMAP rye bread leads to reduced colonic fermentation and flatulence severity when compared with regular rye bread consumption.…”

The role of bread in the UK diet: An update

“…Hence, sourdough bread may be more suitable for some individuals with IBS than standard types of bread. A 2019 review found some evidence from small, low‐quality studies (seven studies) suggesting that sourdough bread may be better tolerated in both healthy individuals and those with gastrointestinal conditions (Dimidi et al 2019) and, in a small additional study ( n = 7), low FODMAP rye bread significantly reduced colonic fermentation compared with standard rye bread, though there was no significant difference in symptoms (Pirkola et al 2018). In addition to FODMAPs, some of the gluten in sourdough bread may be hydrolysed during fermentation, but not all and so while it is sometimes suggested that sourdough bread is more suitable for individuals with coeliac disease, this is in fact not the case.…”

Use of Sourdough in Low FODMAP Baking

“…The use of this zero FODMAP sourdough in low FODMAP rye bread making involves the addition of unfermented rye flour, which is fermented for only a short time [ 65 ]. Nevertheless, the choice of appropriate raw materials and the use of FruA-positive and mannitol-fermenting lactobacilli allows fructan degradation in rye and rye sourdoughs for the production of bread with a low content of fructans and mannitol but a comparable fiber content when compared to regular bread [ 66 , 67 , 68 ].…”

“…Including the low FODMAP rye bread thus also increased the dietary fiber intake to the recommended level in IBS patients, avoiding drawbacks of the other low FODMAP diets [ 15 ]. A second randomized double-blind controlled crossover study evaluated the amount of breath hydrogen levels after consuming low FODMAP rye bread or regular rye bread [ 68 ]. Low FODMAP rye bread reduced the generation of hydrogen by colonic fermentation [ 68 ].…”

“…A second randomized double-blind controlled crossover study evaluated the amount of breath hydrogen levels after consuming low FODMAP rye bread or regular rye bread [ 68 ]. Low FODMAP rye bread reduced the generation of hydrogen by colonic fermentation [ 68 ]. This study showed that significant differences between bread types may occur in their postprandial effects.…”