Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome

Abstract

Background and Aim: Reduction of short-chain poorly absorbed carbohydrates (FODMAPs) in the diet reduces symptoms of irritable bowel syndrome (IBS). In the present study, we aimed to compare the patterns of breath hydrogen and methane and symptoms produced in response to diets that differed only in FODMAP content. Methods: Fifteen healthy subjects and 15 with IBS (Rome III criteria) undertook a single-blind, crossover intervention trial involving consuming provided diets that were either low (9 g/day) or high (50 g/day) in FODMAPs for 2 days. Food and gastrointestinal symptom diaries were kept and breath samples collected hourly over 14 h on day 2 of each diet. Results: Higher levels of breath hydrogen were produced over the entire day with the high FODMAP diet for healthy volunteers (181 Ϯ 77 ppm.14 h vs 43 Ϯ 18; mean Ϯ SD P < 0.0001) and patients with IBS (242 Ϯ 79 vs 62 Ϯ 23; P < 0.0001), who had higher levels during each dietary period than the controls (P < 0.05). Breath methane, produced by 10 subjects within each group, was reduced with the high FODMAP intake in healthy subjects (47 Ϯ 29 vs 109 Ϯ 77; P = 0.043), but was not different in patients with IBS (126 Ϯ 153 vs 86 Ϯ 72). Gastrointestinal symptoms and lethargy were significantly induced by the high FODMAP diet in patients with IBS, while only increased flatus production was reported by healthy volunteers. Conclusions: Dietary FODMAPs induce prolonged hydrogen production in the intestine that is greater in IBS, influence the amount of methane produced, and induce gastrointestinal and systemic symptoms experienced by patients with IBS. The results offer mechanisms underlying the efficacy of the low FODMAP diet in IBS.

Mechanisms and effectiveness of prebiotics in modifying the gastrointestinal microbiota for the management of digestive disorders

“…High doses of fermentable carbohydrates can stimulate colonic gas production, which might increase flatulence and which in the context of visceral hypersensitivity might also induce abdominal discomfort and pain. In a recent study, a diet high in fermentable carbohydrates was shown to increase breath hydrogen in both fifteen patients with IBS and fifteen healthy controls (93) . This was associated with an increase in abdominal pain, bloating and flatulence in patients with IBS, but only in flatulence in the healthy controls (93) .…”

“…In a recent study, a diet high in fermentable carbohydrates was shown to increase breath hydrogen in both fifteen patients with IBS and fifteen healthy controls (93) . This was associated with an increase in abdominal pain, bloating and flatulence in patients with IBS, but only in flatulence in the healthy controls (93) . A study in ileostomists has shown that diets high in fermentable carbohydrates can increase water delivery into the ileum, thus potentially contributing to the generation of diarrhoea (94) .…”

The Low FODMAP Diet and Its Application in East and Southeast Asia

“…However, a diet that reduces the intake of foods containing indigestible and slowly absorbed short-chain carbohydrates, collectively termed "FODMAPs" (fermentable oligo-, di-, mono-saccharides, and polyols), has a growing number of studies that consistently describe efficacy in about 70% of an unselected population of patients with IBS (Table). [9][10][11][12] As a result, the low FODMAP diet is emerging as a first line of treatment for IBS sufferers. The low FODMAP diet, however, varies markedly across geographical regions.…”

Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: probiotics, prebiotics and the low FODMAP diet

“…Firstly some FODMAP increased small intestinal water volume, which in the context of visceral hypersensitivity in IBS might provoke abdominal pain and bloating (102)(103)(104)(105) . Secondly, FODMAP increase colonic hydrogen and methane production (104,106) which increases luminal distension. Importantly, these effects have been correlated with GI symptom response in breath testing (107) and MRI imaging studies (105) .…”