Low Fermentable Oligo- Di- and Mono-Saccharides and Polyols (FODMAPs) or Gluten Free Diet: What Is Best for Irritable Bowel Syndrome?

Abstract

Irritable Bowel Syndrome (IBS) is a very common functional gastrointestinal disease. Its pathogenesis is multifactorial and not yet clearly defined, and hence, its therapy mainly relies on symptomatic treatments. Changes in lifestyle and dietary behavior are usually the first step, but unfortunately, there is little high-quality scientific evidence regarding a dietary approach. This is due to the difficulty in setting up randomized double-blind controlled trials which objectively evaluate efficacy without the risk of a placebo effect. However, a Low Fermentable Oligo-, Di- and Mono-saccharides And Polyols (FODMAP) Diet (LFD) and Gluten Free Diet (GFD) are among the most frequently suggested diets. This paper aims to evaluate their possible role in IBS management. A GFD is less restrictive and easier to implement in everyday life and can be suggested for patients who clearly recognize gluten as a trigger of their symptoms. An LFD, being more restrictive and less easy to learn and to follow, needs the close supervision of a skilled nutritionist and should be reserved for patients who recognize that the trigger of their symptoms is not, or not only, gluten. Even if the evidence is of very low-quality for both diets, the LFD is the most effective among the dietary interventions suggested for treating IBS, and it is included in the most updated guidelines.

Relationship between Persistent Gastrointestinal Symptoms and Duodenal Histological Findings after Adequate Gluten-Free Diet: A Gray Area of Celiac Disease Management in Adult Patients

“…We hypothesize that the high rate of persistent diarrhea in the first years after the beginning of a GFD, as reported in our study, might also be due to dietary modification. In fact, a GFD may often lead to an increase in fiber intake with a consequent enrichment in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) [ 41 ]. FODMAPs are fermentable, poorly absorbed and osmotically active short molecules that are potentially responsible for GI symptoms and the alteration of intestinal microbiota in predisposed patients [ 38 , 39 , 41 ].…”

“…In fact, a GFD may often lead to an increase in fiber intake with a consequent enrichment in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) [ 41 ]. FODMAPs are fermentable, poorly absorbed and osmotically active short molecules that are potentially responsible for GI symptoms and the alteration of intestinal microbiota in predisposed patients [ 38 , 39 , 41 ]. Even though the majority of CD patients had a low intake of gluten-free cereals and sweets, they still consumed a significant amount of vegetables and fruits high in FODMAPs, as demonstrated by a recently published study [ 42 ].…”

Myofascial Pelvic Pain: An Overlooked and Treatable Cause of Chronic Pelvic Pain

“…A surgical consultation with an endometriosis specialist may also be indicated. If irritable bowel syndrome is suspected, patients may be helped by an elimination or low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPS) diet, medications such as laxatives and antispasmodics, and a gastroenterology referral 50 . Patients with interstitial cystitis can be referred to a urologist along with considering dietary changes and medication to make urine less acidic.…”

Probióticos en dispepsia, microbiota y estreñimiento, gluten en el síndrome de intestino irritable y cannabinoides en trastornos motores y funcionales gastrointestinales

“…Por otra parte, hay que considerar que un importante grupo de pacientes que refieren sensibilidad al gluten, en realidad presentan sensibilidad a oligosacáridos, disacáridos, monosacáridos y polioles fermentables (FODMAP), entre los cuales los fructanos son los carbohidratos principales en el trigo, y de allí su confusión. Sin embargo, ambas dietas han sido utilizadas como primera medida de tratamiento por muchos especialistas encargados del manejo de pacientes con SII; no obstante, la dieta libre de gluten es mucho más fácil de implementar y menos restrictiva que la dieta baja en FODMAP 24 . Así mismo, si bien la dieta libre de gluten es esencial en el tratamiento de EC, incluso en el manejo de manifestaciones como la dermatitis herpetiforme y alteraciones psicológicas en estos pacientes, no hay suficientes evidencias para su utilización en otros padecimientos como la SGNC o el SII mismo 25 .…”