Restriction of FODMAP in the management of bloating in irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) is a common functional bowel disorder. Up to 96% of IBS patients experience bloating, resulting in poor response to conventional therapies and high consultation rates. Many IBS patients report that food triggers symptoms, particularly diets with poorly absorbed, short-chain carbohydrates, and restrict intake of certain foods to control their symptoms. IBS patients are especially susceptible to an attack due to visceral hypersensitivity. An emerging therapeutic strategy excludes fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) from the diet. There is evidence supporting the efficacy of a low FODMAP diet in improving symptoms of bloating in IBS patients. Individualised, structured dietary guidance may benefit those with persistent troublesome symptoms despite traditional therapies. In view of the multifactorial aetiology of the condition, it is probably best to use a multipronged approach, involving combination therapies, to address bloating in IBS patients.

Ketogenic Diet and Microbiota: Friends or Enemies?

“…For these reasons, specialized and restricted dietary regimens adopted as a treatment of some diseases, such as low FODMAP for the irritable bowel syndrome and ketogenic diet for refractory epilepsy, should be investigated for their influence on human microbiota [40,42]. These patterns, by reducing or excluding certain type of foods, may affect positively or negatively the microbiota composition and its related influence on host physiology [43,44,45]. That is the case of very low carbohydrate ketogenic diet (VLCKD), a nutritional approach growing up in interest not only for neurological disorders but also for being a “lose-it-quick-plan” [45,46].…”

Beneficial Effects on Abdominal Bloating with an Innovative Food-Grade Formulation of Curcuma longa and Boswellia serrata Extracts in Subjects with Irritable Bowel Syndrome and Small Bowel Dysbiosis

“…LFD has been utilized to ameliorate bloating discomforts, as well as IBS and SIBO in various studies, with promising results [ 19 , 20 , 21 ]. In our study LFD did not appear to be efficacious for bloating relief in IBS subjects with dysbiosis, while the concomitant supplementation with CBP for 30 days was followed by a significant reduction of bloating.…”

“…Growing evidence supports the efficacy of microbiota-directed therapies, such as diet, prebiotics, probiotics, and antibiotics, in the treatment of IBS [ 18 ]. In particular, it has been shown that a diet poor in Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) is efficacious in the treatment of bloating in IBS patients [ 19 , 20 , 21 ].…”

Low FODMAP Diet: Evidence, Doubts, and Hopes

“…It is of paramount importance that future research focuses on the modality of the reintroduction phase, that is, when to commence the "starting" foods, and how long and to what extent they need to be tested. It is crucial to assist patients in identifying specific dietary triggers, reducing the level of dietary restriction required, and increasing the prebiotic intake [68,95].…”