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6 . 2020

Low Fermentable Oligo-, Di- and Monosaccharides and Polyols (FODMAP) diet in the treatment of patients with irritable bowel syndrome: basic principles and methodology

AbstractFermentable oligo-, di-, monosaccharides, and polyols (FODMAP) are a large class of small nondigestible carbohydrates, which are poorly absorbed in the small bowel. The microscopic size, high osmotic activity, and the higher fermentation of unabsorbed FODMAPs by colonic bacteria lead to bloating, abdominal pain, and flatulence in patients with irritable bowel syndrome. Therefore, low FODMAP diet appears to be promising treatment approach in the management of patients with irritable bowel syndrome (IBS). In this review, we analyzed available publications on efficacy and safety of low FODMAP diet in the treatment of IBS patients. Based on the current data we outlined basic principles and methodology of low FODMAP diet usage in clinical practice, and constructed the detailed list of low and high FODMAP products for designing a food regimen in patients with IBS.

Keywords:irritable bowel syndrome, dietotherapy, FODMAP, carbohydrate malabsorption

Funding. The study had no sponsor support.

Conflict of interests. The authors declare no conflicts of interest.

For citation: Kuvaev R.O., Yakovenko E.P., Nikonov E.L., Zaytsev S.V., Pospelova E.E., Krashenkova A.P. Low Fermentable Oligo-, Di- and Monosaccharides and Polyols (FODMAP) diet in the treatment of patients with irritable bowel syndrome: basic principles and methodology. Voprosy pitaniia [Problems of Nutrition]. 2020; 89 (6): 38-47. DOI: 10.24411/0042-8833-2020-10077 (in Russian)

References

1. Agafonova N.A., Yakovenko E.P., Ivanov A.N., Yakovenko A.V. Abdominal pain and visceral hypersensitivity are two facets of the same reality for IBS patients. Effektivnaya farmakoterapiya [Effective Pharmacotherapy]. 2018; (32): 26–33. (in Russian)

2. Makhov V.M., Romasenko L.V., Turko T.V., Sheptak N.N. Irritable bowel syndrome – comorbid somatopsychic Irritated bowel syndrome is a co-morbid somatopsychic condition Dokazatel’naya gastroenterologiya [Evidence-Based Gastroenterology]. 2014; 3 (2): 56–61. (in Russian)

3. Pilipenko V.I., Morozov S.V., Isakov V.A. Diet therapy for irritable bowel syndrome followed by constipation with the use of specialized food product of dietary therapeutic nutrition «jelly concentrate with vitamins and inulin "Intenorm"». Dokazatel’naya gastroenterologiya [Evidence-Based Gastroenterology]. 2018; 7 (4): 92–106. DOI:https://doi.org/10.17116/dokgastro2018704192 (in Russian)

4. Brandt L.J., Chey W.D., Foxx-Orenstein A.E., Schiller L.R., Schoenfeld P.S., Spiegel B.M., et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009; 104 (1): S1–35. DOI: https://doi.org/10.1038/ajg.2008.122.

5. Hayes P., Corish C., O’Mahony E., Quigley E.M. A dietary survey of patients with irritable bowel syndrome. J Hum Nutr Diet. 2014; 27 (2): 36–47. DOI: https://doi.org/10.1111/jhn.12114

6. Ostgaard Н., Hausken T., Gundersen D., El-Salhy M. Diet and effects of diet management on quality of life and symptoms in patients with irritable bowel syndrome. Mol Med Rep. 2012; 5: 1382–90. DOI: https://doi.org/10.3892/mmr.2012.843

7. Thomas А., Quigley Е.М. Diet and irritable bowel syndrome. Curr Opin Gastroenterol. 2015; 31: 166–71. DOI: https://doi.org/10.1097/MOG.0000000000000158

8. Lovell R.M., Ford A.C. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012; 10: 712–21.

9. Nalyotov A.V., V’unichenko Yu.S. The using of low-FODMAP diet is an important step in the treatment of children with irritable bowel syndrome. Pediatr [Pediatrician]. 2017; 8 (6): 94–8. DOI: https://doi.org/10.17816/PED8694-98 (in Russian)

10. Barrett J.S., Gearry R.B., Muir J.G., Irving P.M., Rose R., Rosella O., et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther. 2010; 31: 874–82.

11. McIntosh K., Reed D.E., Schneider T., Dang F., Keshteli A.H., De Palma G., et al. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut. 2017; 66: 1241–51.

12. Sivaprakasam S., Prasad P.D., Singh N. Benefits of short-chain fatty acids and their receptors in inflammation and carcinogenesis. Pharmacol Ther. 2016; 164: 144–51.

13. Vanhoutvin S.A., Troost F.J., Kilkens T.O., Lindsey P.J., Hamer H.M., Jonkers D.M., et al. The effects of butyrate enemas on visceral perception in healthy volunteers. Neurogastroenterol Motil. 2009; 21: 952.

14. Hill P., Muir J.G., Gibson P.R. Controversies and recent developments of the low-FODMAP diet. Gastroenterol Hepatol (N Y). 2017; 13: 36–45.

15. Roberfroid M.B. Inulin-type fructans: functional food ingredients. J Nutr. 2007; 137 (11): 2493–502.

16. Khalif I.L., Tishaeva I.A. Diet with decreased content of fermentable oligo-, di- and monosaccharides and polyols (low FODMAP-diet) in treatment of irritable bowel syndrome. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii [Russian Journal of Gastroenterology, Hepatology, Coloproctology]. 2017; 27 (4): 22–7. DOI: https://doi.org/10.22416/1382-4376-2017-27-4-22-27 (in Russian)

17. Macfarlane G.T., Steed H., Macfarlane S. Bacteria metabolism and health-related effects of galacto oligosaccharides and other prebiotics. J Appl Microbiol. 2008; 104: 305–44.

18. Roberfroid M., et al. Prebiotic effects: metabolic and health benefits. Br J Nutr. 2010; 104 (2): 1–63.

19. Lumer M.C., Parkes G.C., Sanderson J.D. Rewiearticle: lactose intolerance in clinical practice: myths and realities. Aliment Pharmacol Ther. 2008; 27: 93–103.

20. Jones H.F., Butler R.N., Brooks D.A. Intestinal fructose transport amd malabsorption in humans. Am J Physiol Gastrointest Liver Physiol. 2011; 300: G202–6.

21. Barrett J.S. How to institute the low-FODMAP diet. J Gastroenterol Hepatol. 2017; 32 (1): 8–10.

22. Dicheva D.T., Andreev D.N., Ul’yankina E.V. Overlap syndrome of GERD, functional dyspepsia, IBS: pathogenetic associations and treatment approach. Effektivnaya farmakoterapiya [Effective Pharmacotherapy]. 2019; 15 (36): 64–70. DOI: https://doi.org/10.33978/2307-3586-2019-15-36-64-70 (in Russian)

23. Whelan K., Martin L.D., Staudacher H.M., Lomer M.C.E. The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice. J Hum Nutr Diet. 2018; 31 (2): 239–55. DOI: https://doi.org/10.1111/jhn.12530

24. Gibson P.R., Shepherd S.J. Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP approach. J Gastroenterol Hepatol. 2010; 25: 252–8.

25. Halmos E.P., Christophersen C.T., Bird A.R., et al. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut. 2015; 64: 93–100.

26. Staudacher H.M., Lomer M.C.E., Anderson J.L., et al. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr. 2012; 142: 1510–8.

27. Tuck C., Barrett J. Re-challenging FODMAPs: the low FODMAP diet phase two. J Gastroenterol Hepatol. 2017; 32 (1): 11–5. DOI: https://doi.org/10.1111/jgh.13687

28. Marsh A., Eslick E.M., Eslick G.D. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016; 55: 897–906.

29. Schumann D., Klose P., Lauche R., Dobos G., Langhorst J., Cramer H. Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Nutrition. 2018; 45: 24–31.

30. Dionne J., Ford A.C., Yuan Y., Chey W.D., Lacy B.E., Saito Y.A., et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol. 2018; 113: 1290–300.

31. Chumpitazi B.P., Cope J.L., Hollister E.B., Tsai C.M., McMeans A.R., Luna R.A., et al. Randomised clinical trial: gut microbiome biomarkers are associated with clinical response to a low FODMAP diet in children with the irritable bowel syndrome. Aliment Pharmacol Ther. 2015; 42: 418–27.

32. Laatikainen R., Koskenpato J., Hongisto S.M., Loponen J., Poussa T., Hillilä M., et al. Randomised clinical trial: Low FODMAP rye bread vs. regular rye bread to relieve the symptoms of irritable bowel syndrome. Aliment Pharmacol Ther. 2016; 44: 460–70.

33. Staudacher H.M., Lomer M.C.E., Farquharson F.M., Louis P., Fava F., Franciosi E., et al. A Diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and probiotic restores Bifidobacterium species: a randomized controlled trial. Gastroenterology. 2017; 153: 936–47.

34. Hustoft T.N., Hausken T., Ystad S.O., Valeur J., Brokstad K., Hatlebakk J.G., et al. Effects of varying dietary content of fermentable short-chain carbohydrates on symptoms, fecal microenvironment, and cytokine profiles in patients with irritable bowel syndrome. Neurogastroenterol Motil. 2017; 29: e12969.

35. Ivashkin V.T., Shelygin Yu.A., Baranskaya E.K., Belousova E.A., Beniashvili A.G., Vasil’ev S.V., et al. Diagnosis and treatment of the irritable bowel syndrome: clinical guidelines of the Russian gastroenterological association and Russian association of coloproctology. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii [Russian Journal of Gastroenterology, Hepatology, Coloproctology]. 2017; 27 (5): 76–93. DOI: https://doi.org/10.22416/1382-4376-2017-27-5-76-93 (in Russian)

36. Maagaard L., Ankersen D.V., Vegh Z., Burisch J., Jensen L., Pedersen N., et al. Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet. World J Gastroenterol. 2016; 22: 4009–19.

37. O’Keeffe M., Jansen C., Martin L., Williams M., Seamark L., Staudacher H.M., et al. Long-term impact of the low-FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome. Neurogastroenterol Motil. 2018; 30: e13154.

38. O’Keeffe M., Lomer M.C. Who should deliver the low FODMAP diet and what educational methods are optimal: a review. J Gastroenterol Hepatol. 2017; 32 (1): 23–6.

39. Staudacher H.M., Lomer M.C., Anderson J.L., Barrett J.S., Muir J.G., Irving P.M., et al. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr. 2012; 142: 1510–8.

40. Halmos E.P., Christophersen C.T., Bird A.R., Sheperd S.J., Muir J.G., Gibson P.R. Consistent prebiotic effect on gut microbiota with altered FODMAP intake in patients with Crohn’s disease: a randomized controlled cross-over trial of well-defined diets. Clin Transl Gastroenterol. 2016; 7: e164.

41. Halmos E.P., Christophersen C.T., Bird A.R., Shepherd S.J., Gibson P.R., Muir J.G. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut. 2015; 64: 93–100.

42. Staudacher H.M., Ross F.S., Briscoe Z.M., Irving P.M., Whelan K., Lomer M.C. PTU-183 Advice from a dietitian regarding the low FODMAP diet broadly maintains nutrient intake and does not alter fibre intake. Gut. 2015; 64: 143–4.

43. Böhn L., Störsrud S., Liljebo T., Collin L., Lindfors P., Törnblom H., et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015; 149: 1399–407.

44. Harvie R.M., Chisholm A.W., Bisanz J.E., Burton J.P., Herbison P., Schultz K., et al. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World J Gastroenterol. 2017; 23: 4632–43.

45. Eswaran S., Dolan R.D., Ball S.C., Jackson K., Chey W. The impact of a 4-week low-FODMAP and mNICE diet on nutrient intake in a sample of US adults with irritable bowel syndrome with diarrhea. J Acad Nutr Diet. 2020; 120: 641–49.

46. Bellini M., Gambaccini D., Bazzichi L., Bassotti G., Mumolo M.G., Fani B., et al. Bioelectrical impedance vector analysis in patients with irritable bowel syndrome on a low FODMAP diet: a pilot study. Tech Coloproctol. 2017; 21: 451–9.

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CHIEF EDITOR
CHIEF EDITOR
Viktor A. Tutelyan
Full Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Scientific Director of the Federal Research Centre of Nutrition, Biotechnology and Food Safety (Moscow, Russia)
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