Conflicts of interest: SJS has published five cookbooks directed towards issues of celiac disease and low FODMAP diet. The authors have registered the term ‘FODMAPs’ as a trademark.
Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach
Version of Record online: 14 OCT 2009
© 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 25, Issue 2, pages 252–258, February 2010
How to Cite
Gibson, P. R. and Shepherd, S. J. (2010), Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology, 25: 252–258. doi: 10.1111/j.1440-1746.2009.06149.x
- Issue online: 28 JAN 2010
- Version of Record online: 14 OCT 2009
- Accepted for publication 6 October 2009.
- dietary therapy;
- fermentable carbohydrates;
- irritable bowel syndrome;
Background and Aim: Functional gastrointestinal symptoms are common and their management is often a difficult clinical problem. The link between food intake and symptom induction is recognized. This review aims to describe the evidence base for restricting rapidly fermentable, short-chain carbohydrates (FODMAPs) in controlling such symptoms.
Methods: The nature of FODMAPs, their mode of action in symptom induction, results of clinical trials and the implementation of the diet are described.
Results: FODMAPs are widespread in the diet and comprise a monosaccharide (fructose), a disaccharide (lactose), oligosaccharides (fructans and galactans), and polyols. Their ingestion increases delivery of readily fermentable substrate and water to the distal small intestine and proximal colon, which are likely to induce luminal distension and induction of functional gut symptoms. The restriction of their intake globally (as opposed to individually) reduces functional gut symptoms, an effect that is durable and can be reversed by their reintroduction into the diet (as shown by a randomized placebo-controlled trial). The diet has a high compliance rate. However it requires expert delivery by a dietitian trained in the diet. Breath hydrogen tests are useful to identify individuals who can completely absorb a load of fructose and lactose so that dietary restriction can be less stringent.
Conclusions: The low FODMAP diet provides an effective approach to the management of patients with functional gut symptoms. The evidence base is now sufficiently strong to recommend its widespread application.