JGM, PGR, JSB, SJS designed the study. DKO, SM conducted the study and analyzed the samples and DKO, SM, JGM, PGR, JSB, SJS, PMI, JRB, SS collected, analyzed and interpreted the data. JGM, PRG, JSB, JRB drafted the manuscript. DKO, SM, JSB, SJS, PMI, JRB, SS, PRG, JGM have all approved the final draft submitted.
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GASTROENTEROLOGY
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Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome
Article first published online: 14 MAY 2010
DOI: 10.1111/j.1440-1746.2010.06370.x
© 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Additional Information
How to Cite
Ong, D. K., Mitchell, S. B., Barrett, J. S., Shepherd, S. J., Irving, P. M., Biesiekierski, J. R., Smith, S., Gibson, P. R. and Muir, J. G. (2010), Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. Journal of Gastroenterology and Hepatology, 25: 1366–1373. doi: 10.1111/j.1440-1746.2010.06370.x
Conflicts of interest: S.J.S has published cookbooks directed towards issues of dietary fructan restrictions, fructose malabsorption and celiac disease. She has also published shopping guides for low FODMAPs and low fructose and fructan foods.
Publication History
- Issue published online: 21 JUL 2010
- Article first published online: 14 MAY 2010
- Accepted for publication 26 April 2010.
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Keywords:
- breath testing;
- carbohydrates;
- dietary therapy;
- FODMAPs;
- gastrointestinal symptoms;
- 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 ± 77 ppm.14 h vs 43 ± 18; mean ± SD P < 0.0001) and patients with IBS (242 ± 79 vs 62 ± 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 ± 29 vs 109 ± 77; P = 0.043), but was not different in patients with IBS (126 ± 153 vs 86 ± 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.