A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) is an effective strategy to manage symptoms of irritable bowel syndrome (IBS), according to a study published in the Journal of Gastroenterology and Hepatology.

The FODMAP diet should be implemented on a case-by-case basis by a dietitian with expertise in gastrointestinal disorder management, according to Jacqueline S. Barrett, PhD, from Monash University in Melbourne. There are different FODMAP subtypes based on carbohydrate chain length, to which each individual will react with variation. Clinicians are advised to take a detailed history of a patient’s IBS symptoms and usual dietary intake. This includes:

  • Gathering data on symptom type, severity, pattern, and frequency and details regarding usual FODMAP intake
  • Fiber intake
  • Meal pattern
  • Suspected trigger foods

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A more individualized approach to the FODMAP diet is designed in situations in which:

  • FODMAP intake is excessive, but symptoms are mild, suggesting reasonable tolerance and low level of restriction required.
  • Lactose tolerance is known either through food challenge or breath test, in which case dietary lactose is not restricted.
  • Patient has removed only a handful of foods from his or her diet with significant relief, such that a simplified food list or list of specific FODMAP subtypes only is relevant.
  • Additional dietary restrictions are required because of other concurrent medical conditions such as diabetes, when the dietitian needs to consider and prioritize all dietary requirements.
  • Cooking skills or living situation is likely to affect the patient’s ability to comply with the diet, in which case a modified approach is warranted.

The FODMAP diet should only be implemented for a period of 4 to 6 weeks. The long-term goal of low-FODMAP diet education is to reintroduce high-FODMAP foods to personal tolerance. Individual tolerance should be investigated through food-challenge testing, which includes reintroductions of small amounts of fructans and galacto-oligosaccharide (GOS), the FODMAPs with proven prebiotic activity.

“Assessment and education by a dietitian, expert in management in gastrointestinal disorders, is key to the success of the diet, in addition to their use of up-to-date patient resources,” stated Dr Barrett.

Reference

  1.  Barrett JS. How to institute the low-FODMAP diet. J Gastroenterol Hepatol. 28 February 2017. doi:10.1111/jgh.13686

Topics:

Diet and Nutrition Gastroenterology Hepatology