Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance

TY - JOUR

T1 - Review article

T2 - the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance

AU - Lomer, M C E

N1 - © 2014 John Wiley & Sons Ltd.

PY - 2015/2

Y1 - 2015/2

N2 - BACKGROUND: Food intolerance is non-immunological and is often associated with gastrointestinal symptoms.AIM: To focus on food intolerance associated with gastrointestinal symptoms and critically appraise the literature in relation to aetiology, diagnosis, mechanisms and clinical evidence.METHODS: A search using the terms and variants of food intolerance, lactose, FODMAP, gluten, food chemicals within Pubmed, Embase and Scopus was carried out and restricted to human studies published in English. Additionally, references from relevant papers were hand searched for other appropriate studies.RESULTS: Food intolerance affects 15-20% of the population and may be due to pharmacological effects of food components, noncoeliac gluten sensitivity or enzyme and transport defects. There have been significant advances in understanding the scientific basis of gastrointestinal food intolerance due to short-chain fermentable carbohydrates (FODMAPs). The most helpful diagnostic test for food intolerance is food exclusion to achieve symptom improvement followed by gradual food reintroduction. A low FODMAP diet is effective, however, it affects the gastrointestinal microbiota and FODMAP reintroduction to tolerance is part of the management strategy.CONCLUSIONS: There is increasing evidence for using a low FODMAP diet in the management of functional gastrointestinal symptoms where food intolerance is suspected. Exclusion diets should be used for as short a time as possible to induce symptom improvement, and should be followed by gradual food reintroduction to establish individual tolerance. This will increase dietary variety, ensure nutritional adequacy and minimise impact on the gastrointestinal microbiota.

AB - BACKGROUND: Food intolerance is non-immunological and is often associated with gastrointestinal symptoms.AIM: To focus on food intolerance associated with gastrointestinal symptoms and critically appraise the literature in relation to aetiology, diagnosis, mechanisms and clinical evidence.METHODS: A search using the terms and variants of food intolerance, lactose, FODMAP, gluten, food chemicals within Pubmed, Embase and Scopus was carried out and restricted to human studies published in English. Additionally, references from relevant papers were hand searched for other appropriate studies.RESULTS: Food intolerance affects 15-20% of the population and may be due to pharmacological effects of food components, noncoeliac gluten sensitivity or enzyme and transport defects. There have been significant advances in understanding the scientific basis of gastrointestinal food intolerance due to short-chain fermentable carbohydrates (FODMAPs). The most helpful diagnostic test for food intolerance is food exclusion to achieve symptom improvement followed by gradual food reintroduction. A low FODMAP diet is effective, however, it affects the gastrointestinal microbiota and FODMAP reintroduction to tolerance is part of the management strategy.CONCLUSIONS: There is increasing evidence for using a low FODMAP diet in the management of functional gastrointestinal symptoms where food intolerance is suspected. Exclusion diets should be used for as short a time as possible to induce symptom improvement, and should be followed by gradual food reintroduction to establish individual tolerance. This will increase dietary variety, ensure nutritional adequacy and minimise impact on the gastrointestinal microbiota.

KW - Diet

KW - Feeding Behavior

KW - Food Hypersensitivity/diagnosis

KW - Gastrointestinal Diseases/etiology

KW - Glutens/adverse effects

KW - Humans

KW - Lactose/adverse effects

U2 - 10.1111/apt.13041

DO - 10.1111/apt.13041

M3 - Review article

C2 - 25471897

SN - 0269-2813

VL - 41

SP - 262

EP - 275

JO - Alimentary Pharmacology & Therapeutics

JF - Alimentary Pharmacology & Therapeutics

IS - 3

ER -