TY - JOUR
T1 - The low FODMAP diet in clinical practice
T2 - Where are we and what are the long-Term considerations?
AU - Lomer, Miranda C.E.
N1 - Publisher Copyright:
© 2023 Cambridge University Press. All rights reserved.
PY - 2023
Y1 - 2023
N2 - A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) improves functional bowel symptoms and is a second-line dietary management strategy for the treatment of irritable bowel syndrome (IBS). The diet is complex and involves 3 stages: restriction, reintroduction and personalisation and clinical effectiveness is achieved with dietitian-led education; however, this is not always available. The aim of this review is to provide an update on the evidence for using the low FODMAP diet, with a focus on the impact of FODMAP restriction and reintroduction considering long-Term management of IBS in a clinical setting. Randomised controlled trials have assessed symptom response, quality of life, dietary intake, and changes to the gut microbiota during FODMAP restriction. Systematic reviews and meta-Analyses consistently report that FODMAP restriction has a better symptom response compared with control diets and a network analysis reports the low FODMAP diet is superior to other dietary treatments for IBS. Research focused on FODMAP reintroduction and personalisation is limited and of lower quality, however common dietary triggers include wheat, onion, garlic, pulses and milk. Dietitian-led delivery of the low FODMAP diet is not always available and alternative education delivery methods, e.g., webinars, apps, and leaflets, are available but remove the personalised approach and may be less acceptable to patients and may introduce safety concerns in terms of nutritional adequacy. Predicting response to the low FODMAP diet using symptom severity or a biomarker is of great interest. More evidence on less restrictive approaches and non-dietitian-led education delivery methods are needed.
AB - A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) improves functional bowel symptoms and is a second-line dietary management strategy for the treatment of irritable bowel syndrome (IBS). The diet is complex and involves 3 stages: restriction, reintroduction and personalisation and clinical effectiveness is achieved with dietitian-led education; however, this is not always available. The aim of this review is to provide an update on the evidence for using the low FODMAP diet, with a focus on the impact of FODMAP restriction and reintroduction considering long-Term management of IBS in a clinical setting. Randomised controlled trials have assessed symptom response, quality of life, dietary intake, and changes to the gut microbiota during FODMAP restriction. Systematic reviews and meta-Analyses consistently report that FODMAP restriction has a better symptom response compared with control diets and a network analysis reports the low FODMAP diet is superior to other dietary treatments for IBS. Research focused on FODMAP reintroduction and personalisation is limited and of lower quality, however common dietary triggers include wheat, onion, garlic, pulses and milk. Dietitian-led delivery of the low FODMAP diet is not always available and alternative education delivery methods, e.g., webinars, apps, and leaflets, are available but remove the personalised approach and may be less acceptable to patients and may introduce safety concerns in terms of nutritional adequacy. Predicting response to the low FODMAP diet using symptom severity or a biomarker is of great interest. More evidence on less restrictive approaches and non-dietitian-led education delivery methods are needed.
KW - clinical practice
KW - diet
KW - irritable bowel syndrome
KW - Low FODMAP diet
UR - http://www.scopus.com/inward/record.url?scp=85165899321&partnerID=8YFLogxK
U2 - 10.1017/S0029665123003579
DO - 10.1017/S0029665123003579
M3 - Review article
C2 - 37415490
AN - SCOPUS:85165899321
SN - 0029-6651
JO - Proceedings of the Nutrition Society
JF - Proceedings of the Nutrition Society
ER -