Can a low FODMAP diet reduce the symptoms of irritable bowel syndrome (IBS) and small intestine bacterial overgrowth (SIBO), such as cramping, diarrhea, gas, and bloating?
Culinary Medicine
InShort
by Lori A Smolin, PhD and
FODMAP is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. A low FODMAP diet restricts the intake of these poorly absorbed short-chain carbohydrates found in a variety of fruits, vegetables, legumes, grains, dairy products, nuts, and sweeteners. Limiting FODMAP intake has been shown to reduce the symptoms of irritable bowel syndrome (IBS) and small intestine bacterial overgrowth (SIBO), such as cramping, diarrhea, gas, and bloating.
This diet program temporarily eliminates foods high in FODMAPs until symptoms are improved. Then, based on the patient’s preference, individual high FODMAP foods are reintroduced one at a time. If the newly reintroduced food can be consumed for several days without symptoms, it can be permanently added back to the diet.
Indications
A low FODMAP diet is an important treatment option for IBS and SIBO because over 80% of patients link their symptoms to eating specific foods. This diet program may also be helpful in anyone with digestive problems who wants to determine which foods are causing their symptoms.
Adverse Effects
If the diet is not carefully planned, it may be low in fiber, resulting in constipation. Because the diet eliminates so many foods, energy and nutrient deficiencies can occur if the restriction is continued in the long term.
Pearls to Know
• The process of eliminating and then reintroducing foods is most successful when monitored by a Registered Dietitian (RD); RD input also helps to ensure nutritional adequacy in the long-term.
• A recent double-blind study found a low FODMAP diet to be more effective than a gluten-free diet in the treatment of IBS.
Examples of high and low FODMAP foods are given in the table.
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Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols
References
Liu J, Chey W, Haller E, Eswaran S. Low-FODMAP diet for irritable bowel syndrome: What we know and what we have yet to learn. Ann Rev Med. 2020;71:303-314. doi:10.1146/annurev-med-050218-013625.
Cleveland Clinic. Low FODMAP diet.
https://my.clevelandclinic.org/health/treatments/22466-low-fodmap-diet. Accessed August 27, 2023.
Bellini M, Tonarelli S, Nagy AG, et al. Low FODMAP Diet: Evidence, doubts, and hopes. Nutrients.;12(1):148. Published 2020 Jan 4. doi:10.3390/nu12010148.
Nordin E, Brunius C, Landberg R, Hellström PM. Fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs), but not gluten, elicit modest symptoms of irritable bowel syndrome: A double-blind, placebo-controlled, randomized three-way crossover trial. Am J Clin Nutr. 2022;115(2):344-352. doi: 10.1093/ajcn/nqab337.
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