Impact of a low-FODMAPs diet on gastrointestinal symptoms of patients diagnosed with irritable bowel syndrome: a systematic review of the literature
DOI:
https://doi.org/10.12957/demetra.2024.81934Abstract
Introduction: Irritable bowel syndrome (IBS) is a chronic functional intestinal disorder, characterized by recurrent abdominal pain and changes in bowel habits, without clear organic causes. As its etiology is not yet fully understood, there is no treatment universally applicable to all patients. However, the exclusion of FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) from the diet has been studied as a potential strategy to treat the symptoms of the disease. Objective: This study aimed to investigate the effects of low FODMPs diet (LFD) on gastrointestinal symptoms of patients diagnosed with IBS. Method: This is a systematic review of the literature in the databases PubMed, Lilacs, Medline, Virtual Health Library (VHL), ScienceDirect, and Embase, using combinations of descriptors based on the PICO strategy. Eleven randomized controlled trials published in the last ten years (2013-2023) with adults diagnosed with IBS were selected. Studies employing dietary interventions other than a low FODMAP diet (LFD), those involving patients with different intestinal disorders, and those that did not assess gastrointestinal symptoms were excluded. Results: LFD proved to be effective in reducing IBS symptoms, promoting a remarkable decrease in the intensity and frequency of abdominal pain and distension. However, patients following LFD had lower energy and fiber intake, suggesting the need for nutritional monitoring. In addition, the adoption of this diet resulted in a decrease in the population of Bifidobacterium, due to fiber exclusion. Conclusion: This study supports that LFD is an effective nutritional strategy to relieve gastrointestinal symptoms in adults with IBS.
Downloads
References
Martins A, Pequito A, Baltazar, AL. Disbiose intestinal e síndrome do intestino irritável: efeito de uma dieta baixa em FODMAPs. Acta portuguesa de nutrição. 2020;22:38-41. https://dx.doi.org/10.21011/apn.2020.2207
Andrade VLA, Fonseca TN, Gouveia CA, Kobayashi TG, Leite RGS, Matar RA, et al.Dieta restrita de FODMAPs como opção terapêutica na síndrome do intestino irritável: revisãosistemática. GED gastroenterol. endosc. dig. 2015;34(1):34-41.
Oliveira PDTM, Reis JEF, Reis MAS, Ferreira SMS, Candelária ALAA. Dieta com restrição de FODMAP reduz os sintomas no síndroma do intestino irritável? Uma revisão baseada na evidência. Ver Port Med Geral Fam. 2020;36(2):126-34. https://doi.org/10.32385/rpmgf.v36i2.12545
Makker J, Chilimuri S, Bella JN. Genetic epidemiology of irritable bowel syndrome. World Journal of Gastroenterology. 2015;21(40):11353-61. https://doi.org/10.3748/wjg.v21.i40.11353
Mendonça APM, Yamashita LM, Silva ED, Solar I, Santos LAO, Vasques ACJ. Nutritional status, quality of life and life habits of women with irritable bowel syndrome: a case-control study. Arq Gastroenterol. 2020;57(2):114-20. https://doi.org/10.1590/S0004-2803.202000000-22
Santos RB, Sales VC, Debia N, Barros LR, Martins MCC. Efeitos da restrição de FOODMAPs na redução de sintomas da síndrome do intestino irritável. Pesquisas e Ações em Saúde Pública. 2022;1(4):188-95. https://doi.org/10.29327/560779.4-26
Nadai R, Melo C, Custódio JP, Ferreira FB, Clara APHSC, Trindade LZ, Martins FQ, Signorelli IV. Transplante de microbiota fecal no tratamento da síndrome do intestino irritável: uma revisão sistemática. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo. 2017;62(3):156-59. https://doi.org/10.26432/1809-3019.2017.62.3.156
Murillo AZ, Arévalo FE, Jáuregui EP. Diet low in fermentable oligosaccharides, disaccharides, monosaccharides andpolyols (FODMAPs) in the treatment of irritable bowel syndrome: Indications and design. Endocrinol Nutr. 2016;63(3):132-38. https://doi.org/10.1016/j.endonu.2015.10.009.
Paje MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. British Medical Journal. 2021;372(160). https://doi.org/10.1136/bmj.n160
Turco R, Salvatore S, Miele E, Romano C, Marseglia GL, Staiano A. Does a low FODMAPs diet reduce symptoms of functional abdominal pain disorders? A systematic review in adult and paediatric population, on behalf of Italian Society of Pediatrics. Italian Journal of Pediatrics. 2018; 44(1):43-67. https://doi.org/10.1186/s13052-018-0495-8
Eswaran SL, Chey WD, Han-Markey T, Ball S, Jackson KA. A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D. American Journal of Gastroenterology 2016;111(12):1824-32. https://doi.org/10.1038/ajg.2016.434
Halmos PE, Power VA, Shepherd SJ, Gibson PR, Muir JGA. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome. Gastroenterology. 2014;146(1):67-75. https://doi.org/10.1053/j.gastro.2013.09.046
Patcharatrakul T, Juntrapirat A, Lakananurak N, Gonlachanvit S. Effect of Structural Individual Low-FODMAP Dietary Advice vs. Brief Advice on a Commonly Recommended Diet on IBS Symptoms and Intestinal Gas Production. Nutrients. 2019;11(12):2856-68. https://doi.org/10.3390/nu11122856
Algera JP, Demir D, Tornblom H, Nybacka S, Simren M, Storsrud S. Low FODMAP diet reduces gastrointestinal symptoms in irritable bowel syndrome and clinical response could be predicted by symptoms severity: A randomized crossover trial. Clinical Nutrition. 2022;41(12):2792-800. https://doi.org/10.1016/j.clnu.2022.11.001
Mcintosh K, Reed DE, Schneider T, Dang F, Keshteli AH, Palma G, et al. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomized controlled trial. Gut. 2017;66(7):1241-51. https://doi.org/10.1136/gutjnl-2015-311339
Böhn L, Störsrud S, Liljebo T, Collin L, Lindlofors P, Törnblom H, et al. Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome as Well as Traditional Dietary Advice: A Randomized Controlled Trial. Gastroenterology. 2015;149(6):1399-407. https://doi.org/10.1053/j.gastro.2015.07.054
Zhang Y, Feng L, Wang X, Fox M, Luo L, Du L, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. The American Journal of Clinical Nutrition. 2021;113(6):1531-545. https://doi.org/10.1093/ajcn/nqab005
Harvie RM, Chisholm AW, Bisanz JE, Burton JP, Herbison P, Schultz K, et al. Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World Journal of Gastroenterology. 2017;23(25):4632-643. https://doi.org/10.3748/wjg.v23.i25.4632
Russo F, Riezzo G, Orlando A, Linsalata M, D'attoman B, Prospero L, et al. A Comparison of the Low-FODMAPs Diet and a Tritordeum-Based Diet on the Gastrointestinal Symptom Profile of Patients Suffering from Irritable Bowel Syndrome-Diarrhea Variant (IBS-D): A Randomized Controlled Trial. Nutrients. 2022;14(8):1544-559. https://doi.org/10.3390/nu14081544
Staudacher HM, Lomer MCE, Farquharson FM, Louis P, Fava F, Franciosi E, et al. A Diet Low in FODMAPs Reduces Symptoms in Patients with Irritable Bowel Syndrome and A Probiotic Restores Bifidobacterium Species: a Randomized Controlled Trial. Gastroenterology. 2017;153(4):936-47. https://doi.org/10.1053/j.gastro.2017.06.010
Zahedi MJ, Behrouz V, Azimi M. Low FODMAPs diet vs. general dietary advice improves clinical response in patients with diarrhea-predominant irritable bowel syndrome: a randomized controlled trial. J Gastroenterol Hepatol. 2018 Jun;33(6):1192-199. https://doi.org/10.1111/jgh.14051.
Gibson PR. History of the low FODMAP diet. Journal of Gastroenterology and Hepatology. 2017;32(1):5-7. https://doi.org/10.1111/jgh.13685
Barrett JS. How to institute the low-FODMAP diet. Journal of Gastroenterology and Hepatology. 2017;32(1):8-10. https://doi.org/10.1111/jgh.13686
Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology. 2010;25(2):252-58. https://doi.org/10.1111/j.1440-1746.2009.06149.x
Ireton-Jones C. The low FODMAP diet: fundamental therapy in the management of irritable bowel syndrome. Current Opinion in Clinical Nutrition and Metabolic Care. 2017;20(5):414-19. https://doi.org/10.1097/MCO.0000000000000398
Murillo AZ, Arévalo FE, Jáuregui EP. Diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in the treatment of irritable bowel syndrome: Indications and design. Endocrinol Nutr. 2016;63(3):132-38. https://doi.org/10.1016/j.endonu.2015.10.009
Staudacher HM, Whelan K, Irving PM, Lomer MCE. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. Journal of Human Nutrition and Dietetics. 2011;24(5):487-95. https://doi.org/10.1111/j.1365-277X.2011.01162.x
Altobelli E, Negro VD, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017;9(9):940-59. https://doi.org/10.3390/nu9090940
Belline M, Tonarelli S, Nagy AG, Pancetti A, Costa F, Ricchiuti A, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients. 2020;4(12):148-69. https://doi.org/10.3390/nu12010148
Kasti A, Petsis K, Lambrinou S, Katsas K, Nikolaki M, Papanikolaou LS, et al. A Combination of Mediterranean and Low-FODMAP Diets for Managing IBS Symptoms? AskYourGut! Microorganisms. 2022;10(4):751-63. https://doi.org/10.3390/microorganisms10040751
Staudacher H, Ross FS, Briscoe ZM, Irving PM, Whelan K, Lomer MC. PTU-183 Advice from a dietitian regarding the low fodmap diet broadly maintains nutrient intake and does not alter fibre intake. Gut. 2015;64(1). http://dx.doi.org/10.1136/gutjnl-2015-309861.298
Staudacher HM, Lomer MCE, Anderson JL, Barret JS, Muir JG, Irving PM, et al. Fermentable Carbohydrate Restriction Reduces Luminal Bifidobacteria and Gastrointestinal Symptoms in Patients with Irritable Bowel Syndrome. The Journal of Nutrition. 2012;142(8):1510-518. https://doi.org/10.3945/jn.112.159285
Hustoft TN, Hausken T, Ystad SO, Valeur J, Brokstad K, Hatlebakk JG, et al. Effects of varying dietary content of fermentable short-chain carbohydrates on symptoms, fecal microenvironment, and cytokine profiles in patients with irritable bowel syndrome. Neurogastroenterology and Motility. 2016;29(4). https://doi.org/10.1111/nmo.12969
Bennet SMP, Böhn L, Störsrud S, Liljebo, T, Collin L, Lindfors P, et al. Multivariate modelling of faecal bacterial profiles of patients with IBS predicts responsiveness to a diet low in FODMAPs. Gut. 2017;67(5):872-81. https://doi.org/10.1136/gutjnl-2016-313128
Staudacher HM, Rossi M, Kaminski T, Dimidi E, Ralph FSE, Wilson B, et al. Long-term personalized low FODMAP diet improves symptoms and maintains luminal Bifidobacteria abundance in irritable bowel syndrome. Neurogastroenterology and Motility. 2021;34(4). https://doi.org/10.1111/nmo.14241
Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta analysis. European Journal of Nutrition. 2016;55(3):897-906. https://doi.org/10.1007/s00394-015-0922-1
Staudacher HM, Irving PM, Lomer MC, Whelan K. Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nature Reviews Gastroenterology and Hepatology. 2014;11(4):256-66. https://doi.org/10.1038/nrgastro.2013.259
Salhy ME. Recent developments in the pathophysiology of irritable bowel syndrome. Mundial Journal of Gastroenterology. 2015;21(25):7621-636. https://doi.org/10.3748/wjg.v21.i25.7621
Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. 2016;150(6):1262-279. https://doi.org/10.1053/j.gastro.2016.02.032
Wong RKM, Drossman DA. Quality of life measures in irritable bowel syndrome. Expert Rev Gastroenterol Hepatol. 2010;4(3):277-84. https://doi.org/10.1586/egh.10.19
Larussa T, Suraci E, Marasco R, Imeneo M, Abenavoli L, Luzza F. Self-Prescribed Dietary Restrictions are Common in Inflammatory Bowel Disease Patients and Are Associated with Low Bone Mineralization. Medicina. 2019;55(8):507-20. https://doi.org/10.3390/medicina55080507
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Mateus Siqueira, Luciana Marques Vieira
This work is licensed under a Creative Commons Attribution 4.0 International License.
STATEMENT OF AUTHORSHIP RESPONSIBILITY
Title of the manuscript:
________________________________________________________
1. Statement of responsability
I certify that I have participated in the work above specified and take public responsibility for its content.
I certify that the manuscript represents an original work and that none of the material in the manuscript has been previously published, is included in another manuscript, or is currently under consideration for publication elsewhere, whether in printed form or in electronic media, except that described in the attachment.
In case of acceptance of this text by Demetra: Alimentação, Nutrição & Saude, I declare to be in accordance with the policy of public access and copyright adopted by Demetra, which provides as follows: (a) the authors retain the copyright and grant to the Journal the right of first publication, the work being simultaneously licensed under the Creative Commons Attribution License, which allows the sharing of the work with acknowledgment of authorship and initial publication in this journal; (b) authors are authorized to enter additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, publishing in institutional repository or book chapter), with acknowledgment of authorship and initial publication in this journal; and (c) authors are permitted and encouraged to post and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this may lead to productive changes, as well as increase the impact and citation of the published work.
2. Conflict of Interest Statement
I certify that there is no conflict of interest in connection with the submitted article.
Date, signature and full address of all authors.
