Effect of low-FODMAP diet on gastrointestinal symptoms in patients with irritable bowel syndrome: A systematic review of randomized controlled trials

Subject Areas :

Fatemeh  Majzoobi ¹ (Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch. Islamic Azad University, Tehran, Iran)
Fatemeh  Radkhouy ² (Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch. Islamic Azad University, Tehran, Iran)
Negar  Norouzi ³ (Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch. Islamic Azad University, Tehran, Iran)
Shaghayegh  Naziri Monfared ⁴ (Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch. Islamic Azad University, Tehran, Iran)
Behnood  Abbasi ⁵ (Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch. Islamic Azad University, Tehran, Iran)

Received: 2019-02-16 Accepted : 2019-05-08 Published : 2019-05-01

Keywords: Irritable bowel syndrome (IBS), Diarrhea, Constipation, Low-FODMAP diets,

Abstract :

Irritable bowel syndrome is the most common gastrointestinal functional disorder accompanied by symptoms such as abdominal pain and changes in intestinal habits. Lack of proper biochemical criteria for diagnosis, as well as a lack of proper understanding of the pathophysiology of this disease, complicates diagnosis of this disease and undermines the serious efforts to discover the proper drug for it. The present treatments including medical treatments which are related to some side-effects such as dyspepsia, heartburn, headache, bradycardia, anorexia, weakness and fatigue and diet therapy. The aim of this study was to summarize the results of previous studies on the effect of low-FODMAP diet on the improvement of digestive symptoms and nutritional status in patients with IBS. Electronic literature searches were conducted on PubMed, Web of Science and Google Scholar until May 2019. The search was conducted with the following words “FODMAP” or “low-FODMAP diets”, in combination with “gastrointestinal symptoms”, “diarrhea”, “constipation”, “dyspepsia”, “bloating”, “burp”, “heart burn”, “nausea” and “intestinal cramp” among randomized clinical trials. Our search was supplemented with the search of publisher databases Elsevier, Wiley Online and SpringerLink and for any pertinent studies, we screened the references of all included studies. Eligibility criteria included: randomized controlled clinical trial studies published in peer-reviewed journals and studies that used low-FODMAP diets as an intervention. In the total of 5 studies were done on the 299 adults who meet the inclusion criteria. According to the consumption of the results, the low-FODMAP diet caused a significant improvement in many gastrointestinal symptoms, such as abdominal pain, bloating, diarrhea, constipation, and dissatisfaction of the intestinal habits in comparison with control diet. According to the results of various studies, it seems that a low-FODMAP diet can improve digestive symptoms and IBS-related complaints.

References:

1. Laatikainen R, Koskenpato J, Hongisto SM, Loponen J, Poussa T, Hillilä M, et al. Randomised clinical trial: low‐FODMAP rye bread vs. regular rye bread to relieve the symptoms of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2016;44(5):460-70.


2. Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. Journal of Gastroenterology and Hepatology. 2010;25(8):1366-73.


3. Jahangiri P, Jazi MSH, Keshteli AH, Sadeghpour S, Amini E, Adibi P. Irritable bowel syndrome in Iran: SEPAHAN systematic review. International Journal of Preventive Medicine. 2012;3(Suppl1):S1.


4. Zomorrodi S, Tabatabaie SKR, Arbabi M, Azad Falah P, Ebrahimi Daryani N. Comparative efficacy of cognitive-behavioral therapy and mindfulness therapy on reducing symptoms and improving quality of life in patients with the irritable bowel syndrome. Biomedical & Pharmacology Journal. 2014; 7(1):63-74. 


5. Khajedaluee M, Vosooghinia H, Bahari A, Khosravi A, Esmaillzadeh A, Ganji A, et al. Demographic, social and clinical characteristics in patients with irritable bowel syndrome in Mashhad in 2013. Medical Journal of Mashhad University of Medical Sciences. 2014;57(3):579-86.


6. Buono JL, Carson RT, Flores NM. Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea. Health and Quality of Life Outcomes. 2017;15(1):35.


7. Camilleri M, Boeckxstaens G. Dietary and pharmacological treatment of abdominal pain in IBS. Gut. 2017;66(5):966-74.


8. Predictable S. Side effects of antidepressants: an overview. Cleveland Clinic Resources for Medical. 2006;73:351-61.


9. Trinkley KE, Nahata MC. Medication management of irritable bowel syndrome. Digestion. 2014;89(4):253-67.


10. Murray K, Wilkinson-Smith V, Hoad C, Costigan C, Cox E, Lam C, et al. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. The American Journal of Gastroenterology. 2014;109(1):110.


11. Yoon SR, Lee JH, Lee JH, Na GY, Lee K-H, Lee Y-B, et al. Low- FODMAP formula improves diarrhea and nutritional status in hospitalized patients receiving enteral nutrition: a randomized, multicenter, double-blind clinical trial. Nutrition Journal. 2015;14(1):116.


12. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75. e5.


13. Böhn L, Störsrud S, Liljebo T, Collin L, Lindfors 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. e2.


14. Knudsen BK, Hessov I. Recovery of inulin from Jerusalem artichoke (Helianthus tuberosus L.) in the small intestine of man. British Journal of Nutrition. 1995;74(1):101-13.


15. Guibert A, Bornet F, Galmiche J-P. Digestion, excretion, and energy value of fructooligosaccharides in healthy humans13. The American Journal of Clinical Nutrition. 1996(64):324-8.


16. He Y, Wu C, Li J, Li H, Sun Z, Zhang H, et al. Inulin-type fructans modulates pancreatic–gut innate immune responses and gut barrier integrity during experimental acute pancreatitis in a chain length-dependent manner. Frontiers in Immunology. 2017;8:1209.


17. Saunders D, Wiggins H. Conservation of mannitol, lactulose, and raffinose by the human colon. American Journal of Physiology-Gastrointestinal and Liver Physiology. 1981;241(5):G397-G402.


18. Macfarlane GT, Steed H, Macfarlane S. Bacterial metabolism and health‐related effects of galacto‐oligosaccharides and other prebiotics. Journal of Applied Microbiology. 2008;104(2):305-44.


19. Benjamin JL, Hedin CR, Koutsoumpas A, Ng SC, McCarthy NE, Hart AL, et al. Randomised, double-blind, placebo-controlled trial of fructo-oligosaccharides in active Crohn's disease. Gut. 2011.232025.


20. Koga Y, Tokunaga S, Nagano J, Sato F, Konishi K, Tochio T, et al. Age-associated effect of kestose on Faecalibacterium prausnitzii and symptoms in the atopic dermatitis infants. Pediatric Research. 2016;80(6):844.


21. Ramnani P, Costabile A, Bustillo A, Gibson GR. A randomised, double-blind, cross-over study investigating the prebiotic effect of agave fructans in healthy human subjects. Journal of Nutritional Science. 2015;4.


22. Vulevic J, Juric A, Walton GE, Claus SP, Tzortzis G, Toward RE, et al. Influence of galacto-oligosaccharide mixture (B-GOS) on gut microbiota, immune parameters and metabonomics in elderly persons. British Journal of Nutrition. 2015;114(4):586-95.