Editorials

Dietary therapy for irritable bowel syndrome

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3902 (Published 22 July 2016) Cite this as: BMJ 2016;354:i3902
  1. Benjamin Lebwohl, assistant professor of medicine and epidemiology,
  2. Peter H R Green, Phyllis and Ivan Seidenberg professor of medicine
  1. Department of Medicine, Celiac Disease Center, Columbia University, New York, NY 10032, USA
  1. Correspondence to: PHR Green pg11{at}columbia.edu

High expectations for low FODMAP diets

Irritable bowel syndrome (IBS) is a common disorder of the digestive system, affecting about 10% of the global population. The condition has no definitive biomarker or cure, but various drug treatments have been introduced in recent years, including antibiotics (to treat presumed small intestinal bacterial overgrowth) and agents that affect motility through fluid secretion or the enteric nervous system. Despite these advances, perhaps the most popular option among patients in recent years has been a dietary approach, the “low FODMAP diet.”

The term FODMAP was first coined by Gibson and Shepherd in 2005, referring to a new dietary class comprising fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. The authors identified a list of foods that are highly fermented but poorly absorbed, leading to the expansion of ileocolonic bacteria. This broad dietary class includes fructose (in fruits and sweeteners), lactose (in dairy products), fructans (wheat based products), galacto-oligosaccharides (legumes), and polyols such as xylitol and mannitol (fruits and artificial sweeteners). The authors first proposed FODMAPs as a potential trigger for inflammatory bowel disease (Crohn’s disease …

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