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Gastroenterology

FODMAP-free diet: not for all patients

Functional gastrointestinal disorders
Pediatrics Gastroenterology

Its use remains questionable in FGIDs, but a possible correlation between bacterial populations and response to the FODMAP-free diet could help refine the therapeutic choice.18, 19

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Healthy foods. Assorted selection of foods that are considered healthy.

About this article

Created 15 October 2019
Updated 12 October 2021

TREATMENT OF IBS

The FODMAP-free diet (Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols) seems to represent an appropriate therapeutic response to IBS. The incriminated foods in fact cause intestinal disruption when they are fermented by bacteria via the production of gas and shortchain fatty acids. Restricting their intake provides benefits that are confirmed by the literature, but which must be weighed against potential negative effects to confirm the value of this type of diet as a first- line therapeutic option. The absence of FODMAPs can in fact cause eating disorders, deficiencies and biological disruption, directly or following dysbiosis of the intestinal microbiota. They should also not be used as a diagnostic test for IBS in place of recognized symptomatic criteria (those of Rome IV), note the experts, who also recall the importance of the gradual reintroduction of excluded foods, after checking that the organism will tolerate them.

THERAPEUTIC EFFICACY AND BACTERIAL PROFILE

A FODMAP-free diet could therefore be appropriate for some types of disorders or individuals, but not for others. This research area has been explored by a Norwegian team, who compared the composition of the intestinal microbiota of IBS patients with response to treatment. In this study, a patient was judged responsive if they showed a reduction of symptoms of at least 50% at 4 weeks on an IBS-SSS score. Out of 61 subjects, 32 (29 women, 3 men) were considered as respondents and 29 (25 women, 4 men) as non-respondents. The analysis of 54 bacterial markers by means of a specific test demonstrated significant differences between the two groups for 10 of these markers. From the data collected, a response index (RI) graduated from 0 to 10 and based on the median values of 10 bacterial markers of the responsive patients was created. Result: subjects with an RI higher than 3 were five times more likely to respond to treatment. A possible innovative therapeutic approach for the treatment of FGIDs.

AN ALTERNATIVE THERAPY, AMONG OTHERS

These reservations have led to the study of other non-pharmacological alternatives in FGIDs (hypnotherapy, gluten-free diet etc..). The literature tends to demonstrate that the conventional dietary advice given by health professionals provides less benefit: list of products to be avoided (fatty or spicy foods, coffee, alcohol, onions…) and eating habits to be adopted (eating at regular intervals, in reasonable quantities, chewing thoroughly…). On the contrary, hypnotherapy might offer the same physiological advantages as the low-FODMAP diet and a better psychological impact in patients suffering from IBS. Regarding the gluten-free diet, there is no comparative study with the low-FODMAP diet, but drawing comparisons between similar studies holds out the prospect of similar results.

Sources

18 Hill P, Muir JG, Gibson PR. Controversies and Recent Developments of the Low-FODMAP Diet. Gastroenterol Hepatol (N Y). 2017;13(1):36-45.

19 Valeur J, Småstuen MC, Knudsen T, et al. Exploring Gut Microbiota Composition as an Indicator of Clinical Response to Dietary FODMAP Restriction in Patients with Irritable Bowel Syndrome. Dig Dis Sci. 2018;63(2):429-436.

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Tags
IBS Dysbiosis Diet Gut health Functional gastrointestinal disorders Fodmap-free diet

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    Focus
    Functional gastrointestinal disorders from childhood to adulthood
    • Pathophysiology
      • Functional gastrointestinal disorders: a set of diseases defined in correlation with the intestinal microbiota
      • Focus on the gut-brain axis
    • FGIDS: from infants to adults
      • In newborns
      • In children and adolescents
      • In adults
    • What could be the role of microbiota modulation?
      • Modulation of the microbiota by FMT: controversial results
      • FODMAP-free diet: not for all patients
      • Probiotics: what are the benefits?
    • Expert opinion
      • Dr. Marc Bellaiche: Managing FGIDs in children
    Created 15 October 2019
    Updated 12 October 2021

    About this article

    To know more about this topic.

    Main topic

    Functional gastrointestinal disorders

    Medical practice

    Pediatrics Gastroenterology

    Content type

    Dossier detail
    Modulation of the microbiota by FMT: controversial results
    Probiotics: what are the benefits?
    Focus

    Functional gastrointestinal disorders from childhood to adulthood

    Pathophysiology

    Functional gastrointestinal disorders: a set of diseases defined in correlation with the intestinal microbiota Focus on the gut-brain axis

    FGIDS: from infants to adults

    In newborns In children and adolescents In adults

    What could be the role of microbiota modulation?

    Modulation of the microbiota by FMT: controversial results FODMAP-free diet: not for all patients Probiotics: what are the benefits?

    Expert opinion

    Dr. Marc Bellaiche: Managing FGIDs in children

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