Low FODMAP Diet Research and Resources
This section contains information regarding relevant research articles, informational articles, helpful websites and Facebook support groups.
- Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints (2000).
“Combined sugar malabsorption patterns are common in functional bowel disorders and may contribute to symptomatology in most patients. Dietary restriction of the offending sugar(s) should be implemented before the institution of drug therapy.”
- Current issues on irritable bowel syndrome: diet and IBS (2014).
As all poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, a concept has been developed to regard them collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and to evaluate a dietary approach that restricts them all. Based on the observational and comparative studies, and randomized-controlled trials, FODMAPs have been shown to trigger gastrointestinal symptoms in patients with IBS. Food choice via the low FODMAPs and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for managing symptoms of IBS.
- Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with IBS (2012).
“This randomized controlled trial demonstrated a reduction in concentration and proportion of luminal bifidobacteria after 4 wk of fermentable carbohydrate restriction. Although the intervention was effective in managing IBS symptoms, the implications of its effect on the GI microbiota are still to be determined.”
- Food choice as a key management strategy for functional gastrointestinal symptoms (2012).
“Simple concepts of how food might trigger functional GI symptoms have led to at least one efficacious dietary approach that is effective in the majority of patients with functional bowel disorders. The evidence base for the low FODMAP diet is strong, provided dietitians with the skills to implement it are available.”
- Fructose Malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management (2006).
“A comprehensive new diet directed at limiting fructose and fructan intake has been developed on the basis of physiological principles and food composition tables. Application of the diet to patients with IBS and FM has revealed a high level of sustained adherence associated with a high rate of symptomatic improvement.”
- Symptomatic fructose malabsorption in irritable bowel syndrome: a prospective study (2014).
“Our study demonstrates that the prevalence of symptomatic malabsorption of a 25g fructose load was 22% in IBS patients and lower than that previously reported. Moreover, this 25g load of fructose triggered bothersome intestinal symptoms in 28% of the patients who were not always malabsorbers. Different mechanisms are implicated in a poor tolerance to fructose. Therefore, further studies are now warranted to determine whether a low-fructose regimen is effective in intolerant to fructose IBS patients, with and without malabsorption.”
Hydrogen Breath Testing
- Breath tests and irritable bowel syndrome (2014).
“Carbohydrate malabsorption (lactose, fructose, sorbitol) can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS. Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients.”
- How to interpret hydrogen breath tests (2011).
“Hydrogen breath tests using various substrates like glucose, lactulose, lactose and fructose are being used more and more to diagnose small intestinal bacterial overgrowth (SIBO) and lactose or fructose malabsorption. Though quantitative culture of jejunal aspirate is considered as gold standard for the diagnosis of SIBO, hydrogen breath tests, in spite of their low sensitivity, are popular for their non-invasiveness. Glucose hydrogen breath test is more acceptable for the diagnosis of SIBO as conventionally accepted double-peak criterion on lactulose hydrogen breath test is very insensitive and recently described early-peak criterion is often false positive. Hydrogen breath test is useful to diagnose various types of sugar malabsorption. Technique and interpretation of different hydrogen breath tests are outlined in this review.”
- Hydrogen breath tests in gastrointestinal diseases (2014).
Patients with symptoms of abdominal pain, bloating, flatulence and altered bowel movements (diarrhea and constipation), or with a medical diagnosis of irritable bowel syndrome or celiac disease, may have undiagnosed carbohydrate malabsorption or SIBO. Hydrogen breath tests are specific and sensitive diagnostic tests that can be used to either confirm or eliminate the possibility of carbohydrate malabsorption or SIBO in such patients. Breath tests, though valuable tools, are underutilized in evaluating dyspepsia and functional bloating and diarrhea as well as suspected malabsorption. However, because of their simplicity, reproducibility and safety of procedure they are now being substituted to more uncomfortable and expensive techniques that were traditionally used in gastroenterology.
- Before you take probiotics for IBS…
“Although research on the use of probiotics for IBS is complicated due to the difficulty of making comparisons of the many strains that are tested, for the most part, most studies have shown a positive effect of probiotics on the variety of symptoms that make up IBS. More importantly, most studies have not shown any negative effect on IBS symptoms from taking probiotics. The difficult part is making any conclusions as to which strains are most effective.”
- Effect of probiotic species on irritable bowel syndrome symptoms: A bring up to date meta-analysis (2013).
In conclusion, evidence suggests that probiotics are an effective treatment option for IBS patients and that the effects of probiotics are likely species-specific. Future research should focus more specifically on species, combinations, dose, duration, IBS sub-types, and IBS individual symptoms, while employing standardized measurement tools. Although probiotics are a safe therapy, clinicians should consider other concomitant pathologies when prescribing them to their patients.”
- Probiotic Therapy for Irritable Bowel Syndrome (2010).
Conclusions – (1) Additional larger, randomised control trials studying B. infantis 35624 are needed, along with future research regarding the mechanism of immune regulation in IBS patients; (2) The method by which the probiotic payload is released into the intestine may affect the efficacy of higher or lower concentrations of therapeutic bacteria; (3) Lactobacillus does not appear to be effective in single organism studies and studies involving combinations of probiotics, though Bifidobacterium demonstrates some efficacy (Grade 2C evidence).
- Carbohydrate malabsorption syndromes and early signs of mental depression in females (2000).
” Isolated fructose malabsorption and combined fructose/lactose malabsorption was significantly associated with a higher Beck’s depression score. Further analysis of the data show that this association was strong in females (P < 0.01), but there was no such association between carbohydrate malabsorption and early signs of depression in males. In conclusion, the data confirm that fructose malabsorptionmay play a role in the development of mental depression in females and additional lactose malabsorption seems to further increase the risk for development of mental depression.”
- Decreased serum zinc in fructose malabsorbers (2001).
“Fructose malabsorption is associated with lower serum zinc concentrations; in this study, 10 of 147 subjects (6.8%) had zinc deficiency, and all 10 suffered from fructose malabsorption. Although this is probably not attributable to a shortened transit time of a defective DMT-1-transporter, the exact mechanism still remains to be elucidated. Fructose malabsorption may thus reflect only part of a more complex malabsorption syndrome. Because fructose malabsorption can be seen in approximately one-third of the Western European population, fructose malabsorption could be a major etiology of low zinc status.”
- Fructose malabsorption is associated with lower plasma folic acid concentrations in middle-aged subjects (1999).
“Low plasma folic acid concentrations may be attributable to dietary deficiency or malabsorption of folic acid. Another cause may be an unfavorable bacterial composition in the gut because folic acid derived from colonic bacterial metabolism is a major source of resorbed folic acid. Because malnutrition is highly unlikely in our study population, the lower folic acid concentrations in fructose malabsorbers compared with normals are probably attributable to malabsorption of alimentary folic acid or changes in intestinal bacterial colonization. Fructose malabsorption is known to accelerate gastrointestinal transit when patients are exposed to fructose, thus reducing the contact time that is necessary for the absorption of (micro)nutrients. On the other hand, fructose malabsorption leads to a profound change in bacterial colonization, especially in the colon. Because a substantial amount of folic acid derives from intestinal bacteria, it seems reasonable that a change in the population of gastrointestinal bacteria could lead to a change in the plasma concentrations of folic acid.”
- Sex hormones in the modulation of irritable bowel syndrome (2014).
“The results of epidemiological studies and clinical observations confirm significant sex and gender differences in the IBS prevalence and symptomatology. Furthermore, a growing number of clinical and experimental data strongly support a crucial role of sex hormones in the regulatory mechanisms of the brain-gut-microbiota axis involved in the pathophysiology of IBS.”
- SIBO Associated Diseases.
SIBO is associated with many disorders, as an underlying cause, an aftereffect of the pre-existing disease or as a co-existing condition. If you or one of your patients has one of the following conditions, testing and consideration of treatment for SIBO is merited.
- SIBO in irritable bowel syndrome: are there any predictors? (2010).
“Small intestinal bacterial overgrowth was present in a sizeable percentage of patients with IBS with predominance of bloating and flatulence. Older age and female sex were predictors of SIBO in patients with IBS. Identification of possible predictors of SIBO in patients with IBS could aid in the development of successful treatment plans.”
Sports Dietitians Australia: a concise fact sheet on a low FODMAP diet. Easy to read and clear information.
Sue Shepherd: Is an Australian dietitian, who has Coeliac Disease herself but studies and writes cookbooks that cater to FM, lactose intolerance, low FODMAP and irritable bowel disease as well as a gluten free diet. This article is very concise and a must read for those who are newly diagnosed, need to cook for someone with FM or just those who are interested in the condition. In fact, even if you’ve had FM for years, if you want a good scientific spiel about the condition, read it!
Today’s Dietitian: A magazine for dietitians, this article contains useful information on the low FODMAP diet and on FODMAPS in general.
What is a Food Intolerance: Fructose malabsorption is a malabsorptive disorder but many people also have separate food intolerances that confound diagnosis. This article explains food intolerances and their causes very thoroughly.
Wikipedia: http://en.wikipedia.org/wiki/Fructose_malabsorption … Everyone loves Wikipedia. Don’t deny it.
About.com: Irritable Bowel Syndrome.
Clinical Alimentary: link here.
Finnish Food Composition Database (in English): A fantastic website that allows you to enter any food, say “apple,” and it will give you a list of possible foods and their chemical/nutritional components. This allows you to compare glucose and fructose compositions in your food of choice and decide whether it’s worth eating or not.
Fructose Malabsorption Australia: A website on Yahoo! Groups that acts as a support/information hub for those with FM or just those who are interested.
IBS Impact: link here.
Kate Scarlata, RD: link here.
Monash University: the home of low FODMAP research, link here.
RM Dietetics: link here.
Shepherd Works: link here.
The Farting Pear: Apart from the fact that this is an awesomely funny and very apt name for a FM related website, they have a function which will tell you if a food you search is suitable or not. It is a little subjective, as it is partly based on user’s ratings but it would be very helpful if you’re just starting out. Find it here.
The Fructose Malabsorption Diet: this website has good instructions on how to test your fructose boundaries after diagnosis. Go six weeks on a very strict FM diet and slowly introduce foods.
FORK MY BELLY | Low FODMAP, Gluten Free, SIBO: link here.
Fructose Malabsorption Support Group Victoria: link here.
Low FODMAP Australia: link here.
Low FODMAP | Life and Thymez: link here:
Low FODMAP Recipes and Resources: link here.
Low FODMAP USA: link here.
Low FODMAP for Foodies: link here.
Low FODMAP for Vegans: link here.