Journal List > Korean J Gastroenterol > v.64(3) > 1007271

Kim and Sung: Current Issues on Irritable Bowel Syndrome: Diet and Irritable Bowel Syndrome

Abstract

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multifactorial disorder with its pathogenesis attributed to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, communi-cation in the gut-brain axis, and so on. Traditionally, IBS has been treated with diet and lifestyle modification, fiber supplementation, psychological therapy, and pharmacological treatment. Carbohydrates are intermingled with a wide range of regularly consumed food including grains such as rye and wheat, vegetables, fruits, and legumes. Short-chain carbohydrates that are poorly absorbed exert osmotic effects in the intestinal lumen increasing its water volume, and are rapidly fermented by bacteria with consequent gas production. These effects may be the basis for the induction of most of the gastrointestinal symptoms. This has led to the use of lactose-free diets in those with lactose intolerance and of fructose-reduced diets for fructose malabsorption. 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.

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Table 1.
Suitable Food for Low FODMAPs Diet
Fruits Vegetables Grain Dairy Others
Banana, blueberry grape, orange, strawberry, tangelo Bamboo shoot, carrot, potato, sweet potato, tomato, zucchini, lettuce Rice, gluten-free bread, oatmeal Lactose-free milk, lactose-free yogurt Sugar

FODMAPs, fermentable oligosaccharides, disaccharides, monosaccharides and polyols.

Table 2.
High FODMAPs Content Food to Avoid
Free fructose Lactose Fructans Galactans Polyols
Apple, mango, pear, watermelon, honey, high fructose syrup (soda, cola) Milk from cows, soft unripened cheese, yogurt, ice cream Garlic, onion, cabbage, custard apple, watermelon Legumes Apple, pear, watermelon, mushroom, xylitol, sorbitol

FODMAPs, fermentable oligosaccharides, disaccharides, monosaccharides and polyols.

Table 3.
Characteristics of Common FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols)
F Fermentable   Absorption/hydrolysis in small intestine
O Oligosaccharides Fructans, galactan No absorption (no small intestinal hydrolysis)
D Disaccharides Lactose in lactase deficiency Decreased digestion, hydrolyzed if lactase activity
M Monosaccharides Free fructose (fructose in excess of glucose) Slow active absorption in excess of glucose
A And    
P Polyols Sorbitol, mannitol and xylitol Slow passive absorption
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