Evidence-based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach

Peter R Gibson; Susan J Shepherd

Disclosures

J Gastroenterol Hepatol. 2010;25(2):252-258. 

In This Article

The FODMAP Concept in the Management of Functional Gut Symptoms

There are two key components to the FODMAP concept.

  • The dietary approach restricts FODMAP intake globally, not individually. Restriction of individual FODMAPs has been used with varying success in the management of functional gut symptoms for a long time. The best example is restriction of dietary lactose in patients with hypolactasia. Restriction of fructose, with or without sorbitol, has also been reported. However, such approaches have not become widespread in their application, perhaps in part related to their limited success. Restricting one FODMAP in isolation ignores the likelihood that there is potentially a range of FODMAPs in the diet, all of which have similar end-effects in the bowel. The innovation in the FODMAP concept is that global restriction should have a far greater and more consistent effect than limited restriction. Thus, the central focus is to reduce the intake of all poorly absorbed short chain carbohydrates to be more effective in reducing luminal distension than merely concentrating on one of these. Such a global approach to restricting carbohydrates that have similar actions (high osmotic effect and rapid fermentation) should optimize symptom control in patients with IBS.

  • FODMAPs do not cause the underlying FGID, but represent an opportunity for reducing symptoms. This concept is important as it steers away from the more traditional concepts of lactose 'intolerance' versus 'malabsorption' and fructose 'intolerance' versus 'malabsorption'. The reason the symptoms are triggered by the ingestion of lactose or fructose in the individual is the response of the enteric nervous system to luminal distension (due to visceral hypersensitivity, excessive gas production due to the nature of the resident microbiota, or motility problems with clearance of the fluid/gas) not because the malabsorption of the sugar is abnormal or a 'condition'. After all, delivery of dietary FODMAP to the distal small and proximal large intestine is a normal phenomenon, one that will generate symptoms if the underlying bowel response is exaggerated or abnormal.

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