Randomised Clinical Trial

Yoga vs a Low-FODMAP Diet in Patients With Irritable Bowel Syndrome

D. Schumann; J. Langhorst; G. Dobos; H. Cramer


Aliment Pharmacol Ther. 2018;47(2):203-211. 

In This Article


Irritable bowel syndrome (IBS) describes a group of symptoms, including abdominal pain or discomfort, and changes in bowel movement patterns and defecation, for which a correlation between pathophysiology and symptoms is mostly lacking.[1] IBS is the most common functional gastrointestinal (GI) disorder.[2] Its diagnosis is based on criteria devised by the Rome Foundation.[3] Although almost 60% of IBS patients claim that certain foods trigger their symptoms, eliminating those foods from their diet often leads to only minor symptom improvements.[4] A recent treatment option for IBS is the use of a low Fermentable, Oligo-, Di-, Monosaccharides and Polyol (FODMAP) diet, which focuses on restricting fermentable, short-chain carbohydrates, including galacto- and fructo-oligosaccharides (GOS, FOS), disaccharides (lactose), monosaccharides (fructose) and polyols (such as sorbitol and mannitol). This diet produces gastrointestinal symptom relief by reducing the fermentable load on the colon, in order to reduce gas production and luminal distension.[5]

Past theorists have hypothesised that irritable bowel syndrome is partly caused by visceral hypersensitivity and psychosocial factors, with links between such factors as disturbed stress regulation and autonomic nervous system dysfunction and the condition's pathophysiology.[6,7] Psychiatric comorbidities are also common in patients with IBS.[8] Yoga, based on an ancient Indian philosophy, has been adapted for use in complementary medicine, especially with regard to preventing and treating of disease.[9] Traditionally, yoga consists of body postures (sanskrit: Asana), breathing exercises (Pranayama) and meditation (Dhyana); a practice to "still the mind."[10,11] It is hypothesised that yoga practice corrects stress-induced underactivity of the parasympathetic nervous system.[12] Yoga has been shown to reduce stress and psychological distress, in varied patient populations.[13–18] It may prove equally effective in improving the symptoms of IBS.[19] The primary purpose of this study was to analyse the effectiveness of a yoga-based intervention compared to the use of a low-FODMAP diet in treating the gastrointestinal symptoms of patients with IBS. The secondary goal was to determine these interventions' potential effects on patients' perceived quality of life, perceived stress and health status, body awareness and responsiveness; whilst considering the safety of these treatments.