Review Article

Biological Mechanisms for Symptom Causation by Individual FODMAP Subgroups

The Case for a More Personalised Approach to Dietary Restriction

Xiao Jing Wang; Michael Camilleri; Stephen Vanner; Caroline Tuck


Aliment Pharmacol Ther. 2019;50(5):517-529. 

In This Article

Conclusions: Time to Encourage a More Personalised Approach

While some of the components of the low-FODMAP diet have strong biologic plausibility for symptom generation (lactose, fructans, galacto-oligosaccharides), others such as excess fructose and polyols may only cause symptoms in specific individuals when consumed in high doses but this remains to be established clinically. Furthermore, high quality trials need to be conducted to evaluate the effect of low-FODMAP diet on not only symptomology, but on the microbiome, the intestinal barrier and immune function.

We suggest that clinicians consider a tailored, personalised "bottom-up" approach to the low-FODMAP diet in some patients, individualised to the patient, such as dietary restriction relevant to the patients' ethnicity, symptom profile, prior experience with specific foods and usual dietary intake. These clinical features will not apply to all patients, and as such a standard approach may be more effective. If utilising a "bottom-up" approach, combinations of subgroups may need to be restricted in order to achieve symptomatic relief. There appear to be promising ways to predict response (Table 7) prior to implementing the dietary intervention, but these require further validation prior to being implemented into standard care.