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The Role of Low-FODMAP Diet in the Precision Medicine Era: Not Only IBS

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (25 October 2024) | Viewed by 6489

Special Issue Editor

Prof. Dr. Massimo Bellini

E-Mail Website
Guest Editor
Gastrointestinal Unit, Department of Translational Sciences and New Technology in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy
Interests: disorders of gut-brain interaction; irritable bowel syndrome; FODMAPs; low-FODMAPs diet; anorectal manometry; chronic constipation; functional dyspepsia; gastroparesis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The management of the gut–brain interaction disorders has improved significantly in recent decades in terms of clinical approach to diagnosis and therapy, moving in the direction of precision medicine. Surely, diet therapy plays an important role nowadays in the management of these patients.

Among the different diets proposed as therapeutic strategies, a diet low in fermentable oligo-, di-, mono-saccharides and polyols (LFD) has proven to be effective and safe in the management of patients with irritable bowel syndrome (IBS), so much so that it is included in most IBS guidelines.

Some studies, both in experimental and clinical settings, suggest the possible application of this dietary regimen to other “non-organic” disorders, such as functional dyspepsia, abdominal bloating, and functional heartburn, as well as to organic disturbances, such as inflammatory bowel diseases.

However, in order to achieve a tailored therapeutic management, many issues remain to be clarified and explored, and many needs are still unmet.

In the era of precision medicine, a careful personalization of LFD is strongly recommended in order to achieve appreciable results; “when”, “why”, “to whom”, and “how” should this dietary approach be applied?

The aims of this Special Issue will be to highlight recent advances, limits, problems and possible applications of LFD in the precision medicine era.

We welcome research papers, reviews, systematic reviews and meta-analyses.

Dr. Massimo Bellini
Guest Editor

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Keywords

  • fodmaps
  • low-fodmap diet
  • precision medicine
  • disorders of gut–brain interaction
  • irritable bowel syndrome
  • functional dyspepsia
  • diet therapy

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Published Papers (4 papers)

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Research

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7 pages, 215 KiB  
Communication
FODMAP Diet in Celiac Disease and Gluten-Related Disorders
by Paolo Usai Satta, Giammarco Mocci and Mariantonia Lai
Nutrients 2024, 16(23), 4190; https://doi.org/10.3390/nu16234190 - 4 Dec 2024
Viewed by 584
Abstract
Background: Individuals with celiac disease (CD) often report the persistence of gastrointestinal symptoms despite adherence to a gluten-free diet (GFD). A diet rich in fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) could cause symptoms in CD on a GFD, and conversely a [...] Read more.
Background: Individuals with celiac disease (CD) often report the persistence of gastrointestinal symptoms despite adherence to a gluten-free diet (GFD). A diet rich in fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) could cause symptoms in CD on a GFD, and conversely a low-FODMAP diet could positively influence the therapeutic management of CD and non-celiac gluten sensitivity (NCGS). The aim of this review was to explore the hypothetical impact of the FODMAD diet and the low-FODMAP diet (LFD) in CD and gluten-related disorders. Methods: A complete online search for FODMAP related to CD, NCGS, and the GFD was carried out using the Pubmed, Medline, and Cochrane databases. Results: Indeed, an LFD could successfully provide symptom relief in GFD-treated CD patients. Fructans, typical components of FODMAPs, have been associated with digestive symptoms in NCGS, and an LFD could improve the clinical picture. According to some evidence, an LFD could also improve the psychological status both in celiac patients on a GFD and in NCGS. However, an LFD should not have a significant impact on gut microbiota. Conclusions: Recent evidence supports the role of FODMAP restriction in CD patients with persistent symptoms on a GFD and in decreasing gastrointestinal disturbances in NCGS, although the GFD still represents the first-line therapy. Full article
(This article belongs to the Special Issue The Role of Low-FODMAP Diet in the Precision Medicine Era: Not Only IBS)
16 pages, 298 KiB  
Article
Adapted Low-FODMAP Diet in IBS Patients with and without Fibromyalgia: Long-Term Adherence and Outcomes
by Christian Lambiase, Alessandra Rossi, Riccardo Morganti, Lorenzo Cancelli, Antonio Grosso, Riccardo Tedeschi, Francesco Rettura, Marta Mosca, Nicola de Bortoli and Massimo Bellini
Nutrients 2024, 16(19), 3419; https://doi.org/10.3390/nu16193419 - 9 Oct 2024
Viewed by 1296
Abstract
Background/Objectives: A low-FODMAPs Diet (LFD) is considered a “second line” dietary strategy for irritable bowel syndrome (IBS) but, after a period of strict restriction of all FODMAP foods, it has to be adapted and tailored to each patient (AdLFD). Fibromyalgia often coexists with [...] Read more.
Background/Objectives: A low-FODMAPs Diet (LFD) is considered a “second line” dietary strategy for irritable bowel syndrome (IBS) but, after a period of strict restriction of all FODMAP foods, it has to be adapted and tailored to each patient (AdLFD). Fibromyalgia often coexists with IBS in up to 65% of cases. Our aims were to evaluate if comorbid fibromyalgia influenced the long-term clinical outcomes and adherence to an AdLFD in IBS patients. Methods: IBS patients with or without fibromyalgia who had started an AdLFD were enrolled. Patients had been evaluated before starting the LFD (T0). After a mean follow-up of 62.5 ± 22.7 months (T1), they were re-evaluated using questionnaires on disease severity, bowel habits, psychological status, and adherence to AdLFD. Results: In total, 51 IBS patients entered the study. Nineteen of them had comorbid fibromyalgia. Thirty patients reported a reduction in symptom severity at T1 in comparison with T0. Despite some slight differences in single IBS Symptom Severity Score items, comorbid fibromyalgia did not influence the IBS-SSS total score at T1. Patients with comorbid fibromyalgia showed a higher Hospital Anxiety and Depression Scale (HADS) score at baseline. A total of 44 patients showed good long-term adherence to the AdLFD. All patients improved their HADS score and had long-term adherence to the AdLFD. Conclusions: Comorbid fibromyalgia showed only a slight influence on long-term outcomes of an AdLFD on IBS symptoms, without affecting the relief of global symptoms. No influence on long-term adherence to AdLFD was detected. Hence, this approach can be taken into account in fibromyalgia patients for a nonpharmacological management of IBS symptoms. However, multicentric studies on larger samples would be welcome in the future. Full article
(This article belongs to the Special Issue The Role of Low-FODMAP Diet in the Precision Medicine Era: Not Only IBS)

Review

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12 pages, 838 KiB  
Review
Gut–Brain Axis and Psychopathology: Exploring the Impact of Diet with a Focus on the Low-FODMAP Approach
by Emanuela Ribichini, Giulia Scalese, Chiara Mocci and Carola Severi
Nutrients 2024, 16(20), 3515; https://doi.org/10.3390/nu16203515 - 17 Oct 2024
Viewed by 2200
Abstract
Background: The gut–brain axis (GBA) is a bidirectional communication network connecting the central nervous system with the gastrointestinal (GI) tract, influencing both mental and physical health. Recent research has underscored the significant role of diet in modulating this axis, with attention to how [...] Read more.
Background: The gut–brain axis (GBA) is a bidirectional communication network connecting the central nervous system with the gastrointestinal (GI) tract, influencing both mental and physical health. Recent research has underscored the significant role of diet in modulating this axis, with attention to how specific dietary patterns can impact anxiety and depression, particularly when linked to disorders of gut–brain interaction (DGBIs), like intestinal bowel syndrome (IBS). Aims and Methods: This narrative review examines the effects of specific diet regimens on the GBA and its potential role in managing psychopathology, focusing on anxiety and depression, IBS, and the low-FODMAP diet. We conducted a search on PubMed and MEDLINE by combining the following key terms: “Gut–Brain Axis”, “Irritable Bowel Syndrome”, “Low FODMAP diet”, “Mediterranean Diet”, “Psychopathology”, “Anxiety and Depression”, and “Gut Microbiota”. We applied the following filters: “Clinical Trials”, “Randomized Controlled Trials”, “Reviews”, “Meta-Analyses”, and “Systematic Reviews”. In total, 59 papers were included. Results: Low-FODMAP diet, originally developed to alleviate GI symptoms in IBS, may also positively influence mental health by modulating the GBA and improving the gut microbiota (GM) composition. New insights suggest that combining the low-FODMAP diet with the Mediterranean diet could offer a synergistic effect, enhancing both GI and psychological therapeutic outcomes. Conclusions: Understanding the complex interactions between diet, the GM, and mental health opens new avenues for holistic approaches to managing psychopathology, particularly when linked to GI symptoms. Full article
(This article belongs to the Special Issue The Role of Low-FODMAP Diet in the Precision Medicine Era: Not Only IBS)
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Other

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15 pages, 2776 KiB  
Systematic Review
Changes in Fecal Short-Chain Fatty Acids in IBS Patients and Effects of Different Interventions: A Systematic Review and Meta-Analysis
by Xuan Ju, Zhenliang Jiang, Jiayin Ma and Dong Yang
Nutrients 2024, 16(11), 1727; https://doi.org/10.3390/nu16111727 - 31 May 2024
Cited by 1 | Viewed by 1741
Abstract
Context: Short-chain fatty acids (SCFAs) have been reported to be associated with the pathogenesis of irritable bowel syndrome (IBS), but the results are conflicting. Objective: Here, a systematic review of case–control studies detecting fecal SCFAs in IBS patients compared with healthy controls (HCs) [...] Read more.
Context: Short-chain fatty acids (SCFAs) have been reported to be associated with the pathogenesis of irritable bowel syndrome (IBS), but the results are conflicting. Objective: Here, a systematic review of case–control studies detecting fecal SCFAs in IBS patients compared with healthy controls (HCs) and self-controlled studies or randomized controlled trials (RCTs) investigating fecal SCFA alterations after interventions were identified from several databases. Data sources: A systematic search of databases (PubMed, Web of Science, and Embase) identified 21 studies published before 24 February 2023. Data extractions: Three independent reviewers completed the relevant data extraction. Data analysis: It was found that the fecal propionate concentration in IBS patients was significantly higher than that in HCs, while the acetate proportion was significantly lower. Low-FODMAP diets significantly reduced the fecal propionate concentration in the IBS patients while fecal microbiota transplantation and probiotic administration did not significantly change the fecal propionate concentration or acetate proportion. Conclusions: The results suggested that the fecal propionate concentration and acetate proportion could be used as biomarkers for IBS diagnosis. A low-FODMAP diet intervention could potentially serve as a treatment for IBS while FMT and probiotic administration need more robust trials. Full article
(This article belongs to the Special Issue The Role of Low-FODMAP Diet in the Precision Medicine Era: Not Only IBS)
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