Inflammatory Bowel Diseases and Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols: An Overview

J Med Food. 2018 Jul;21(7):633-640. doi: 10.1089/jmf.2017.0120. Epub 2018 Jan 12.

Abstract

Inflammatory bowel diseases (IBDs) are mainly represented by ulcerative colitis and Crohn's disease, and the increase in the incidence tends to follow the rapid industrialization and lifestyle of modern societies. FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) consist of molecules that are poorly absorbed in the small intestine and are fermented by bacteria in the colon leading to symptoms such as bloating, flatulence, diarrhea, and abdominal pain. Reduction of the ingestion of FODMAP could reduce the symptoms and improve the quality of life. This review aimed to summarize some important aspects of IBD and evaluate the effects of this diet on this inflammatory condition. Studies including the term FODMAP (and similar terms) and IBD were selected for this review (MEDLINE database was used PubMed/PMC). A low FODMAP diet may be an effective tool to the management of the common abdominal symptoms in patients with functional gastrointestinal symptoms once these molecules trigger these symptoms. This diet may also reduce the expression of pro-inflammatory markers such as C-reactive protein and fecal calprotectin and may interfere with the microbiome and its metabolites. The use of a low FODMAP diet can bring benefits to the IBD patients, but may also modify their nutritional status. Thus it should be utilized in appropriated conditions, and dietary supplements should be necessary to avoid deficiencies that could be caused by a low FODMAP diet over long periods. We suggest that further investigations are required to elucidate when and how to apply the FODMAP diet in IBD patients.

Keywords: Crohn's disease; FODMAP; fermentable carbohydrates; inflammatory bowel disease; ulcerative colitis.

MeSH terms

  • Animals
  • Bacteria / metabolism
  • Cytokines / metabolism
  • Disaccharides / metabolism*
  • Humans
  • Inflammatory Bowel Diseases / diet therapy
  • Inflammatory Bowel Diseases / metabolism*
  • Inflammatory Bowel Diseases / microbiology
  • Monosaccharides / metabolism*
  • Oligosaccharides / metabolism*
  • Polymers / metabolism*

Substances

  • Cytokines
  • Disaccharides
  • Monosaccharides
  • Oligosaccharides
  • Polymers
  • polyol