carbohydrates

Summary: A low-FODMAP diet, which is a common intervention for IBS, is being increasingly studied in IBD patients. Unfortunately, the diet does not currently show efficacy for reducing inflammation, but has been shown in clinical trials to be effective at managing functional gastrointestinal symptoms in patients whose disease is in remission. Although a common concern with low-FODMAP diets is potential adverse effects on the microbiome from removing fermentable substrates, its actual effects on the microbiome in practice have not yet been clearly characterized, with inconsistent results across studies. For those who wish to support their microbiome on a low-FODMAP diet, resistant starch and Sunfiber are good low-FODMAP prebiotic options.

This article is part of the IBD Index. Last updated on April 20, 2022.

The low-FODMAP diet is somewhat unique among IBD interventions because it promises to intervene in the common but oft-overlooked situation of continuing functional gastrointestinal symptoms even in the absence of inflammation.

I cover the basics and practical aspects of a low-FODMAP diet in The Low-FODMAP Diet for IBD: Everything You Need to Know. In this article, I take a deep dive into all the evidence regarding the effectiveness of a low-FODMAP diet for IBD, both from the perspective of reducing inflammation and managing symptoms. I also address the most common concern about a low-FODMAP diet: its effects on the microbiome.

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Summary: The low-FODMAP diet originated in 2005 out of a hypothesis about IBD pathogenesis, but quickly became a go-to treatment for IBS. For IBD, the diet has found its niche as an intervention for addressing lingering functional gastrointestinal symptoms in patients whose IBD is in remission. For this purpose, the diet has demonstrated successful symptom reduction in clinical trials, but no evidence yet indicates that it is helpful for quelling inflammation. The biggest risk associated with a low-FODMAP diet is adverse effects on the microbiome from depriving it of fermentable carbohydrates, but this can be addressed by including low-FODMAP prebiotics (such as Sunfiber and resistant starch) and by reintroducing FODMAP-containing foods as tolerated.

This article is part of the IBD Index. Last updated on April 20, 2022.

This article aims to give a high-level overview of the low-FODMAP diet, as well as practical guidance. For a deeper dive into the science, you can check out my article Is the Low-FODMAP Diet Effective for IBD?.

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