Is the restriction of Fermentable Short Chain Carbohydrate (FODMAP) a credible solution for the Irritable Bowel Syndrome patient? : review

Irritable Bowel Syndrome (IBS) is a debilitating condition affecting 11% of the population. It can severely affect quality of life and it is notoriously difficult to treat due to its many manifestations and inconsistent pathogenesis. Diet seems to be closely linked with symptoms and fibre, lactose, sorbitol and gluten have all been implicated in the past. Recently a group of short-chain-fermentable-carbohydrates, collectively know as FODMAPs, have taken the limelight and the body of evidence for the use of this diet in IBS patients is building. This review aims to summarise the history behind the development of the low FODMAP diet and its implementation. The review will also evaluate possible mechanisms and appraise recent learnings. For optimum results and minimising nutritional, microbiological and psychological risks, the low FODMAP diet should ideally be administered by a dietitian trained in the diet. Low FODMAP group programmes have been shown to be more cost effective but just as clinically efficient as one to one counselling. Wheat and the overlap of IBS symptoms with coeliac related disorders is still a grey area needing more research. In conclusion, the evidence base is sufficiently strong to recommend the use of the low FODMAP diet in South Africa.