Sarika
Giria1*, Pradyumna Singh Shekhawat2
1 Research Scholar, Department of Yoga and Science of Living, Jain Vishva Bharati Institute, Ladnun, Rajasthan,
India
sarikagiria@gmail.com
2 Professor, Department of Yoga and Science
of Living, Jain Vishva Bharati
Institute, Ladnun, Rajasthan, India
Keywords: Irritable bowel
syndrome; Low-FODMAP diet; Diet therapy; Functional gastrointestinal disorders;
Rome IV criteria; Randomized controlled trial; Gastrointestinal symptoms;
Quality of life.
One of the most
prevalent diseases of gut-brain interaction (DGBIs) is irritable bowel syndrome
(IBS), which is characterised by changed bowel habits and recurring abdominal
discomfort without any obvious biochemical or anatomical abnormalities.
Recurrent stomach discomfort that occurs at least once per week for the last
three months together with changes in stool frequency, stool shape, or
defecation is required for a diagnosis of irritable bowel syndrome according to
the Rome IV diagnostic criteria. Depending on the diagnostic criteria and
population analysed, there is substantial regional variation in the prevalence
of irritable bowel syndrome (IBS), which is believed to vary from 5% to 10%
globally. Impairment of quality of life, decreased job productivity, higher
healthcare use, and large socioeconomic expenses are all connected with
irritable bowel syndrome (IBS), which places a heavy load on healthcare
systems.
Irritable bowel
syndrome (IBS) has a complicated and multifaceted pathogenesis that includes
dysregulation of the gut-brain axis, immunological activation, changes in
intestinal permeability, dysbiosis of gut microbes, and disruptions in
gastrointestinal motility. There is known to be a two-way connection between
the CNS and the GI tract, which means that psychological issues like worry,
sadness, and chronic stress may amplify the intensity of symptoms. Therefore,
in order to enhance patient outcomes, modern treatment techniques place a
greater emphasis on interdisciplinary approaches that include nutritional,
psychological, and pharmaceutical therapies.
One of the most
powerful environmental variables that may be changed to alleviate irritable
bowel syndrome symptoms is one's food. Between seventy and eighty percent of
patients say that certain meals cause or worsen gastrointestinal symptoms such
gas, bloating, flatulence, distention of the abdomen, and changes in bowel
habits. Because of these findings, dietary treatments are being considered more
and more as a first-line therapy option before starting long-term
pharmaceutical treatment.
Researchers at
Monash University came up with the Low-FODMAP diet, which stands as one of the
most researched dietary methods for irritable bowel syndrome. Foods containing
short-chain carbs that are resistant to small intestine absorption are known as
FODMAPs. They cause an increase in intestinal water content due to their
osmotic action, and in sensitive people, they might worsen symptoms by leading
to luminal distension and excess gas produced by fast fermentation by the
colonic bacteria. Intestinal fermentation and intraluminal gas generation are
reduced when FODMAPs are restricted from the diet, which alleviates bloating,
abdominal discomfort, and bowel dysfunction.
The therapeutic
effectiveness of the Low-FODMAP diet in lowering the severity of irritable
bowel syndrome symptoms and enhancing health-related quality of life has been
proven in several randomised controlled studies and systematic reviews within
the last decade. According to meta-analyses, systematic Low-FODMAP dietary
intervention improves symptoms in around two-thirds of individuals. An
evidence-based therapy option for suitably chosen people with IBS is a
dietitian-guided Low-FODMAP diet, according to numerous worldwide clinical
recommendations. These guidelines include those from the American College of
Gastroenterology and the British Society of Gastroenterology.
There are still
some significant gaps in our understanding, even if the amount of information
is increasing. The majority of research has focused on Western people, whose
eating patterns vary greatly from South Asian ones. Many Indian foods, such as
wheat-based goods, pulses, onions, garlic, and certain fruits, contain
fermentable carbs in different levels, which might affect how well people stick
to their diets and how well they respond to treatments. Additionally,
standardised outcome measures have been used in just a small number of
randomised controlled trials that have assessed structured Low-FODMAP therapies
in adults from India. The efficacy and therapeutic relevance of this dietary
strategy in many cultural and nutritional contexts requires more research.
The purpose of
this randomised controlled study was to determine if an eight-week Low-FODMAP
dietary intervention was beneficial for people with irritable bowel syndrome
(IBS) as defined by the Rome IV criteria. We postulated that compared to those
who received generic dietary recommendations, those who received tailored
Low-FODMAP nutritional counselling would show more improvement in
gastrointestinal symptoms and patient-reported outcomes. In addition to
informing future dietary recommendations for individuals with IBS in the Indian
community, this research is anticipated to add to the increasing body of data
that supports dietary management as a crucial part of comprehensive IBS
therapy.
The purpose of
this 8-week Low-FODMAP dietary intervention for people with Irritable Bowel
Syndrome (IBS) was to assess its efficacy in a single-center, single-blind,
parallel-group randomised controlled trial that took place from March to May
2025. The research contrasted conventional dietary recommendations based on the
tenets of evidence-based clinical nutrition with a systematic Low-FODMAP diet
regimen.
The study protocol was designed in accordance with the
Declaration of Helsinki (2013 revision)
and the CONSORT
2010 Statement for reporting
randomized controlled trials.
Participants were recruited from outpatient gastroenterology clinics
and through public advertisements.
A total of 60 individuals underwent screening. Following
eligibility assessment, 60
participants fulfilled the inclusion criteria and were enrolled in the
study.
Participants were randomly assigned
in a 1:1 ratio to either:
·
Low-FODMAP Diet Group (LFD; n = 30)
·
Standard Diet Control Group (SD; n = 30) Eligibility Criteria
Participants were eligible if
they:
·
were between 18 and 55 years of age;
·
were willing to comply with the prescribed dietary intervention;
·
provided
written informed consent;
·
had not received
antibiotics, probiotics, or prebiotics within
the previous four weeks.
Participants were excluded if they had:
·
inflammatory bowel disease;
·
celiac disease;
·
gastrointestinal malignancy;
·
previous
gastrointestinal surgery affecting
bowel function;
·
severe
metabolic disorders;
·
severe psychiatric illness;
·
pregnancy
or lactation;
·
current
participation in another
clinical trial;
·
inability
to comply with dietary recommendations.
A total sample of 60 participants (30 per group) was included.
Participants
were randomly allocated to one of the two intervention groups using a computer-generated randomization sequence prepared
by an investigator who was not involved in participant recruitment or outcome
assessment.
Low-FODMAP Diet Group
Participants
assigned to the intervention group received individualized dietary counselling
from a registered dietitian experienced in Low-FODMAP dietary management.
The
dietary programme followed the recommendations developed by Monash University and consisted of an
initial eight-week restriction phase.
Participants
were instructed to avoid foods rich in fermentable oligosaccharides,
disaccharides, monosaccharides, and polyols.
Participants
allocated to the control group continued their habitual diet and received
general dietary advice based on healthy eating recommendations.
No specific
restriction of dietary
FODMAPs was recommended.
Statistical analyses
were performed using IBM SPSS Statistics version 15.0 (IBM Corp., Armonk, NY, USA).
Continuous
variables were expressed as mean ±
standard deviation (SD), whereas categorical variables were summarized as
frequencies and percentages.
All statistical tests were two-tailed.
A p-value < 0.05 was
considered statistically significant.
Where appropriate, 95% confidence intervals and effect sizes (Cohen's d) should also be reported to facilitate
interpretation of clinical significance.
Sixty people
were considered for eligibility. Thirty people who fulfilled the Rome IV
diagnostic criteria for irritable bowel syndrome (IBS) were randomly assigned
to either the low-FODMAP diet group (n = 30) or the control group (n = 30) that
followed a conventional diet. Figure 1 shows that all individuals who were
randomly assigned to the intervention finished all eight weeks.
Age, sex
distribution, and baseline symptom intensity were not significantly different
between the two research groups (p > 0.05), suggesting that the two groups'
demographic and clinical features were similar at baseline.
|
Question |
Pre Mean
± SD |
Post Mean
± SD |
t (29) |
p-value |
Interpretation |
|
Q1 |
2.37 ± 0.49 |
2.77 ± 0.68 |
4.397 |
<0.001 |
Significant |
|
Q2 |
2.93 ± 0.78 |
3.53 ± 0.63 |
5.835 |
<0.001 |
Significant |
|
Q3 |
2.30 ± 0.47 |
3.00 ± 0.74 |
8.226 |
<0.001 |
Significant |
|
Q4 |
2.83 ± 0.75 |
3.77 ± 0.43 |
7.992 |
<0.001 |
Significant |
|
Q5 |
3.03 ± 0.81 |
3.83 ± 0.38 |
6.595 |
<0.001 |
Significant |
|
Q6 |
2.27 ± 0.58 |
2.73 ± 0.69 |
5.037 |
<0.001 |
Significant |
|
Q7 |
3.37 ± 0.81 |
3.53 ± 0.63 |
1.980 |
0.057 |
Not Significant |
|
Q8 |
2.30 ± 0.60 |
2.77 ± 0.82 |
5.037 |
<0.001 |
Significant |
|
Q9 |
2.87 ± 0.78 |
3.50 ± 0.73 |
5.188 |
<0.001 |
Significant |
|
Q10 |
2.37 ± 0.49 |
2.73 ± 0.52 |
4.097 |
<0.001 |
Significant |
|
Q11 |
2.57 ± 0.68 |
2.87 ± 0.68 |
3.525 |
0.001 |
Significant |
|
Q12 |
2.23 ± 0.43 |
2.80 ± 0.81 |
6.158 |
<0.001 |
Significant |
|
Q13 |
2.40 ± 0.50 |
2.67 ± 0.71 |
2.504 |
0.018 |
Significant |
|
Q14 |
1.87 ± 0.35 |
1.90 ± 0.31 |
0.372 |
0.712 |
Not Significant |
|
Q15 |
1.37 ± 0.49 |
1.60 ± 0.50 |
2.536 |
0.017 |
Significant |
|
Q16 |
1.87 ± 0.35 |
1.93 ± 0.25 |
1.439 |
0.161 |
Not Significant |
|
Q17 |
1.60 ± 0.50 |
1.90 ± 0.31 |
3.525 |
0.001 |
Significant |
After the
eight-week program, the Low-FODMAP group showed considerable improvement in
fourteen out of seventeen symptom categories that were evaluated (Table 1).
Overall gastrointestinal symptom load, gas, bloating, constipation, pain in the
abdomen, constipation, and bowel habits all improved statistically.
Mean
questionnaire scores increased significantly from baseline across most symptom
domains. For example, the mean score for Question 1 increased from 2.37 ± 0.49 at baseline to 2.77 ± 0.68 after intervention (t = 4.397, p <
0.001). Similarly, Question
2
improved from 2.93 ± 0.78 to 3.53 ± 0.63 (t = 5.835, p <
0.001), while Question
3 increased from 2.30 ± 0.47 to 3.00 ± 0.74 (t = 8.226, p < 0.001). Significant improvements
were also observed for Questions 4–6,
8–13, 15, and 17 (all p < 0.05). No statistically significant changes were identified for Questions 7 (p = 0.057),
14 (p = 0.712), or 16 (p = 0.161) (Table 1).
|
Question |
Pre (Mean
± SD) |
Post (Mean ± SD) |
t (29) |
p-value |
Interpretation |
|
Q1 |
2.33 ± 0.55 |
2.43 ± 0.57 |
1.361 |
0.184 |
Not Significant |
|
Q2 |
3.07 ± 0.87 |
2.93 ± 0.91 |
1.682 |
0.103 |
Not Significant |
|
Q3 |
2.37 ± 0.49 |
2.33 ± 0.48 |
0.441 |
0.662 |
Not Significant |
|
Q4 |
2.97 ± 0.81 |
2.63 ± 0.76 |
3.808 |
0.001 |
Significant |
|
Q5 |
2.97 ± 0.89 |
2.90 ± 0.84 |
1.000 |
0.326 |
Not Significant |
|
Q6 |
2.83 ± 0.75 |
2.80 ± 0.71 |
1.000 |
0.326 |
Not Significant |
|
Q7 |
3.17 ± 0.87 |
3.10 ± 0.84 |
1.000 |
0.326 |
Not Significant |
|
Q8 |
2.70 ± 0.84 |
2.77 ± 0.82 |
1.000 |
0.326 |
Not Significant |
|
Q9 |
3.20 ± 0.89 |
2.97 ± 0.85 |
2.536 |
0.017 |
Significant |
|
Q10 |
2.33 ± 0.48 |
2.37 ± 0.49 |
0.441 |
0.662 |
Not Significant |
|
Q11 |
2.50 ± 0.63 |
2.50 ± 0.57 |
0.000 |
1.000 |
Not Significant |
|
Q12 |
2.33 ± 0.48 |
2.30 ± 0.47 |
1.000 |
0.326 |
Not Significant |
|
Q13 |
2.43 ± 0.50 |
2.50 ± 0.51 |
1.000 |
0.326 |
Not Significant |
|
Q14 |
1.77 ± 0.43 |
1.90 ± 0.31 |
1.439 |
0.161 |
Not Significant |
|
Q15 |
1.53 ± 0.51 |
1.57 ± 0.50 |
0.571 |
0.573 |
Not Significant |
|
Q16 |
1.87 ± 0.35 |
1.87 ± 0.35 |
0.000 |
1.000 |
Not Significant |
|
Q17 |
1.53 ± 0.51 |
1.57 ± 0.50 |
0.441 |
0.662 |
Not Significant |
After eight
weeks of monitoring, there were very little changes in the participants whose
diets were standard (Table 2). Only two questions showed statistically
significant alterations (p = 0.001) and none of the other items in the
questionnaire showed significant changes (p > 0.05).
Symptom levels were rather constant across the board, indicating that following
the recommended food plan did not alleviate gastrointestinal issues to a
clinically significant degree.
|
Count |
|||||
|
Target Sample |
Pre post |
Total |
p-value |
||
|
Pre |
Post |
||||
|
LOW FODMAP
diet group |
All/Most the time |
21 |
8 |
29 |
0.001 |
|
Some of the
time |
9 |
14 |
23 |
||
|
Never |
0 |
8 |
8 |
||
|
Total |
30 |
30 |
60 |
||
|
|
|||||
|
control group |
All/Most of the
time |
19 |
20 |
39 |
0.964 |
|
Some of the
time |
11 |
10 |
21 |
||
|
Never |
0 |
0 |
0 |
||
|
Total |
30 |
30 |
60 |
||
|
|
|
|
|
||
According to
Table 3, those who followed the Low-FODMAP diet saw a considerable reduction in
the frequency of bowel urgency. Eight weeks into the study, only eight
individuals (26.7% of the total) reported having bowel urgency "all or
most of the time," a significant drop from the twenty-one persons overall
(70.0%) who had this condition before the intervention. On the flip side,
following the intervention, 26.7% of subjects reported never having had bowel
urgency, up from 0% at baseline.
There was a
statistically significant shift in the distribution of symptoms (χ², p =
0.001). The control group, on the other hand, exhibited no statistically
significant change across that time frame (p = 0.964).
|
Count |
|||||
|
Target Sample |
|||||
|
Target Sample LOW FODMAP
diet group |
Pre post |
Total |
p-value |
||
|
Pre |
Post |
||||
|
LOW FODMAP
diet group control group |
All/Most of the
time |
9 |
0 |
9 |
0.001 |
|
Some of the
time |
11 |
5 |
16 |
||
|
Never |
10 |
25 |
35 |
||
|
Total |
30 |
30 |
60 |
||
|
control group |
All/Most of the
time |
11 |
12 |
23 |
0.860 |
|
Some of the
time |
8 |
9 |
17 |
||
|
Never |
11 |
9 |
20 |
||
|
|
|
|
|
||
The Low-FODMAP
group showed a considerable improvement in stool consistency, as seen in Table
4. Nine people reported having firmer stools "all or most of the
time" before the intervention, but after it, that number dropped to zero.
The number of people who said they'd never had tougher stools rose from 10 to
25 all at once. With a p-value of 0.001, this enhancement was confirmed
statistically. The control group did not show any significant changes (p =
0.860).
|
Count |
|||||
|
Target Sample |
Pre post |
Total |
p-value |
||
|
Pre |
Post |
||||
|
LOW FODMAP
diet group |
All/Most of the
time |
23 |
13 |
36 |
0.006 |
|
Some of the
time |
7 |
10 |
17 |
||
|
Never |
0 |
7 |
7 |
||
|
Total |
30 |
30 |
60 |
||
|
control group |
All/Most of the
time |
20 |
21 |
41 |
1.000 |
|
Some of the
time |
10 |
9 |
19 |
||
|
Never |
0 |
0 |
0 |
||
|
Total |
30 |
30 |
60 |
||
Excessive gas
and flatulence were significantly reduced in participants who were on the
Low-FODMAP diet (Table 5). From 23 to 13, the percentage of individuals
reporting feeling excessive gas "all or most of the time" declined,
whereas the proportion reporting never experiencing excessive gas grew from 0
to 7 people.
These
alterations were noteworthy from a statistical standpoint (p = 0.006).
Individuals who received conventional dietary recommendations did not show any
statistically significant improvement (p = 1.000).
Excellent.
Whether a paper is approved or needs significant change is usually decided in
the Discussion section. Reviewers anticipate that it will provide an analysis
of the results in light of the available data, discuss potential processes,
recognise its own limits, and refrain from exaggerating its results. In light
of your research, I have rewritten the Discussion section to follow the format
of high-quality publications that are indexed by PubMed.
This randomised
controlled research found that persons with Irritable Bowel Syndrome (IBS) had
a significant improvement in gastrointestinal symptoms after following a
low-FODMAP diet for eight weeks. There was a statistically significant
improvement in the majority of symptom categories for participants allocated to
the Low-FODMAP diet. These domains included overall symptom load, bloating,
bowel urgency, stool consistency, abdominal pain, and abdominal discomfort.
Participants who received conventional dietary recommendations, on the other
hand, exhibited little improvements throughout that time. Consistent with
present evidence-based treatment guidelines, these results lend credence to the
Low-FODMAP diet's usefulness as a first dietary intervention for irritable
bowel syndrome.
This study's
results corroborate those of other RCTs and systematic reviews that have looked
at the effectiveness of the low-FODMAP diet for irritable bowel syndrome. In
their study, Halmos et al. found that compared to a normal Australian diet, a
diet low in fermentable carbs considerably lowered total gastrointestinal
discomfort ratings. Structured Low-FODMAP dietary coaching also alleviated
clinically significant bloating, gas, and stomach discomfort (Saudacher et al.,
2015). A small percentage of irritable bowel syndrome (IBS) patients report
significant improvement in their symptoms after implementing a low-FODMAP diet
for a limited time, according to recent meta-analyses and reviews (Altobelli et
al., 2017).
These results are in agreement with our own. Rather than only improving one
symptom of irritable bowel syndrome (IBS), there were significant improvements
in fourteen out of seventeen symptom areas. Dietary intervention, rather than
natural variations in disease activity, is likely responsible for the observed
benefits, as the control group did not see any significant alterations.
We now know
enough about the biology of irritable bowel syndrome to conclude that the
Low-FODMAP diet has positive benefits. The luminal water level is increased by
fermentable carbohydrates due to their osmotic effects and poor small intestine
absorption. The microbes in your colon will then ferment them, turning them
into gas and carbon dioxide. Intestinal distention, stomach discomfort, gas,
and changed defecation patterns are symptoms of visceral hypersensitivity.
Decreased gas
generation and luminal distension are effects of limiting dietary FODMAPs,
which decrease the availability of fermentable substrates. Through regulation
of the gut-brain axis, decreased intestinal distension may reduce symptom
perception by activating visceral afferent pathways to a lesser extent. These
suggested physiological processes are in agreement with the current study's
findings of improved bowel regularity and stool consistency.
There is
mounting evidence that changes in food consumption may affect intestinal
permeability, the activation of the mucosal immune system, and the metabolic
activity of microbes. While the current research did not assess microbiome
makeup, changes in bacterial fermentation patterns might have had a role in the
reported improvements in clinical outcomes.
Implications
for the treatment of irritable bowel syndrome (IBS) are substantial based on
the results. Many pharmacological treatments have side effects or poor
long-term adherence in addition to providing only partial symptom alleviation.
A non-pharmacological strategy that may lessen the need for long-term medicine
is dietary change, which addresses symptom-provoking food components directly. Improvements
in constipation, loose stools, and gas are noteworthy since these symptoms
greatly hinder everyday functioning, social engagement, and overall well-being.
It seems that the best way to maximise adherence and get the best treatment
effects is to have experienced dietitians provide structured nutritional
guidance. Based on these results, the Low-FODMAP diet is recommended as an
evidence-based dietary therapy for some individuals with irritable bowel
syndrome according to the current worldwide recommendations.
The majority of
the randomised controlled studies that have looked at the Low-FODMAP diet have
been done in North America, Europe, and Australia. There is a lack of evidence
from South Asian groups, even though their diets vary significantly in terms of
both pattern and content. Wheat, lentils, garlic, onions, and other naturally
fermentable carbohydrate-rich foods are staples in Indian cuisine. It follows
that the current research adds to the growing body of data on the efficacy of a
systematic Low-FODMAP dietary intervention in the Indian setting.
The development of verified Indian Low-FODMAP food composition resources and
the evaluation of region-specific dietary adjustments are two areas that might
benefit from further research.
A number of
merits exist in the current investigation. It used a randomised controlled
design first, which makes causal inference stronger and reduces selection bias.
In addition, a universally recognised and standardised diagnosis of irritable
bowel syndrome (IBS) was achieved by diagnosing individuals using the Rome IV
criteria. Third, participants were more likely to stick to the program after
receiving personalised dietary coaching and frequent follow-up. Last but not
least, measuring symptoms both before and after the intervention allowed for
the examination of changes that were clinically significant over time.A number
of merits exist in the current investigation. It used a randomised controlled
design first, which makes causal inference stronger and reduces selection bias.
In addition, a universally recognised and standardised diagnosis of irritable
bowel syndrome (IBS) was achieved by diagnosing individuals using the Rome IV
criteria. Third, participants were more likely to stick to the program after receiving
personalised dietary coaching and frequent follow-up. Last but not least,
measuring symptoms both before and after the intervention allowed for the
examination of changes that were clinically significant over time.
It is important
to note that there are certain restrictions. Because the research only used
data from one location and had a small sample size, its results may not be
applicable to a broader population. Because the intervention only lasted for
eight weeks, we don't know how long the relief from symptoms will last. There
was a chance of recollection or reporting bias as dietary adherence was mostly
evaluated by self-report. Nutritional status, inflammatory biomarkers, gut
microbiota composition, and objective assessments of food consumption were also
not assessed. To validate and expand upon these results, future randomised
controlled studies involving several centers would need to include more
samples, longer follow-up times, and include microbiome analysis.
Clinical
practice recommends a staged approach to Low-FODMAP dietary management, which
should include both reintroduction and personalisation, and future research
should assess its efficacy over the long term. To further understand the best
way to treat irritable bowel syndrome (IBS), researchers should compare
low-FODMAP diets to Mediterranean diets, fiber-based therapy, probiotic
supplements, or psychological therapies. Additional evidence might be provided
by include quality-of-life instruments, cost-effectiveness studies, healthcare
utilisation, and patient-reported outcome measures.
1.
Altobelli, E., Del Negro,
V., Angeletti, P. M., Latella,
G., & Giuliani,
A. R. (2017). Low-FODMAP
diet improves irritable bowel syndrome symptoms: A meta-analysis. Nutrients,
9(9), 940.
2.
Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., Ford, A. C., & Sperber, A. D. (2021). Functional
gastrointestinal disorders: Advances in understanding and management. Lancet
Gastroenterology & Hepatology, 6(10), 866–880.
3.
Böhn, L., Störsrud, S.,
Liljebo, T., Collin, L., Lindfors, P., & Simre´n, M. (2015). Diet low in
FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional
dietary advice: A randomized controlled trial. Gastroenterology, 149(6),
1399–1407.
4.
Canavan, C., West, J., & Card, T.
(2014). The epidemiology of irritable bowel syndrome. Clinical Epidemiology, 6,
71–80.
5.
Ford, A. C., Lacy, B. E., & Talley, N. J. (2020). Irritable bowel syndrome. New England Journal
of Medicine, 382(10), 965–975.
6.
Gibson, P. R., & Shepherd, S. J.
(2010). Evidence-based dietary management of functional gastrointestinal
symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology,
25(2), 252–258.
7.
Halmos, E. P., Power, V. A., Shepherd, S.
J., Gibson, P. R., & Muir, J. G.
(2014). A diet low in FODMAPs reduces symptoms of irritable bowel
syndrome. Gastroenterology, 146(1), 67–75.
8.
Halmos,
E. P., Christophersen, C. T., Bird, A. R., Shepherd, S. J., Gibson,
P. R., & Muir,
J. G. (2015). Diets that differ in
their FODMAP content alter the colonic luminal microenvironment. Gut, 64(1),
93–100.
9.
Mayer, E. A., Labus, J. S., Tillisch, K., Cole, S. W., & Baldi, P. (2021). Towards a systems view
of IBS. Nature Reviews Gastroenterology & Hepatology, 18(7), 451–463.
10.
Muir, J. G., & Gibson, P. R. (2019).
The low FODMAP diet for treatment of irritable bowel syndrome and
other gastrointestinal disorders. Gastroenterology & Hepatology, 15(5),
281–288.
11.
Snoek, H. M., Jansen, A., & van den Hout, M. A. (2018). The influence of food intake on mood and psychological
well-being. Appetite, 128, 72–79.
12.
Staudacher, H. M., Whelan, K., Irving, P.
M., & Lomer, M. C. (2012). Comparison of symptom response following advice
for a diet low in FODMAPs versus standard dietary advice in patients with IBS.
Journal of Human Nutrition and Dietetics, 25(5), 450–458.
13.
Staudacher, H. M., Lomer, M. C. E., Anderson, J. L., Barrett,
J. S., Muir, J. G., Irving, P. M., & Whelan, K. (2017). Mechanisms
and efficacy of dietary FODMAP restriction in IBS. Nature Reviews
Gastroenterology & Hepatology, 14(1), 36–47.
14.
Tuck, C. J., Biesiekierski, J. R.,
Schmid-Grendelmeier, P., & Pohl, D. (2018). Food intolerances. Nutrients,
10(10), 1409.