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Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms

Gibson, Peter R MD1; Shepherd, Susan J PhD1

American Journal of Gastroenterology: May 2012 - Volume 107 - Issue 5 - p 657–666
doi: 10.1038/ajg.2012.49
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Recognition of food components that induce functional gut symptoms in patient's functional bowel disorders (FBD) has been challenging. Food directly or indirectly provides considerable afferent input into the enteric nervous system. There is an altered relationship between the afferent input and perception/efferent response in FBD. Defining the nature of food-related stimuli may provide a means of minimizing such an input and gut symptoms. Using this premise, reducing the intake of FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols)—poorly absorbed short-chain carbohydrates that, by virtue of their small molecular size and rapid fermentability, will distend the intestinal lumen with liquid and gas—improves symptoms in the majority of patients. Well-developed methodologies to deliver the diet via dietician-led education are available. Another abundant source of afferent input is natural and added food chemicals (such as salicylates, amines, and glutamates). Studies are needed to assess the efficacy of the low food chemical dietary approach. A recent placebo-controlled trial of FODMAP-poor gluten provided the first valid evidence that non-celiac gluten intolerance might actually exist, but its prevalence and underlying mechanisms require elucidation. Food choice via the low FODMAP and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for functional gut symptoms.

1 Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia

Correspondence: Peter R. Gibson, MD, Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, 55 Commercial Road, Victoria 3004, Australia. E-mail: peter.gibson@monash.edu

Received 12 November 2011; accepted 13 February 2012

published online 10 April 2012

© The American College of Gastroenterology 2012. All Rights Reserved.
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