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Literature Review

Title of Paper Citation Summary of Paper Strengths Weaknesses


Low FODMAPs diets are often used to manage GI symptoms in patients with
IBS despite much evidence to its efficacy (at the time of study). 30 patients
Halmos, Emma P., Victoria A. Power, Susan J. Shepherd, Peter R. with IBS were placed on a low FODMAP diet or regular Austrailan Diet. Food Food was provided during interventional diet period Small study - only 30 participants. Was not
A Diet Low in Roadmaps Reduces
Gibson, and Jane G. Muir. A Diet Low in FODMAPs Reduces was provided and stool samples were collected throughout the study. to maintin control on food consumption. All stools double-blinded. Australian diet not Western Diet
Symptoms of Irritable Bowel
Symptoms of Irritable BowelSyndrome. Gastroenterology 146, Individuals who consumed the low FORMAL diet reported a reduction in were collected from days 17-21 - the study period so the effectivness of this study on a global
Syndrome
no. 1 (January 2014): 6775.e5. doi:10.1053/j.gastro.2013.09.046. functional GI symptoms and the authors claim the "high quality evidence" to measure stool content. scene is questioned.
demonstrated in the study supports the theory that a diet low in FODMAPs is
suitable for a first-line defense therapy.
Whig ham, L., T. Joyce, G. Harper, P. M. Irving, H. M. Staudacher, K.
Clinical effectiveness and economic
Whelan, and M. C. E. Lomer. Clinical Effectiveness and Economic
costs of group versus one-to-one
Costs of Group versus One-to-One Education for Short-Chain The paper suggests that agroup lead Registered Dietitian education is Demonstrates the Clinical Effectiveness of FODMAP
education for short-chain fermentable Cost analyses were based on a lot of
Fermentable Carbohydrate Restriction (low FODMAP Diet) in the effective in a clinical setting and the costs associated with this method of Diet delivered in a group setting by an RD
carbohydrate restriction (low FORMAL assumptions.
Management of Irritable Bowel Syndrome. Journal of Human deliverty may represent a solid method for routine clinical care. compared to individual consultation parameters.
diet) in the management of irritable
Nutrition and Dietetics 28, no. 6 (December 1, 2015): 68796.
bowel syndrome
doi:10.1111/jhn.12318.

The four statements regarding satisfaction of


the low FODMAP diet were a little presuming. For
Comparison of symptom response Staudacher, H. M., K. Whelan, P. M. Irving, and M. C. E. Lomer. This paper compares the FODMAD effectiveness against the UK National The study summarizes standard treatments example: "I found the diet easy to follow" is a
following advice for a diet low in Comparison of Symptom Response Following Advice for a Diet Institute of Health and Clinical Excellence (NICE) guidelines. The article protocols in the UK. This study looks at leading question. Also, ethical bias' were not
fermentable carbohydrates Low in Fermentable Carbohydrates (FODMAPs) versus Standard concludes that a Low FODMAP diet appears to be more affective than effectiveness of low FODMAP diet on IBS symptoms taken into consideration. In addition, the low
(FODMAPs) versus standard dietary Dietary Advice in Patients with Irritable Bowel Syndrome. Journal standard dietary approaches (UK) for symptom control in IBS. The study OUTSIDE of Australia, which until this point (when number of responses to the survey may have
advice in patients with irritable bowel of Human Nutrition and Dietetics 24, no. 5 (October 1, 2011): 487 showed that the low FODMAP diet participants reported more satisfaction in the study was released) the data was only collected skewed the significance of the data. Anothe
syndrome 95. doi:10.1111/j.1365-277X.2011.01162.x. their symptom response (76%) compared to standard group (46%). from Austrailian designed studies. weakness was that patients were seen by
different dietitians throught the study so there
may have been inconsistenceis in reporting.

Federal, Amy, and Satish S. C. Rao. Dietary Fructose Intolerance, The study focuses on dietary fructose and fructant intolerances which have Good stats on prevalence of IBS (5-30% of the
Dietary Fructose Intolerance, Fructan Fructan Intolerance and FODMAPs. Current Gastroenterology been poorly recognized to give clarification on what they actually are i.e. world's population). Good Table to show High More studies need to be done to understand the
Intolerance and FODMAPs Reports 16, no. 1 (December 20, 2013): 18. doi:10.1007/s11894- Fructose is a 6 -carbon monosaccharide moleculeand how fructose is fructose foods and alternatives. FODMAP was long term dietary effects of FODMAP diet
013-0370-0. absorbed (or not) in humans.= developed in 2001 (history of diet)
Murray, Kathryn, Victoria Wilkinson-Smith, Caroline Hoad, Carolyn The study aimed at understanding IBS symptoms using magnetic resonance
Costigan, Eleanor Cox, Ching Lam, Luca Marciani, Penny Gowland, imaging of the Gut. The study found that fructose increased under the AUC This study explains why carbs longer than 10 chain
Differential Effects of FODMAPs
and Robin C. Spiller. Differential Effects of FODMAPs (Fermentable cure significantly more than glucose. The authors of the study wanted to lengths are called inulins, which is the focus of the
(Fermentable Oligo-, Di-, Mono-
Oligo-, Di-, Mono-Saccharides and Polyols) on Small and Large investigate HOW fructose and inulin influence small and large bowel volumes study. A very scientific study examing why Single blind. Small Study. MRI technique used to
Saccharides and Polyols) on Small and
Intestinal Contents in Healthy Subjects Shown by MRI. The to understand HOW diets high in FODMAPS cause IBS symptoms. The FODMADS cause IBS symptoms. Great paper for measure colonic gas has not been validated.
Large Intestinal Contents in Healthy
American Journal of Gastroenterology 109, no. 1 (January 2014): authors conclude that fructose, being more somotically active and poorly understanding the mechanisms behind FODMAP
Subjects Shown by MRI
11019. doi:10.1038/ajg.2013.386. absorbed, substantially increases small bowl water by nearly double metabolism.
compared with well absorbed glucose.
Whelan, K. Editorial: Fibre and FODMAPs in Constipation and
Editorial: fibre and FODMAPs in This article was actually an invited editorial discussing the effectivmness of
Irritable Bowel Syndrome. Alimentary Pharmacology & Very "rigouous detail and critical summary of the Systematic review may be limited by the studies
constipation and irritable bowel the article "Fibre and FODMAPs in constipation and irritable bowel syndrome.
Therapeutics 42, no. 3 (August 1, 2015): 38384. included studies" examined.
syndrome The authors point out the stenghts and weaknesses of the study.
doi:10.1111/apt.13279.
Great background on the evolution of thought on
how to best treat IBS. It discusses diets high in
This article discusses the background of IBS treatments and the evolution of
Extending Our Knowledge of Barrett, Jacqueline S. Extending Our Knowledge of Fermentable, fiber, elimination diets, and how the FODMAP came
the FODMAP diet concept, which includes new and emerging FODMAP No new data presented. Just summarizing and
Fermentable, Short-Chain Short-Chain Carbohydrates for Managing Gastrointestinal to be. The paper lists some foods high in FODMAP
cocepts. The paper also lists limitations of the diet, effect on gut microflora, offering suggestion for implementation based on
Carbohydrates for Managing Symptoms. Nutrition in Clinical Practice 28, no. 3 (June 1, 2013): and safe alternatives to those foods. The article
and how an RD would deliver FODMAP Treatment (i.e. Nutrition in Clinical previous studies.
Gastrointestinal Symptoms 300306. doi:10.1177/0884533613485790. explains the mechanism of action for digestion of
practice).
FODMAPs which is helpful in understanding FODMAP
metabolism.
This paper summarizes the evidence and application of the most common
Fermentable oligosaccharides, Barrett, Jacqueline S., and Peter R. Gibson. Fermentable The paper offers great background information on
approaches to managing food intolerance in IBS: the low-FODMAP diet, the
disaccharides, monosaccharides and Oligosaccharides, Disaccharides, Monosaccharides and Polyols the FODMAP diet. It also discusses the reasons why Not a lot of new information presented. Again a
elimination diet for food chemical sensitivity and others including possible
polyols (FODMAPs) and nonallergic (FODMAPs) and Nonallergic Food Intolerance: FODMAPs or Food breath testing is used as well as gives an background summary and historical anectode to
noncoeliac gluten intolerance. The authors of the study confirm that low-
food intolerance: FODMAPs or food Chemicals? Therapeutic Advances in Gastroenterology 5, no. 4 explanation to why breath testing is an effective the development of FODMAP diet.
FODMAP diets should be the first dietary mainipulation tried in patients
chemicals? (July 2012): 26168. doi:10.1177/1756283X11436241. proceudre for identifing absorbtion of FODMAPs.
presenting with IBS symoptoms.
Hungin, A. P. S., A. Becher, B. Cayley, J. J. Heidelbaugh, J. W. M. The paper provides an Explanitory Model for the
Irritable bowel syndrome: an Muris, G. Rubin, B. Seifert, A. Russell, and N. J. De Wit. Irritable The article helps the reader develop an understanding of IBS and pragmatic treatment of IBS and discusses why these models are
Bowel Syndrome: An Integrated Explanatory Model for Clinical needed for the treatment of conditions, like IBS. The No discussion of FODMAPs or any other
integrated explanatory model for uses for treating it in the clinical setting. This paper does not discuss low-
Practice. Neurogastroenterology & Motility 27, no. 6 (June 1, paper includes great suggestions for effective lannguage treatment protocol.
clinical practice FODMAPdiet per se, but helped me better understand IBS in general. for communicating with patietns about their IBS
2015): 75063. doi:10.1111/nmo.12524.
condition.

I found this paper Interesting because it was the


studyy I found that indicated the low-FODMAP diet Very short summary of previous FODMAP studies
The authors of this study conclude that the low-FODMAP might improve
may not improve IBS symptoms, and the author's limiting factors. The paper did not not give much
symptoms for those with primarily diarrhea-subtype IBS. However, the
Hackett, Cian, and Michael R. Kolber. Low FODMAP Diet. claimed the studies that suggesed improvemnts of context to why they were disputing the
Low FODMAP diet authors aruge that most of the studies conducted up until this point were of
Canadian Family Physician 61, no. 8 (August 1, 2015): 691691. IBS symptoms on a low FOMAP diet were of low relevance of the studies. Instead, the gave just
low quality, and they artuge that high-quality studies are needed in order to
quality. The paper gives, a quick summary of the a few bullet point for why each study they
determine the effectivness and indication of a low-FODMAP diet.
potential pitfalls to pevious studies. It was easy to exampined was low in quality.
read and right to the point.

Khan, Muhammad Ali, Salman Nusrat, Muhammad Imran Khan, Ali


This study suggests that while a low-FODMAP diet reduces IBS symtpoms , The study is a thourough meta-analysis that
Nawras, and Klaus Bielefeldt. Low-FODMAP Diet for Irritable Bowel
Low-FODMAP Diet for Irritable Bowel the diet is also associated with marked changes in gut microbiata. The suggests the low-FODMAP diet is in fact ready for
Syndrome: Is It Ready for Prime Time? Digestive Diseases and Again, no new data presented.
Syndrome: Is It Ready for Prime Time? authors conclude that futher evaluative trials needs to be investiaged to "Prime Time". Clever and catchy article name with
Sciences 60, no. 5 (November 20, 2014): 116977.
asess the long term effects. solid analysis of the data examined.
doi:10.1007/s10620-014-3436-4.
This paper gives an excellent explanaition of why
breath testing is used in diagnosis (cheaper / less
This paper gave an excellent review of the pathophysiology of IBS and the invasive). There is also an excellentchart descriing
role of FODMAPs for the treatment of this condition. The study also provides foods high in FODMAPs and suitable alternatives.
Magge, Suma, and Anthony Lembo. Low-FODMAP Diet for
Low-FODMAP Diet for Treatment of great data on the cost of IBS to the healthcare system, and a description of The authors bring up good point regarding the
Treatment of Irritable Bowel Syndrome. Gastroenterology & No new data presented.
Irritable Bowel Syndrome how small intestinal bacerial overgrowth relates to IBS in patients. The autors limitations of a low-FODMAP treatment protocol
Hepatology 8, no. 11 (November 2012): 73945.
provide suggestions for the debuking of food alergies via (ig) E mediated including the fact that foods panels do not list their
type 1 hypersenitivity (only 1-2% of the population). FODMAP content and is confusing to the lay client.
The cut offs for FODMAPs (what is/isn't low?) are
also not clearly defined.

Yoon, So Ra, Jong Hwa Lee, Jae Hyang Lee, Ga Yoon Na, Kyun-Hee
Low-FODMAP formula improves This study was a randomized, clinical trial where
Lee, Yoon-Bok Lee, Gu-Hun Jung, and Oh Yoen Kim. Low-FODMAP This study was very detailed and clinically sound,
diarrhea and nutritional status in This study investigated the effect of FODMAP content in enternal nutrition patietns received one of three fomulas. The
Formula Improves Diarrhea and Nutritional Status in Hospitalized and it was the only paper that focused on low-
hospitalized patients receiving enteral formulas used to treat gastrointestinal intolerance and nutritional status in results would have been stronger had each
Patients Receiving Enteral Nutrition: A Randomized, Multicenter, FODMAP options in a clinicl setting where EN is
nutrition: a randomized, multicenter, hospitalized patients receiving enternal nutritiaion. . subject consumed all three EN formalus in a
Double-Blind Clinical Trial. Nutrition Journal 14, no. 1 (December being used.
double-blind clinical trial crossover design.
2015). doi:10.1186/s12937-015-0106-0.

Ong, Derrick K, Shaylyn B Mitchell, Jacqueline S Barrett, Sue J


Shepherd, Peter M Irving, Jessica R Biesiekierski, Stuart Smith,
Manipulation of dietary short chain This study compared breath hydrogen and methane volumes based on
Peter R Gibson, and Jane G Muir. Manipulation of Dietary Short This study was a strong design as it used crossover
carbohydrates alters the pattern of FODMAP diet content. The authors concluded that high volume FODMAP
Chain Carbohydrates Alters the Pattern of Gas Production and study methodology using both healthy volunteers Small study that lasted only 2 days.
gas production and genesis of sujects had highter breath hydrogen, and that breath methane was not
Genesis of Symptoms in Irritable Bowel Syndrome. Journal of and volunteers diagnosed with IBS.
symptoms in irritable bowel syndrome produced by the patients with IBS.
Gastroenterology & Hepatology 25, no. 8 (August 2010): 136673.
doi:10.1111/j.1440-1746.2010.06370.x.
Biesiekierski, J. R., O. Rosella, R. Rose, K. Liels, J. S. Barrett, S. J.
Quantification of fructans, galacto- Shepherd, P. R. Gibson, and J. G. Muir. Quantification of Fructans,
Food samples were only done in Australia, and
oligosacharides and other short-chain Galacto-Oligosacharides and Other Short-Chain Carbohydrates in The study aimed to quantify the major FODMAPs present in processed grain, Study used high performance liquid
food products from other countries may differ
carbohydrates in processed grains Processed Grains and Cereals. Journal of Human Nutrition and cereal, bisquets, breads and pulse products that are commomly consumed. chromatography and light scattor techniques.
and could potentially yield diferent results.
and cereals Dietetics 24, no. 2 (April 1, 2011): 15476. doi:10.1111/j.1365-
277X.2010.01139.x.
Shepherd, Susan J., Miranda C. E. Lomer, and Peter R. Gibson. There is a good table classifing the major
This is a review paper, not an analysis of the current data available on low No new data presented. Conflict of interest as
Short-Chain Carbohydrates and Short-Chain Carbohydrates and Functional Gastrointestinal carbohydrates in the diet on a molecular level
FODMAP diets. The study explains the mechanisms of action for each type of author ownes the trademark "FODMAP"and
Functional Gastrointestinal Disorders Disorders. The American Journal of Gastroenterology 108, no. 5 (alpha vs. beta bonds). The authors explains the
short chain carbohydrate. FODMAP Food Company.
(May 2013): 70717. doi:10.1038/ajg.2013.96. mechanims of absorbtion of each carbohydrate
The author's introduced the idea of "how much is
Mansueto, Pasquale, Aurelio Seidita, Alberto DAlcamo, and The study's aim was to summarize the current evidence from the most
too much" in a low-FODMAP a diet. There is a great
Role of FODMAPs in Patients With Antonio Carroccio. Role of FODMAPs in Patients With Irritable commom approaches to manage suspected food intoleracne with IBS with a
tablet that summarizes each of the study's No new data presented.
Irritable Bowel Syndrome Bowel Syndrome. Nutrition in Clinical Practice 30, no. 5 (October main focus on the role of FODMAPs and the effect of a low FODMAP diet. The
examined. This paper will be a good resouce for
1, 2015): 66582. doi:10.1177/0884533615569886. study found efficacy for a low FODMAP diet as a viable treatment option.
finding any addiitonal study data for my paper.
Very detailed information regarding the 2-step
process for the "Elimination Phase" and
The study gives a great overview of the different types of sugars from
"Reintroduction/Challenge Phase" of the low-
glucose to disaccharides, mono-saccharides, oligosaccharides and
FODMAP diet. The paper also offers a case study Again, no new data was presented in this paper.
The Low-FODMAP Diet: An Approach Riggs, Stacey. The Low-FODMAP Diet: An Approach for Controlling polysaccharides etc. to explain the potential mechanisms of malabsorbption
that follows a 28 year old female who has been There was bias as it was written by an RD who
for Controlling Irritable Bowel Irritable Bowel Syndrome. Topics in Clinical Nutrition 29, no. 4 among those affected with IBS. The paper offers suggerstions for how to
diagnosed with IBS-D and discusses the susessful argues the importance of an RD assisting
Syndrome (2014): 30412. doi:10.1097/TIN.0000000000000015. properly implement the low-FODMAP diet in a 2-step process, and offeres
implentation of a low-FODMAP diet and re- patiens with the low-FODMAP diet.
reasoning behind why RDs play a pivitoal role in the sucessful implemention
intorduction of FODMAPs t "trigger foods" which
and management of the low-FODMAP diet.
include: garlic, onions, bread, pasta, watermelon,
and sugar-free chewing gum.

This article is not a research paper, but rather an


article explining the FODMAP components. Of all the
studies I have seen, this paper puts the FODMAP
The study breaks down the components and theories behind the low
components into laymans terms which will be There is clear bias in this article as it was written
FODMAP diet. The study discusses the diet background, description of each
helpful when I am writing my summary paper and by an RD and she questions the efficacy of the
Marcason, Wendy. What Is the FODMAP Diet? Journal of the type of short chain carbohydrate. The paper also discusses some of the
explaining what the FODMAP diet is in my research education of low-FODMAP diets since training
What is the FODMAP Diet? Academy of Nutrition and Dietetics 112, no. 10 (October 2012): concers related to the efficacy of the FODMAP diet including: recomendations
paper. Also, the paper gives detailed information on was not provided by RDs in the majority of
1696. doi:10.1016/j.jand.2012.08.005. are based only on clinical observation, eduction so far has not been
what the current recomendations are from the studies conducted at the time when this paper
completed by an RD, and there have not been long-term studies examining
American iIetetic Association for the treatment of was published.
the long term effects of the study.
IBS which will be a good resource for discussiing
different therapies and how the FODMAP differs
from convenioal thearpaies.

This paper looks at a multitude of IBS disease states


Unclear how the authors produced the data
including chromes, malapsorption, lactose
Gilkin Jr, Robert J. The Spectrum of Irritable Bowel Syndrome: A regarding the healthcare cost impacts as the
The spectrum of irritable bowel This study provides an overview of the IBS disease states and discusses intolerance, endocrine tumors, and the various
Clinical Review. Clinical Therapeutics 27, no. 11 (November study reffers to an outside webstie/resource not
syndrome: A clinical review various treatment options. treatment methods and how those treatments
2005): 16961709. doi:10.1016/j.clinthera.2005.11.012. discussed in the the study or included as an
impact the heath care system and the society. This
appendix.
was one of the more unique studies I reviewd.

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