Disorders of gut-brain interaction (CID), formerly known as functional gastrointestinal disorders, affect approximately 40% of the world’s population. Among the gastrointestinal symptoms of patients with these disorders, abdominal bloating is one of the most frequent, which affects 3.5% of the general population and 23% of those referred to a general gastroenterology clinic. Thus, the quality of the food consumed plays an important role in the pathophysiology of these disorders, which brings to light studies that address strategies that enable the improvement of this condition.
Abdominal Bloating and Disorders of Gut-Brain Interaction
Functional abdominal bloating/distention (PID) refers to a recurrent bloating – a feeling of abdominal fullness – and/or distension – a measurable increase in waist circumference. Its pathogenesis is complicated, multifactorial, not fully understood and may be associated with possible factors such as altered microbiota, abnormal gastrointestinal motility, abdominogenic dyssynergy, pelvic floor dysfunction, and visceral hypersensitivity. It is worth noting that in patients with irritable bowel syndrome (IBS), a type of IBD, around 96% of them report bloating and abdominal distention, with these symptoms often coexisting. Understand more about diets and IBS with Vitória Corrêa on Science Play Youtube
Overall, one possible approach to treating patients with abdominal bloating/distention concerns the elimination of gas-producing foods such as onions, plums, and broccoli; and foods that stimulate gastrointestinal symptoms, as well as the adoption of healthy eating habits, that is, regular meals, alcohol restriction and spicy foods eliminate from the diet. Furthermore the literature cites the low-FODMAP diet as a possible dietary strategy for the treatment of functional abdominal bloating/distention.
Low-FODMAP and IDAF Diet
The low-FODMAP diet is a low-fermentation diet of oligosaccharides, disaccharides, monosaccharides and polyols. Its role in the pathogenesis of functional gastrointestinal symptoms has been studied mainly in patients with irritable bowel syndrome. Given this, the literature highlights a significant symptomatic and pathogenetic overlap between functional abdominal bloating/distension and irritable bowel syndrome, so it is possible that the same pathophysiological mechanisms are involved in both disorders.
In this context, due to the relationship between FODMAPs and IBS, it is likely that there is also a relationship between FODMAPs consumption and functional abdominal bloating/distention. Thus, a diet rich in FODMAP is associated with an increase in intraluminal water, aberrant intestinal motility, dysbiosis and visceral hypersensitivity, thus the Low-FODMAP diet may be a recommended strategy in certain cases of STAI.
Phases of the Low-FODMAP Diet
In a period of 2 to 8 weeks one has a restriction of the intake of foods rich in FODMAPs, these are replaced by suitable foods low in FODMAPs from the same food group. In this period, when the absence of clinical benefit is noted, an attempt with an alternative treatment is advisable.
Subsequently, there is the gradual reintroduction of FODMAP-rich foodss, taking into account the nutritional needs and preferences of the patient. This phase is performed every 2 to 3 days in order to allow the identification of specific food triggers and the reintroduction of tolerated foods into the diet.
Finally, a maintenance diet is defined personalized taking into account the foods that are triggers for severe symptoms. Thus reintroducing those foods that are rich in FODMAPs, but that are well tolerated.
Clinical practice
The study described here highlights that adherence to the second and third phases may be unsatisfactory in the absence of support from a nutritionist. In addition, before prescribing a thorough nutritional evaluation is necessary, as restrictive diets should be avoided in patients at risk of malnutrition. Furthermore, indirect evidence on the potential efficacy of low-FODMAP diet in functional bloating/bloating is provided by reducing bloating in IBS patients.
Bibliographic references
Suggested reading:
FODMAP in irritable bowel syndrome
Watch the video on Science Play with Márcio André:
Low FODMAP Diet
IDAF article and low-FODMAP diet
: Pessarelli T, Sorge A, Elli L, Costantino A. The low-FODMAP diet and the gluten-free diet in the management of functional abdominal bloating and distension. Frontiers in Nutrition. 2022;9. doi:https://doi.org/10.3389/fnut.2022.1007716
