REVIEW Low-FODMAP Diet for Irritable Bowel Syndrome: Is It Ready for Prime Time? Muhammad Ali Khan • Salman Nusrat • Muhammad Imran Khan • Ali Nawras • Klaus Bielefeldt Received: 20 August 2014 / Accepted: 11 November 2014 Ó Springer Science+Business Media New York 2014 Abstract Irritable bowel syndrome (IBS) is a chronic gastrointestinal disease, which adversely affects the quality of life. Its prevalence has been reported to be around 10–15 % in North America and constitutes the most common cause for gastroenterology referral. Unfortu- nately, the pathophysiology of IBS is not completely understood. Not surprisingly, the management strategies can leave the patients with inadequate symptom control, making IBS a debilitating gastrointestinal syndrome. Die- tary interventions as a treatment strategy for IBS have been recently evaluated. One such intervention includes dietary restriction of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs). FODMAPs define a group of short-chain carbohydrates that are incompletely absorbed in small intestine and later fermented in the colon. Evi- dence in the form of randomized controlled trials and observational studies have evaluated the mechanism of action and efficacy of low-FODMAP diet. This dietary intervention has showed promising results in symptom reduction in IBS patients. However, latest trials have also shown that the low-FODMAP diet is associated with marked changes in gut microbiota specifically reduction in microbiota with prebiotic properties. Implications of such changes on gastrointestinal health need to be further eval- uated in future trials. Keywords IBS Á FODMAP Á Irritable bowel syndrome Á Fermentable carbohydrates Introduction Irritable bowel syndrome (IBS) is a common condition characterized by chronic gastrointestinal symptoms like abdominal discomfort or pain and altered bowel habits, with many patients also complaining about bloating and abdominal distention in the absence of any organic cause [1]. Population-based studies have estimated the preva- lence of IBS symptoms to be as high as 10–15 % in North America [2–6]. Women are affected twice as common as men, mostly with a lower socioeconomic status and age \ 50 years [3, 7]. Despite the benign nature of this functional illness, IBS patients have remarkably decreased quality of life. They have lower work productivity, higher rates of absenteeism, and may even experience social isolation or even stigma- tization [8, 9]. IBS is the second most common cause of work absenteeism after common cold [10]. Although only about 15 % of patients seek medical attention [11, 12], IBS is responsible for a very large number of primary care visits and is the most common cause of gastroenterology referrals [13]. This translates into an exponential burden on health care: The annual costs (both direct and indirect) for man- aging IBS patients is estimated to be between $15 and 30 billion [14, 15]. Muhammad Ali Khan and Salman Nusrat have contributed equally to the work. M. A. Khan Á M. I. Khan Á A. Nawras Department of Gastroenterology, University of Toledo, Toledo, OH, USA S. Nusrat (&) Department of Gastroenterology, University of Oklahoma Health Sciences Center, Room WP 1345, 920 SL Young Blvd., Oklahoma City, OK 73104, USA e-mail: salman-nusrat@ouhsc.edu K. Bielefeldt Department of Gastroenterology, University of Pittsburgh, Pittsburgh, PA, USA 123 Dig Dis Sci DOI 10.1007/s10620-014-3436-4