Our FODZYME clinician team attended Digestive Disease Week 2026, one of the biggest conferences in gastroenterology (GI). This article covers some of my biggest takeaways. As a dietitian, I was excited to see how digestive enzymes like FODZYME align with many of the practical takeaways surrounding nutrition and GI conditions. You'll see some of my specific connections between FODZYME and the research throughout the blog.
Low FODMAP vs. Traditional Dietary Advice (TDA) - Presentation 210
A head-to-head comparison of the low FODMAP diet against Traditional Dietary Advice (TDA) was presented in IBS and functional dyspepsia patients. The primary outcome showed a combined response rate of 61.1% for low FODMAP versus 26.4% for TDA, suggesting meaningful superiority of the low FODMAP approach in this population.
A broader evidence synthesis on dietary interventions for IBS was presented, with the low FODMAP diet still emerging as the most effective dietary strategy overall.
FODZYME is a digestive enzyme blend for the FODMAPs lactose, GOS, and fructan. We know FODMAP reduction can make a difference. We also believe it can be better for many patients to offer a break down of the FODMAPs without the restriction.
Fiber Supplementation: Psyllium and PHGG (PMID 39521003)
When it comes to fiber supplementation in IBS, psyllium remains a first-line option. The mechanism was reviewed: psyllium is a gel-forming soluble fiber (polysaccharide) that moderates transit, stool consistency, and fermentation dynamics. Its evidence base, tolerability profile, and accessibility make it a well-supported starting point. Partially hydrolyzed guar gum (PHGG) follows as a next consideration, and may be more highly recommended specifically for constipation-predominant presentations.
Understanding Fermentation: The Gut-Brain Axis and Food in IBS (Reference: PMID 3550686)
A dedicated talk explored how microbial fermentation sits at the heart of IBS symptomatology. Key context provided:
A low FODMAP diet often decreases fibers that feed SCFA-producing microbes. FODZYME helps break down FODMAPs to reduce the symptoms associated with FODMAP intake, while still preserving some of the SCFA-producing capability of those fibers. Which means FODZYME may help support more points of these IBS connections than long term FODMAP restriction.
Low FODMAP Diet in Inflammatory Bowel Disease (IBD) (Chey & Hashash, Gastroenterology 2022; Hashash, Gastroenterology 2024)
An important distinction was drawn between the use of low FODMAP in IBS versus IBD. While the diet has strong evidence in IBS, it is not as evidence-based in inflammatory bowel disease. Key clinical guidance presented:
The goal is to reduce FODMAP-related symptoms in IBD. So FODZYME can be an excellent option to add to the diet before restriction, in order to help break down FODMAPs without restricting the diet during IBD treatment.
Chronic Bloating: Pathophysiology and Dietary Management (Presentation 0002)
A multifactorial model of chronic bloating was presented, with the AGA 2023 stepwise diagnostic algorithm highlighted as the clinical framework. Among dietary approaches:
According to our peer-reviewed prospective data, 78.0% of participants report clinically significant improvements to bloating after 4 weeks of FODZYME use. Using FODZYME as a digestive enzyme for FODMAPs may be an effective first step for bloating reduction, before FODMAP restriction.
When it comes to sucrose, the fructan hydrolase enzyme in FODZYME also has specificity for sucrose. Read more about our connection to sucrose here.
Non-Celiac Wheat Sensitivity (NCWS): Is It Gluten or Fructan? (Biesiekierski et al., Gastroenterology 2013)
NCWS is defined by the clear establishment that gluten is a symptom trigger (removal = no symptoms; reintroduction = clear symptoms), in the absence of celiac disease. However, evidence presented challenges the assumption that gluten itself is the culprit:
FODZYME is the only enzyme blend on the market that contains fructan hydrolase, and enzyme that targets a broad spectrum of fructans. Our in vitro data using a SHIME digestive model demonstrated the ability of fructan hydrolase to break down 3g of fructan (or ~6 garlic cloves worth).
You can also dive into the difference between gluten and fructan from a Q&A we recently had with Dr. Jessica Biesiekierski.
The Nocebo Effect in NCWS (De Graaf et al., 2024; Seiler & Bercik, Lancet Gastroenterology & Hepatology 2025)
Emerging data presented at DDW 2026 complicates the picture further by implicating the nocebo effect (the expectation of harm causing harm) as a key driver:
Key takeaway: Belief may be driving both symptoms AND behavior in many patients who identify as gluten-sensitive. This has major implications for how we counsel patients about wheat avoidance versus addressing psychological contributors to food fear.
ARFID Prevalence Across GI Conditions (Session 0006)
Despite further evidence presented at DDW 2026 that dietary restriction can be successful in GI patients, ARFID — assessed using two validated screening tools — was shown to be significantly more prevalent across all GI conditions compared with healthy controls. While 89% of healthy volunteers had no ARFID features, approximately 26% of IBS patients screened positive. The fear-based type of ARFID is the most prevalent subtype, and data indicates that food-related pain is the primary driver. The type of ARFID presentation varied by GI condition, suggesting condition-specific contributors to avoidant eating behavior.
Clinical implication: Restriction-forward dietary therapies must be implemented thoughtfully and may not be appropriate for all patients. Screening for ARFID — particularly fear-based subtypes driven by pain — should be part of routine clinical nutrition practice in GI patients before initiating elimination protocols.
Food-Related Abdominal Pain (FRAP) and the Fear-Based Eating Pathway (Session 0006)
Food-related abdominal pain (FRAP) was identified as a meaningful construct linking fear of eating to ARFID development. Key findings:
This work highlights the importance of screening for ARFID and food fear in clinical nutrition practice, particularly in patients presenting with IBS or functional GI conditions.
This can also be a great case for digestive enzymes. When you add FODZYME to meals, there is a break down of FODMAPs that commonly cause symptoms and an increase in confidence that you’re taking an action to make a meal safer. This can lead to less fear or expectation of symptoms and therefore improved ability to cope with feelings of digestion (aka less hypervigilance).
Mediterranean vs. Western Diet: Microbial Diversity and Function (Sa1769)
A systematic review and meta-analysis spanning 25 years of studies compared the Mediterranean diet (MD) and Western diet on gut microbial outcomes. The MD was associated with a more diverse and functionally beneficial microbial ecosystem, characterized by:
Enhanced short-chain fatty acid (SCFA) production
Reduced pro-inflammatory microbial signatures
This provides mechanistic context for why the Mediterranean diet is increasingly recommended as the long-term dietary pattern of choice in patients with GI conditions, including those transitioning off the low FODMAP diet.
For some patients, this transition to a Mediterranean diet that includes a variety of FODMAPs is easier said than done. FODZYME provides support in these cases to reduce FODMAP-related symptoms as FODMAP-rich foods are added back into the diet. This could be a long-term support tool to help someone with prolonged FODMAP triggers to still add those foods in. Or this can be a short-term strategy of support while the gut microbiome is adapting to increased FODMAP intake.
Prebiotic Fructans in Stool: Impaired Fermentative Capacity in IBS (Sa1767)
A small but mechanistically interesting study (n=10; 3 IBS-D, 7 healthy controls) quantified prebiotic fructans in stool as a marker of microbial fermentative efficiency. Key findings:
IBS-D patients had more unfermented inulin in stool compared to healthy controls.
This was associated with increased stool SCFA levels despite greater microbial diversity in the IBS-D group.
The apparent paradox — more diversity but worse fermentation — suggests that impaired microbial functional efficiency (not just compositional diversity) may contribute to IBS symptoms and food intolerances. This supports the idea that microbial function matters as much as microbial composition in IBS.
This is where FODZYME can be helpful! FODZYME contains fructan hydrolase, a digestive enzyme that breaks down fructans, including inulin. This reduces the amount of fermentation required by gut microbes in the colon.
Fiber Intake and Laxation in Healthy People (Sa1771)
A systematic review of 113 RCTs examined the dose-response relationship between fiber intake and laxation outcomes in healthy adults. Increasing fiber intake overall produced:
Softer stool consistency
Increased total and dry fecal weight
Increased stool frequency
Shorter gut transit time
Importantly, 30–40 g/day emerged as the optimal range, with diminished benefit beyond 40 g/day. Low-soluble and low-fermentable fibers had the strongest effects on laxation outcomes, which is a relevant consideration when counseling patients on fiber type selection.
IgG-Guided Elimination Diet for IBS Symptoms (Sa1740)
A real-world follow-up (n=62) to a prior RCT on IgG-guided elimination diets in IBS examined outcomes when patients avoided foods flagged by IgG testing. Results showed:
Moderate decline in bloating and abdominal pain symptoms.
More than half of patients tested positive for 4 or fewer foods, making it a relatively less restrictive approach compared to full low FODMAP.
Symptom response remained lower than the low FODMAP diet.
Important caveats: IgG food testing remains an out-of-pocket expense, results can be confusing to interpret clinically, and this study may reflect responder bias and adherence bias among those who followed through with the protocol.
Since FODZYME also exists as a possible alternative to a low FODMAP diet, in order to support FODMAP-related symptoms, we are excited to see more conversation around strategies that are less restrictive for patients. We believe FODZYME can still be a first step to reduce food-related symptoms and identify FODMAPs as a possible cause of food-related symptoms, without the cost and restriction from a test like this one.
Elemental Diet for Abdominal Pain in IBS (Mo1426)
A post-hoc analysis of a prospective trial (n=22 IBS patients) examined pain and symptom outcomes following a two-week exclusive palatable elemental diet (PED). Results:
73% improvement in abdominal pain (greatest response in IBS-C)
64% improvement in discomfort and distention
59% reduction in bloating
Symptom relief persisted within 2 weeks of returning to a normal diet post-PED
The mechanism of symptom relief was not formally studied given the prospective design, but these outcomes reinforce the PED as a promising short-term intervention for IBS symptom reduction across multiple symptom domains.
And if there are still FODMAP-related symptoms after a PED for this patient population, FODZYME can help as a digestive enzyme blend for FODMAPs.
SIBO and Type 2 Diabetes: A Quantitative Metagenomics Link (Presentation 215)
A large quantitative metagenomics study (n=1,139; 121 T2D patients) revealed a compelling connection between SIBO and type 2 diabetes (T2D):
T2D patients had higher prevalence of SIBO, lower duodenal microbial diversity, and higher gram-negative CFU/mL compared to non-T2D patients.
Elevated gram-negative bacterial abundance persisted independently even after SIBO was cleared — suggesting the microbial imbalance is not solely a consequence of SIBO.
Several Streptococcus species persisted after SIBO clearance.
Abundances of Escherichia, Fusobacterium, and Streptococcus correlated with fasting glucose levels, suggesting potential microbial involvement in glucose dysregulation.
These findings raise important questions about bidirectional relationships between the upper GI microbiome, SIBO, and metabolic disease — an emerging area with significant clinical implications for both GI and endocrinology practice.
Stress, Late-Night Eating, and Gut Health: A Multi-Cohort Study (Mo1769)
Using NHANES data, this multi-cohort study examined how the combination of stress and late-night eating influences bowel habits and gut microbiota composition. Key findings:
Late-night eating alone was associated with 1.7x higher likelihood of abnormal bowel habits compared to low stress + normal eating schedule.
High stress + poor diet combination was associated with 2.5x higher likelihood of abnormal bowel movements.
Key takeaway: The combination of high stress AND late-night eating may be especially disruptive to bowel habits and gut microbiome diversity, compounding effects beyond either factor alone. This has practical counseling implications: addressing meal timing and stress management together may yield greater GI benefit than targeting either in isolation.
From clinical practice, we know that one reason those with GI symptoms eat the majority of their daily calories at the end of the day is the desire to eat less to experience fewer food-related symptoms during the day. This may be due to their job, being away from a toilet, taking care of kids, or other responsibilities during the day that are tough to manage with symptoms present. FODZYME can be a great option for these patients, if you are encouraging more food intake during the day and want support from food-related symptoms.