A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D

Eswaran, Shanti; Chey, William D.; Han-Markey, Theresa; Ball, Sarah; Jackson, Kenya

doi:10.1038/ajg.2016.434

Cited by 297 publications

(362 citation statements)

References 28 publications

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“…One study randomised 38 patients to low FODMAP advice and 37 to standard dietary advice for 4 weeks with a clinical response (≥50 point reduction in IBS-SSS) reported in 50% in the low FODMAP group and 46% in the standard advice group, with no difference between groups 75. In the second RCT, although there was no difference in proportion of patients achieving the adequate relief endpoint, there were a greater number of pain responders in the low FODMAP group (51%) compared with standard advice (23%, p=0.008), as well as a greater magnitude of response of multiple individual symptoms (abdominal pain, bloating, stool consistency frequency and urgency) 70. These data on individual symptom response are consistent with previous findings of a non-randomised comparative trial that reported a significant difference in the numbers responding to low FODMAP dietary advice (76%) compared with standard National institute for Health and Care Excellence (NICE) guideline dietary advice (54%) 63.…”

Section: The Low Fodmap Dietmentioning

confidence: 89%

The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS

Staudacher

Whelan

2017

Gut

269

236

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There is an intensifying interest in the interaction between diet and the functional GI symptoms experienced in IBS. Recent studies have used MRI to demonstrate that short-chain fermentable carbohydrates increase small intestinal water volume and colonic gas production that, in those with visceral hypersensitivity, induces functional GI symptoms. Dietary restriction of short-chain fermentable carbohydrates (the low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet) is now increasingly used in the clinical setting. Initial research evaluating the efficacy of the low FODMAP diet was limited by retrospective study design and lack of comparator groups, but more recently well-designed clinical trials have been published. There are currently at least 10 randomised controlled trials or randomised comparative trials showing the low FODMAP diet leads to clinical response in 50%-80% of patients with IBS, in particular with improvements in bloating, flatulence, diarrhoea and global symptoms. However, in conjunction with the beneficial clinical impact, recent studies have also demonstrated that the low FODMAP diet leads to profound changes in the microbiota and metabolome, the duration and clinical relevance of which are as yet unknown. This review aims to present recent advances in the understanding of the mechanisms by which the low FODMAP diet impacts on symptoms in IBS, recent evidence for its efficacy, current findings regarding the consequences of the diet on the microbiome and recommendations for areas for future research.

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Section: The Low Fodmap Dietmentioning

confidence: 89%

The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS

Staudacher

Whelan

2017

Gut

269

236

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“…However, a more recent randomised, controlled trial has shown that a diet low in FODMAPs reduces symptoms of IBS as well as traditional dietary advice,30 and there was no significant difference in the primary end point of the proportion of patients reporting adequate relief of IBS-D symptoms by ≥50% during intervention weeks 3 and 4 of the 4-week trial 31. In the latter study, a secondary end point was a 30% reduction in mean daily abdominal pain score during 2 of the 4 weeks in the study, and this pain end point was significantly reduced by low FODMAP diet compared with control diet.…”

Section: Current Approaches To Manage Visceral Pain In Patients With Ibsmentioning

confidence: 96%

Dietary and pharmacological treatment of abdominal pain in IBS

Camilleri

Boeckxstaens

2017

Gut

121

122

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This review introduces the principles of visceral sensation and appraises the current approaches to management of visceral pain in functional GI diseases, principally IBS. These approaches include dietary measures including fibre supplementation, low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet, and pharmacological approaches such as antispasmodics, peppermint oil, antidepressants (tricyclic agents, selective serotonin reuptake inhibitors), 5-HT receptor antagonists (alosetron, ondansetron, ramosetron), non-absorbed antibiotic (rifaximin), secretagogues (lubiprostone, linaclotide), μ-opioid receptor (OR) and κ-OR agonist, δ-OR antagonist (eluxadoline), histamine H1 receptor antagonist (ebastine), neurokinin-2 receptor antagonist (ibodutant) and GABAergic agents (gabapentin and pregabalin). Efficacy and safety are discussed based on pivotal trials or published systematic reviews and meta-analysis, expressing ORs or relative risks and their 95% CIs. Potential new approaches may be based on recent insights on mucosal expression of genes, and microRNA and epigenetic markers in human biopsies and in animal models of visceral hypersensitivity.The objectives of this review are to appraise the physiology and anatomy of gut sensation and the efficacy in the relief of visceral pain (typically in IBS) of several classes of therapies. These include fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and different classes of medications (box 1). Box 1Classes of pharmacological agents for visceral painAntidepressants (tricyclic agents, selective serotonin reuptake inhibitors)Peppermint oil5-HT receptor antagonists (alosetron, ondansetron, ramosetron)Non-absorbed antibiotic (rifaximin)Secretagogues (lubiprostone, linaclotide)μ-Opioid receptor (OR) and κ-OR agonist and δ-OR antagonist (eluxadoline)Histamine H1 receptor antagonist (ebastine)Neurokinin-2 receptor antagonist (ibodutant)GABAergic agents (gabapentin and pregabalin).

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“…Table 1 reports the clinical trials that are available in the literature on the effect of a low-FODMAP diet in IBS patients [3,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. In general, most studies and one meta-analysis [6] have shown that IBS symptoms, particularly bloating and abdominal pain, may benefit from this treatment.…”

Section: Efficacy Of the Low-fodmap Diet: What Is The Quality Of Tmentioning

confidence: 99%

“…Indeed, studies comparing the efficacy of the low-FODMAP diet vs. proper dietary advice for IBS did not show a clear-cut advantage of the low-FODMAP diet: (a) in a US trial, 40%–50% of patients reported adequate relief of their IBS with diarrhea symptoms with the low-FODMAP diet or a diet based on modified NICE guidelines, even though the low-FODMAP diet led to significantly greater improvement in individual IBS symptoms, particularly pain and bloating, compared with the NICE diet [31]; (b) in a Swedish study the severity of IBS symptoms was reduced in both the low-FODMAP and the conventional IBS diet groups, at the end of a four-week period of treatment [26]. …”

Section: Efficacy Of the Low-fodmap Diet: What Is The Quality Of Tmentioning

confidence: 99%

The Low FODMAP Diet: Many Question Marks for a Catchy Acronym

et al. 2017

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FODMAP, “Fermentable Oligo-, Di- and Mono-saccharides And Polyols”, is a heterogeneous group of highly fermentable but poorly absorbed short-chain carbohydrates and polyols. Dietary FODMAPs might exacerbate intestinal symptoms by increasing small intestinal water volume, colonic gas production, and intestinal motility. In recent years the low-FODMAP diet for treatment of irritable bowel syndrome (IBS) has gained increasing popularity. In the present review we aim to summarize the physiological, clinical, and nutritional issues, suggesting caution in the prolonged use of this dietary treatment on the basis of the existing literature. The criteria for inclusion in the FODMAPs list are not fully defined. Although the low-FODMAP diet can have a positive impact on the symptoms of IBS, particularly bloating and diarrhea, the quality of the evidence is lower than optimal, due to frequent methodological flaws, particularly lack of a proper control group and/or lack of blinding. In particular, it remains to be proven whether this regimen is superior to conventional IBS diets. The drastic reduction of FODMAP intake has physiological consequences, e.g., on the intestinal microbiome and colonocyte metabolism, which are still poorly understood. A low-FODMAP diet imposes an important restriction of dietary choices due to the elimination of some staple foods, such as wheat derivatives, lactose-containing dairy products, many vegetables and pulses, and several types of fruits. For this reason, patients may be at risk of reduced intake of fiber, calcium, iron, zinc, folate, B and D vitamins, and natural antioxidants. The nutritional risk of the low-FODMAP diet may be higher in persons with limited access to the expensive, alternative dietary items included in the low-FODMAP diet.

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A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D

Cited by 297 publications

References 28 publications

The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS

The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS

Dietary and pharmacological treatment of abdominal pain in IBS

The Low FODMAP Diet: Many Question Marks for a Catchy Acronym

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