Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?

Abstract

Objectives:The low FODMAPs diet has emerged as an option for the treatment of irritable bowel syndrome (IBS). One major challenge of this diet is that it is very restrictive, and compliance is usually low. Preliminary findings suggest an association between eating disorder (ED) and the risk of developing IBS. The primary aim of the study is to assess the correlation between compliance to low FODMAPs diet and risk of eating disorder behaviours among an irritable bowel syndrome cohort. Methods:We report a single centre study in the IBS patient population at University College London Hospital (UCLH). 233 patients (186 female) who commenced a low FODMAPs group programme for IBS (Rome III or IV). Self-reported diet adherence at the end of the 6week programme was measured. At baseline, participants completed the SCOFF questionnaire (a validated 5-item screening tool for EDs), the validated HADS questionnaire and the validated IBS-symptom severity score (IBS-SSS). Results:The SCOFF questionnaire identified 54 (23%) patients at an increased risk of ED behaviour. Overall, 95 (41%) participants were diet-adherent at 6 weeks, with significantly greater adherence in identified ED individuals (57%). The highest adherence rate (51%) was in the IBS-D subtype and the lowest rate (10%) in IBS-C. There was no significant relationship between IBS symptom severity and either adherence or ED severity. Conclusion:In our IBS patient cohort greater adherence to a low FODMAPs diet is associated with eating disorder behaviour. The implications of our study are for clinicians to have a high index of suspicion of EDs in IBS patients, but also that low FODMAPs dietary advice to the general IBS population should be couched alongside psychological support.

Anxiety and Depression Profile Is Associated With Eating Disorders in Patients With Irritable Bowel Syndrome

“…low-FODMAP diet, gluten-free diet) are increasingly discussed as a first-line therapeutic option in IBS management (30). Indeed in a recent IBS study, greater adherence to a low-Fermentable Oligo-, Di-, Mono-saccharides And Polyols (FODMAP) diet was associated with a positive SCOFF (31). Further investigation is required to explore suitable therapeutic options for these patients with a combination of IBS and underlying EDs associated with anxiety or depression and poor quality of life.…”

Commentary: Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?

“…Eating disorder behavior was recently evaluated by Mari et al using the SCOFF instrument within a population of adults with irritable bowel syndrome (IBS) who were instructed to begin a low FODMAP diet (5). The included subjects had failed previous IBS interventions (5).…”

Low FODMAP Diet: Evidence, Doubts, and Hopes

“…It is therefore not improbable that recommending a restrictive diet will prompt or reinforce an eating disorder. Although Mari et al reported that these kinds of patients have greater adherence to an LFD, elimination diets should be avoided in patients with eating disorders, such as orthorexia nervosa and/or avoidant/restrictive food intake disorder [90]. These patients have an obsessive focus on food that compromises their social and work life [91].…”

“…It is also mandatory that future studies use common and shared outcome measures in terms of symptom severity scores and quality of life questionnaires, as this will enable a reliable comparison between different studies. It is also to be hoped that in the near future, an easy and reliable tool to assess patients' adherence will be available, especially to evaluate the patients in the medium-and long-term, i.e., during the aLFD period, after the reintroduction phase [90].…”