Effect of Structural Individual Low-FODMAP Dietary Advice vs. Brief Advice on a Commonly Recommended Diet on IBS Symptoms and Intestinal Gas Production

Abstract

A low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet has been recommended for irritable bowel syndrome (IBS) patients. This study compared the efficacy of two types of dietary advice: (1) brief advice on a commonly recommended diet (BRD), and (2) structural individual low-FODMAP dietary advice (SILFD). Patients with moderate-to-severe IBS were randomized to BRD or SILFD groups. Gastrointestinal symptoms, 7-day food diaries, and post-prandial breath samples were evaluated. The SILFD included (1) identifying high-FODMAP items from the diary, (2) replacing high-FODMAP items with low-FODMAP ones by choosing from the provided menu. The BRD included reducing traditionally recognized foods that cause bloating/abdominal pain and avoidance of large meals. Responders were defined as those experiencing a ≥30% decrease in the average of daily worst abdominal pain/discomfort after 4 weeks. Sixty-two patients (47 F, age 51 ± 14 years), BRD (n = 32) or SILFD (n = 30), completed the studies. Eighteen (60%) patients in SILFD vs. 9 (28%) in the BRD group fulfilled responder criteria (p = 0.001). Global IBS symptom severity significantly improved and the number of high-FODMAP items consumed was significantly decreased after SILFD compared to BRD. Post-prandial hydrogen (H2) breath production after SILFD was significantly lower than was seen after BRD (p < 0.001). SILFD was more effective than BRD. This advice method significantly reduced FODMAP intake, improved IBS symptoms, and lowered intestinal H2 production.

Adherence and Effects Derived from FODMAP Diet on Irritable Bowel Syndrome: A Real Life Evaluation of a Large Follow-Up Observation

“…We can explain this result because patients with IBS usually have a surrounding visceral hypersensitivity and are more susceptible to bowel distension. Low FODMAPs diet reduces the amount of bowel gas, as demonstrated by Patcharatrakul T et al and this, in turn, could be the reason of our observation [37]. They demonstrated a difference in H2 and CH4 breath concentrations, before and after low FODMAPs diet.…”

Nutritional Management of Gastrointestinal Diseases and Disorders

“…This situation makes it challenging to evaluate the effect of a low-FODMAP diet effect on Asian patients with IBS. In this issue, the effect of a low-FODMAP diet in Thai IBS patients is compared to the commonly recommended diet, which is a variant of National Institute for Health and Care Excellence-modified diet (NICE-modified diet) [4]. It was found that 60% of the Thai IBS patients responded to a low-FODMAP diet, which is similar to reports that 50-72% of western IBS patients respond to a low-FODMAP diet [5][6][7].…”

Food supplements and diet as treatment options in irritable bowel syndrome

“…The low FODMAP diet also led to greater reductions in bloating, urgency, and stool frequency 41 . Similarly, another RCT showed higher response rates in the low FODMAP group (60%) compared to first‐line IBS diet (28%, P = .001), as well as lower total IBS‐SSS scores 42 …”