Feasibility of Low Fermentable Oligosaccharide, Disaccharide, Monosaccharide, and Polyol Diet and Its Effects on Quality of Life in an Italian Cohort

Abstract

The low Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet has demonstrated excellent results in terms of symptom control and health-related quality of life (HRQoL) in irritable bowel syndrome (IBS) sufferers, but patients have complained about unsatisfying taste, difficulty in following the diet, and time consumption. To investigate the feasibility of the low FODMAP diet in an Italian (Sardinian) cohort, sixty consecutive eligible outpatients (11 men and 49 women) with IBS were enrolled and followed a low FODMAP diet (gluten allowed, restriction phase of four weeks, reintroduction phase of four weeks). Food habits were assessed using 24-hour dietary recall, Bristol Stool Scale for stool consistency, Visual Analogue Scale for abdominal bloating, VAS (Visual Analogue Scale) for abdominal pain, IBS Severity Scoring System for perceived disease severity, and a 12-item Short Form Survey for HRQoL (psychological component summary + mental component summary) were applied at baseline (T0) and at the end of each phase (T1-four weeks and T2-eight weeks). Statistical analysis was performed by dividing the cohort into diarrhoea-dominant IBS (IBS-D) and other IBS subtypes (selected IBS-others). Comparisons between T1 and T2 vs. T0 and T2 vs. T1 were performed. The low FODMAP diet lowered VASp (VAS pain), VASb (VAS bloating), and IBS SSS (IBS Severity Scoring System), and increased PCS (Physical Component Summary) and MCS (Mental Component Summary) in both subgroups. Bristol Stool Scale (BSS) only improved in the IBS-D subgroup. The dropout mean values for MCS were higher than treated subjects and the percentage of unemployment was lower in the dropouts. According to the dropout features, the low FODMAP diet seems to show greater feasibility for patients with more time to dedicate to the diet (unemployed, homemakers, housewives, or students), more motivation, and more severe clinical features, independent of their place of residence.

Effect of Low FODMAPs Diet on Irritable Bowel Syndromes: A Systematic Review and Meta-Analysis of Clinical Trials

“…Three studies on stool habit change in patients with IBS-D showed a significant decrease in stool frequency (MD, −5.56/week; 95% CI, −7.40, −3.72) and a significant improvement in stool consistency (MD, −0.86; 95% CI, −1.52, −0.19) in the LFD group compared to that in the control group. This study result is consistent with those of previous studies that showed LFD is particularly effective at improving stool habits in IBS-D type patients [ 42 , 43 ]. This can be explained by the fact that food-related symptoms are most often reported by patients with IBS-D, and LFD induces a reduction in osmotic action exerted by FODMAPs in the intestinal lumen and reduces diarrhea [ 40 ].…”

FODMAP Intake in Spanish Population: Open Approach for Risk Assessment

“…In this respect, considerable efforts have been made in recent years to determine the FODMAP content of foods and to establish cut-off values for their classification in low-and high-content food [17]. Nevertheless, there is still a lack of information about composition of food products in different regions and so it is difficult to establish an accurate FODMAP intake worldwide [29]. Moreover, some FODMAPs, such as fructans, are more difficult to find in food composition databases, and their intake is not always determined in diet-related studies [6,22,24,25,30].…”

“…Obviously, the results shown in the present research are limited to the Spanish population. Several authors have proposed data related to different countries or cultures for food composition databases and intake [29,40]. Hence, we would like to highlight the importance of this approach performed to calculate the total FODMAP intake, in order to make its use widespread.…”

Psychological and Gastrointestinal Symptoms of Patients with Irritable Bowel Syndrome Undergoing a Low-FODMAP Diet: The Role of the Intestinal Barrier

“…Conversely, when considering only IBS-D patients, our positive data aligned with those in the literature. The reduction of the osmotic action in the intestinal lumen due to FODMAPs and the correction of the “minimal inflammation” in these patients have both been considered possible determinants of the positive effects of LFD [ 43 ].…”