Gut Symptoms during FODMAP Restriction and Symptom Response to Food Challenges during FODMAP Reintroduction: A Real-World Evaluation in 21,462 Participants Using a Mobile Application

Abstract

Background: There is limited evidence regarding the use of low FODMAP diet apps. This study aimed to evaluate the effectiveness of an app intended to reduce symptoms in FODMAP restriction and symptoms and tolerance of high FODMAP food challenges during FODMAP reintroduction and personalisation. Methods: Data were collected from 21,462 users of a low FODMAP diet app. Self-reported gut symptoms during FODMAP restriction, reintroduction, and personalisation and dietary triggers were identified from symptom response data for FODMAP food challenges. Results: Compared with baseline, at the end of FODMAP restriction, participants (n = 20,553) reported significantly less overall symptoms (11,689 (57%) versus 9105 (44%)), abdominal pain (8196 (40%) versus 6822 (33%)), bloating (11,265 (55%) versus 9146 (44%)), flatulence (10,318 (50%) 8272 (40%)), and diarrhoea (6284 (31%) versus 4961 (24%)) and significantly more constipation (5448 (27%) versus 5923 (29%)) (p < 0.001 for all). During FODMAP reintroduction, participants (n = 2053) completed 8760 food challenges; the five most frequent challenges and n/N (%) of dietary triggers identified were wheat bread 474/1146 (41%), onion 359/918 (39%), garlic 245/699 (35%), milk 274/687 (40%), and wheat pasta 222/548 (41%). The most frequently reported symptoms during food challenges were overall symptoms, abdominal pain, bloating, and flatulence. Conclusions: In a real-world setting, a low FODMAP diet app can help users improve gut symptoms and detect dietary triggers for long-term self-management.

The Low FODMAP Diet for Children with Inflammatory Bowel Disease and Overlapping Functional Gastrointestinal Symptoms – a Case Series

“…The LFD appears to be more efficacious for those with symptoms of flatulence, diarrhoea, abdominal pain and distention [10]. Moreover, the carbohydrate intolerances identified during the reintroduction process are similar for both adults and children, with fructan and lactose intolerance being the most common [18].…”

The Role of the FODMAP Diet in IBS

“…In addition, most guidelines suggest that the course of the diet and the food reintroduction according to tolerance should be supervised by a trained dietitian [101,103]. In some studies, including real-life studies, above all during the SARS-CoV-2 pandemic, apps and remote instructions were tried in order to lead patients to follow a correct diet and resulted in being useful to help patients improve their symptoms with a distant supervisor [104]. As for the guidelines' recommendations, the Italian guidelines for the management of IBS suggest a traditional diet as the first line approach, followed by a low FODMAP diet in case of failure [6], while UEG and the ESNM recommend the use of a low FODMAP diet in patients with IBS-D, especially when other kinds of treatment have failed [5].…”