Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs

Abstract

AIMTo investigate the long-term effect of dietary education on a low fermentable oligosaccharide, disaccharide and polyol (FODMAP) diet on irritable bowel syndrome (IBS) symptoms and quality of life (QoL).METHODSParticipants with IBS (Rome III) were randomized to two groups. Group I commenced a low FODMAP diet at baseline. At three months, group II, so far a comparator group, crossed over to a low FODMAP diet while group I started re-challenging foods. All patients completed the IBS SSS (IBS symptom severity scoring system, 0-500 points increasing with severity), IBS QoL questionnaire (0-100 increasing with QoL), a FODMAP specific food frequency questionnaire and provided a stool sample at baseline, three and six months for microbiome analysis.RESULTSFifty participants were enrolled into group I (n = 23) or group II (n = 27). Participants in both groups were similar in baseline values but with more men in group I. There was a significantly lower IBS SSS (275.6 ± 63.6 to 128.8 ± 82.5 vs 246.8 ± 71.1 to 203.6 ± 70.1) (P < 0.0002) and increased QoL (68.5 ± 18.0 to 83 ± 13.4 vs 72.9 ± 12.8 to 73.3 ± 14.4) (P < 0.0001) in group I vs group II at 3 mo. The reduced IBS SSS was sustained at 6 mo in group I (160 ± 102) and replicated in group II (124 ± 76). Fiber intake decreased on the low FODMAP diet (33 ± 17 g/d to 21 ± 8 g/d) (P < 0.01) and after re-introducing FODMAP containing foods increased again to 27 ± 9 g/d. There was no change seen in the intestinal microbiome when participants adopted a low FODMAP diet.CONCLUSIONThis study demonstrated that a reduction in FODMAPs improves symptoms in IBS and this improvement can be maintained while reintroducing FODMAPs.

The long‐term effect and adherence of a low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in patients with irritable bowel syndrome

“…With a mean IBS‐QOL score of 72.3 out of a total of 100, the long‐term IBS related QOL appears to be similar to, or even slightly better than, the results found in short‐term studies . The predominant disease course in the participants of the study was mild IBS with indolent course.…”

Dietary therapies for functional bowel symptoms: Recent advances, challenges, and future directions

“…Changes to nutrient intake have also been noted following institution of the low FODMAP diet, with reductions in total energy, carbohydrate, fiber and calcium intake reported during the initial restrictive phase . These effects may resolve following re‐challenge, as suggested by data to date from long‐term studies . It may be that the institution of any diet and/or involvement in a dietary study has effects on total energy intake, as total energy intake was also reduced in comparison groups randomized to the NICE guidelines .…”

“…Long‐term studies: Two recently published papers showing efficacy of the low FODMAP diet in the long‐term following re‐challenge …”

Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome

“…Therefore, it would be expected that a low‐FODMAP diet would reverse this prebiotic effect, but this is not necessarily the case. Several well‐controlled studies assessing varying FODMAP intake have shown that a low‐FODMAP diet has no effects on bacterial diversity, a marker of good gut health, among patients with IBS, Crohn's disease, or healthy subjects . Total bacterial abundance decreases in these patient populations, but the health significance of this is unknown and possibly favorable as indicated in a study in which fecal water from patients on a low‐FODMAP diet increased markers of inflammation when infused into a rat colon .…”