Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome

King's College London, Nutritional Sciences Division, London, UK.
Journal of Human Nutrition and Dietetics (Impact Factor: 2.07). 05/2011; 24(5):487-95. DOI: 10.1111/j.1365-277X.2011.01162.x
Source: PubMed

ABSTRACT Emerging evidence indicates that the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may result in symptoms in some patients with irritable bowel syndrome (IBS). The present study aimed to determine whether a low FODMAP diet is effective for symptom control in patients with IBS and to compare its effects with those of standard dietary advice based on the UK National Institute for Health and Clinical Excellence (NICE) guidelines.
Consecutive patients with IBS who attended a follow-up dietetic outpatient visit for dietary management of their symptoms were included. Questionnaires were completed for patients who received standard (n = 39) or low FODMAP dietary advice (n = 43). Data were recorded on symptom change and comparisons were made between groups.
In total, more patients in the low FODMAP group reported satisfaction with their symptom response (76%) compared to the standard group (54%, P = 0.038). Composite symptom score data showed better overall symptom response in the low FODMAP group (86%) compared to the standard group (49%, P < 0.001). Significantly more patients in the low FODMAP group compared to the standard group reported improvements in bloating (low FODMAP 82% versus standard 49%, P = 0.002), abdominal pain (low FODMAP 85% versus standard 61%, P = 0.023) and flatulence (low FODMAP 87% versus standard 50%, P = 0.001).
A low FODMAP diet appears to be more effective than standard dietary advice for symptom control in IBS.

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    • "It is unclear whether dietary exclusion–reintroduction diets or FODMAP diets maintain remission through persistence of mucosal healing or are of predominant symptomatic benefit by alleviating 'functional' symptoms. FODMAP diets have been shown to be efficacious in patients with irritable bowel syndrome [Staudacher et al. 2011], and it is likely that they also reduce functional symptoms in patients with CD, possibly by reducing the osmotic load and bacterial fermentation associated with the food delivered [Gibson and Shepherd, 2010], rather than having a primary anti-inflammatory effect. "
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    ABSTRACT: Nutritional care and therapy forms an integral part of the management of patients with Crohn's disease (CD). Nutritional deficiencies result from reduced oral intake, malabsorption, medication side effects and systemic inflammation due to active disease. Enteral nutrition has a role in support for the malnourished patient, as well as in primary therapy to induce and maintain remission. The use of parenteral nutrition in CD is mainly limited to the preoperative setting or for patients with intestinal failure, but does not offer any additional advantage over EN in disease control. Dietary modifications, including elimination-reintroduction diets and a low fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet may improve symptoms but there are currently no data to suggest that these approaches have any role in the induction or maintenance of remission.
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    • "A longer double blind control study randomized 82 patients with IBS to a low FODMAP diet or a standard diet. Significantly more patients in the low FODMAP group reported satisfaction with symptom response, less abdominal pain, bloating and flatulence [11]. The mechanisms by which FODMAPs exert their effects in IBS-D have been studied in two separate trials. "
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    • "Placebo response was minimal . Subsequent study of this dietary approach in the UK has shown it superior to a dietary approach previously considered as best practice [Staudacher et al. 2011]. "
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    ABSTRACT: Food intolerance in irritable bowel syndrome (IBS) is increasingly being recognized, with patients convinced that diet plays a role in symptom induction. Evidence is building to implicate fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in the onset of abdominal pain, bloating, wind and altered bowel habit through their fermentation and osmotic effects. Hypersensitivity to normal levels of luminal distension is known to occur in patients with IBS, with consideration of food chemical intolerance likely to answer many questions about this physiological process. This paper summarizes the evidence and application of the most common approaches to managing food intolerance in IBS: the low-FODMAP diet, the elimination diet for food chemical sensitivity and others including possible noncoeliac gluten intolerance.
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