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: 1.99). 05/2011; 24(5):487-95. DOI: 10.1111/j.1365-277X.2011.01162.x
Source: PubMed


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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    • "Galactans and fructans are present in wheat, rye, garlic, onions, legumes, cabbage, artichokes, leeks, asparagus, lentils, inulin, soy, Brussels sprouts and broccoli (39,40,44). A low intake of FODMAPs has been found to reduce the gastrointestinal symptoms in patients with IBS (42,43,45,46). "
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    ABSTRACT: Several endocrine cell abnormalities have been reported in different segments of the gastrointestinal tract of patients with irritable bowel syndrome (IBS). These cells have specialized microvilli that project into the lumen; they function as sensors for the gut contents and respond to luminal stimuli (mostly ingested nutrients) by releasing hormones into the lamina propria, where they exert their effects via a paracrine/endocrine mode of action. Certain food items trigger the symptoms experienced by IBS patients, including those rich in fermentable oligo-, di- and monosaccharides, and polyols (FODMAPs). In this review, we present the argument that the effects of both FODMAPs and the proportional intake of proteins, fats and carbohydrates on IBS symptoms may be caused by an interaction with the gut endocrine cells. Since the gut hormones control and regulate gastrointestinal motility and sensation, this interaction may be responsible for abnormal gastrointestinal motility and the visceral hypersensitivity observed in these patients. There is no consistent evidence that IBS patients suffer from food allergy. The role of gluten intolerance in the development of IBS symptoms in these patients remains a matter of controversy. Individual guidance on food management, which includes restrictions in the intake of FODMAP-rich foods and testing diets with different proportions of proteins, fats and carbohydrates has been found to reduce the symptoms, improve the quality of life, and make the habitual diet of IBS patients more healthy.
    Full-text · Article · Jun 2014 · International Journal of Molecular Medicine
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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.
    Full-text · Article · May 2013 · Therapeutic Advances in Gastroenterology
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    • "Recently, studies have shown that the foods high in FODMAP (Fermentable oligo, di, monosaccharides and polyoles) are responsible for triggering the symptoms of IBS and dietary intervention with foods low in FODMAP are shown to reduce the symptoms of IBS in particular abdominal pain and flatulence. Diets low in FODMAP are also shown to reduce the colonic gas production both in IBS and healthy controls [39]. [40]. "
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    Full-text · Article · Mar 2013 · PLoS ONE
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