Gastroenterology

Gastroenterology

Volume 149, Issue 6, November 2015, Pages 1399-1407.e2
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome as Well as Traditional Dietary Advice: A Randomized Controlled Trial

https://doi.org/10.1053/j.gastro.2015.07.054Get rights and content

Background & Aims

A diet with reduced content of fermentable short-chain carbohydrates (fermentable oligo-, di-, monosaccharides, and polyols [FODMAPs]) has been reported to be effective in the treatment of patients with irritable bowel syndrome (IBS). However, there is no evidence of its superiority to traditional dietary advice for these patients. We compared the effects of a diet low in FODMAPs with traditional dietary advice in a randomized controlled trial of patients with IBS.

Methods

We performed a multi-center, parallel, single-blind study of 75 patients who met Rome III criteria for IBS and were enrolled at gastroenterology outpatient clinics in Sweden. Subjects were randomly assigned to groups that ate specific diets for 4 weeks—a diet low in FODMAPs (n = 38) or a diet frequently recommended for patients with IBS (ie, a regular meal pattern; avoidance of large meals; and reduced intake of fat, insoluble fibers, caffeine, and gas-producing foods, such as beans, cabbage, and onions), with greater emphasis on how and when to eat rather than on what foods to ingest (n = 37). Symptom severity was assessed using the IBS Symptom Severity Scale, and patients completed a 4-day food diary before and at the end of the intervention.

Results

A total of 67 patients completed the dietary intervention (33 completed the diet low in FODMAPs, 34 completed the traditional IBS diet). The severity of IBS symptoms was reduced in both groups during the intervention (P < .0001 in both groups before vs at the end of the 4-week diet), without a significant difference between the groups (P = .62). At the end of the 4-week diet period, 19 patients (50%) in the low-FODMAP group had reductions in IBS severity scores ≥50 compared with baseline vs 17 patients (46%) in the traditional IBS diet group (P = .72). Food diaries demonstrated good adherence to the dietary advice.

Conclusions

A diet low in FODMAPs reduces IBS symptoms as well as traditional IBS dietary advice. Combining elements from these 2 strategies might further reduce symptoms of IBS. ClinicalTrials.gov ID NCT02107625.

Section snippets

Subjects

For this multi-center, parallel, randomized, controlled, single-blind, comparative trial, we recruited adult patients (18−70 years of age) meeting Rome III criteria for IBS2 from the gastroenterology outpatient clinics of Sahlgrenska University Hospital, Gothenburg; Karolinska University Hospital, Stockholm; and Sabbatsbergs Hospital, Stockholm. In Gothenburg, patients were also recruited through advertisement in the local newspaper. Exclusion criteria were presence of a severe cardiac, liver,

Subjects

Eighty-four patients entered the screening period of the study (mean age 42.5 [SD 16.3] years; 66 females) (Sahlgrenska University Hospital, n = 70; Karolinska University Hospital, n = 9; Sabbatsbergs Hospital, n = 5). There were 9 screening failures (mean age 44.0 [SD 17.1] years; 5 females) (Sahlgrenska University Hospital, n = 8; Karolinska University Hospital, n = 0; Sabbatsbergs Hospital, n = 1), which were not randomized because they did not fulfill the randomization criterion of IBS-SSS

Discussion

In this study, we found that providing dietary advice to patients with IBS in the clinical setting reduces GI symptoms, but without obvious differences between a low-FODMAP diet and traditional IBS dietary advice. The assessment of food diaries demonstrated that it seems possible to give dietary advice and reach the desired effects, for example, reduced intake of FODMAPs, based on careful verbal and written instructions, but that calorie and nutrient intakes need to be monitored thoroughly in

Acknowledgments

Author contributions: LB: study concept and design; dietary advice; acquisition of data; analysis and interpretation of data; drafting of manuscript; statistical analysis. SS: study concept and design; supervision of dietitians; critical revision of the manuscript for important intellectual content. TL: dietary advice; acquisition of data; critical revision of the manuscript for important intellectual content. LC: dietary advice; acquisition of data; critical revision of the manuscript for

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    Conflicts of interest The authors disclose no conflicts.

    Funding This work was supported by the Swedish Medical Research Council (grants 13409, 21691 and 21692); the Marianne and Marcus Wallenberg Foundation, University of Gothenburg; Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg; and the Faculty of Medicine, University of Gothenburg.

    Author names in bold designate shared co-first authorship.

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