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A diet low in FODMAPs reduces symptoms of irritable bowel syndrome.
Gastroenterology 2014; 146(1):67-75.e5G

Abstract

BACKGROUND & AIMS

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) often is used to manage functional gastrointestinal symptoms in patients with irritable bowel syndrome (IBS), yet there is limited evidence of its efficacy, compared with a normal Western diet. We investigated the effects of a diet low in FODMAPs compared with an Australian diet, in a randomized, controlled, single-blind, cross-over trial of patients with IBS.

METHODS

In a study of 30 patients with IBS and 8 healthy individuals (controls, matched for demographics and diet), we collected dietary data from subjects for 1 habitual week. Participants then randomly were assigned to groups that received 21 days of either a diet low in FODMAPs or a typical Australian diet, followed by a washout period of at least 21 days, before crossing over to the alternate diet. Daily symptoms were rated using a 0- to 100-mm visual analogue scale. Almost all food was provided during the interventional diet periods, with a goal of less than 0.5 g intake of FODMAPs per meal for the low-FODMAP diet. All stools were collected from days 17-21 and assessed for frequency, weight, water content, and King's Stool Chart rating.

RESULTS

Subjects with IBS had lower overall gastrointestinal symptom scores (22.8; 95% confidence interval, 16.7-28.8 mm) while on a diet low in FODMAPs, compared with the Australian diet (44.9; 95% confidence interval, 36.6-53.1 mm; P < .001) and the subjects' habitual diet. Bloating, pain, and passage of wind also were reduced while IBS patients were on the low-FODMAP diet. Symptoms were minimal and unaltered by either diet among controls. Patients of all IBS subtypes had greater satisfaction with stool consistency while on the low-FODMAP diet, but diarrhea-predominant IBS was the only subtype with altered fecal frequency and King's Stool Chart scores.

CONCLUSIONS

In a controlled, cross-over study of patients with IBS, a diet low in FODMAPs effectively reduced functional gastrointestinal symptoms. This high-quality evidence supports its use as a first-line therapy.

CLINICAL TRIAL NUMBER

ACTRN12612001185853.

Authors+Show Affiliations

Department of Medicine, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia; Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia. Electronic address: Emma.Halmos@monash.edu.Department of Medicine, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.Department of Medicine, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.Department of Medicine, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia; Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia.Department of Medicine, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia; Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24076059

Citation

Halmos, Emma P., et al. "A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome." Gastroenterology, vol. 146, no. 1, 2014, pp. 67-75.e5.
Halmos EP, Power VA, Shepherd SJ, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75.e5.
Halmos, E. P., Power, V. A., Shepherd, S. J., Gibson, P. R., & Muir, J. G. (2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 146(1), pp. 67-75.e5. doi:10.1053/j.gastro.2013.09.046.
Halmos EP, et al. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome. Gastroenterology. 2014;146(1):67-75.e5. PubMed PMID: 24076059.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. AU - Halmos,Emma P, AU - Power,Victoria A, AU - Shepherd,Susan J, AU - Gibson,Peter R, AU - Muir,Jane G, Y1 - 2013/09/25/ PY - 2013/06/01/received PY - 2013/09/10/revised PY - 2013/09/18/accepted PY - 2013/10/1/entrez PY - 2013/10/1/pubmed PY - 2014/2/19/medline KW - Abdominal Pain KW - Clinical Trial KW - FODMAP KW - FWC KW - Food Intolerance KW - IBS KW - IBS-C KW - IBS-D KW - IBS-M KW - IBS-U KW - KSC KW - King's Stool Chart KW - Short-Chain Carbohydrates KW - VAS KW - constipation-predominant irritable bowel syndrome KW - diarrhea-predominant irritable bowel syndrome KW - fecal water content KW - fermentable oligosaccharides, disaccharides, monosaccharides, and polyol KW - irritable bowel syndrome KW - mixed diarrhea and constipation irritable bowel syndrome KW - neither diarrhea nor constipation irritable bowel syndrome KW - visual analogue scale SP - 67 EP - 75.e5 JF - Gastroenterology JO - Gastroenterology VL - 146 IS - 1 N2 - BACKGROUND & AIMS: A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) often is used to manage functional gastrointestinal symptoms in patients with irritable bowel syndrome (IBS), yet there is limited evidence of its efficacy, compared with a normal Western diet. We investigated the effects of a diet low in FODMAPs compared with an Australian diet, in a randomized, controlled, single-blind, cross-over trial of patients with IBS. METHODS: In a study of 30 patients with IBS and 8 healthy individuals (controls, matched for demographics and diet), we collected dietary data from subjects for 1 habitual week. Participants then randomly were assigned to groups that received 21 days of either a diet low in FODMAPs or a typical Australian diet, followed by a washout period of at least 21 days, before crossing over to the alternate diet. Daily symptoms were rated using a 0- to 100-mm visual analogue scale. Almost all food was provided during the interventional diet periods, with a goal of less than 0.5 g intake of FODMAPs per meal for the low-FODMAP diet. All stools were collected from days 17-21 and assessed for frequency, weight, water content, and King's Stool Chart rating. RESULTS: Subjects with IBS had lower overall gastrointestinal symptom scores (22.8; 95% confidence interval, 16.7-28.8 mm) while on a diet low in FODMAPs, compared with the Australian diet (44.9; 95% confidence interval, 36.6-53.1 mm; P < .001) and the subjects' habitual diet. Bloating, pain, and passage of wind also were reduced while IBS patients were on the low-FODMAP diet. Symptoms were minimal and unaltered by either diet among controls. Patients of all IBS subtypes had greater satisfaction with stool consistency while on the low-FODMAP diet, but diarrhea-predominant IBS was the only subtype with altered fecal frequency and King's Stool Chart scores. CONCLUSIONS: In a controlled, cross-over study of patients with IBS, a diet low in FODMAPs effectively reduced functional gastrointestinal symptoms. This high-quality evidence supports its use as a first-line therapy. CLINICAL TRIAL NUMBER: ACTRN12612001185853. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/24076059/A_diet_low_in_FODMAPs_reduces_symptoms_of_irritable_bowel_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(13)01407-8 DB - PRIME DP - Unbound Medicine ER -