Effect of Structural Individual Low-FODMAP Dietary Advice vs. Brief Advice on a Commonly Recommended Diet on IBS Symptoms and Intestinal Gas Production.

Tanisa Patcharatrakul,Akarawut Juntrapirat,Narisorn Lakananurak,Sutep Gonlachanvit

doi:10.3390/nu11122856

Abstract

A low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet has been recommended for irritable bowel syndrome (IBS) patients. This study compared the efficacy of two types of dietary advice: (1) brief advice on a commonly recommended diet (BRD), and (2) structural individual low-FODMAP dietary advice (SILFD). Patients with moderate-to-severe IBS were randomized to BRD or SILFD groups. Gastrointestinal symptoms, 7-day food diaries, and post-prandial breath samples were evaluated. The SILFD included (1) identifying high-FODMAP items from the diary, (2) replacing high-FODMAP items with low-FODMAP ones by choosing from the provided menu. The BRD included reducing traditionally recognized foods that cause bloating/abdominal pain and avoidance of large meals. Responders were defined as those experiencing a ≥30% decrease in the average of daily worst abdominal pain/discomfort after 4 weeks. Sixty-two patients (47 F, age 51 ± 14 years), BRD (n = 32) or SILFD (n = 30), completed the studies. Eighteen (60%) patients in SILFD vs. 9 (28%) in the BRD group fulfilled responder criteria (p = 0.001). Global IBS symptom severity significantly improved and the number of high-FODMAP items consumed was significantly decreased after SILFD compared to BRD. Post-prandial hydrogen (H2) breath production after SILFD was significantly lower than was seen after BRD (p < 0.001). SILFD was more effective than BRD. This advice method significantly reduced FODMAP intake, improved IBS symptoms, and lowered intestinal H2 production.

Highlights

Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder that affects10%–20% of the adult population worldwide [1]
Incomplete small intestinal absorption of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) which mainly come from the ingestion of fruits, vegetables, beverages, and dairy products, can aggravate abdominal pain, discomfort, and bloating by increasing luminal fluid through osmotic activity in IBS patients—especially in those with visceral hypersensitivity [5]
The aim of this study was to compare the efficacy of two low-FODMAP dietary advice methods in an out-patient setting administered by gastroenterologist—(1) brief advice on a commonly recommended diet (BRD), and (2) structural individual low-FODMAP dietary advice (SILFD)—on IBS symptoms and postprandial hydrogen (H2 ) and methane (CH4 ) gas production in Thai IBS patients

Summary

Introduction

Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder that affects10%–20% of the adult population worldwide [1]. The mechanisms by which food aggravates gastrointestinal symptoms include gastrocolic reflex, food maldigestion/malabsorption, Nutrients 2019, 11, 2856; doi:10.3390/nu11122856 www.mdpi.com/journal/nutrients. Incomplete small intestinal absorption of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) which mainly come from the ingestion of fruits, vegetables, beverages, and dairy products, can aggravate abdominal pain, discomfort, and bloating by increasing luminal fluid through osmotic activity in IBS patients—especially in those with visceral hypersensitivity [5]. A meta-analysis showed that a FODMAP restriction diet significantly improved IBS symptoms compared to standard diet [7], and it was recommended by IBS guidelines [8,9]. The recent Second Asian Consensus on IBS indicated that a low-FODMAP diet could be helpful in IBS, but studies in the Asian population are lacking [10]

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