Abstract
BackgroundThere has been increasing interest in utilizing a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) for the treatment of irritable bowel syndrome (IBS), a functional gastrointestinal disease. While studies have indicated that this diet can be effective at symptom reduction, it is a restrictive diet and patients may find it challenging to find low FODMAP products to meet their nutrient needs. The primary objective of this study was to assess the gastrointestinal (GI) tolerance of three low FODMAP oral nutrition supplements (ONS) in healthy adults.MethodsA double-blind randomized controlled crossover study was conducted in 21 healthy adults (19–32 years). Fasted subjects consumed one of four treatments at each visit, with a one week wash out period between visits. Each participant received all treatments. Treatments included three low FODMAP ONS formulas (A, B, and C) as well as a positive control consisting of 5 g fructooligosaccharides (FOS) mixed in lactose-free milk. Breath hydrogen was measured at baseline, 1, 2, 3, and 4 h post treatment consumption. Subjective GI symptom questionnaires were completed at baseline, 0.5, 1, 1.5, 2, 3, 4, 12, 24 and 48 h following treatment consumption. Mean breath hydrogen concentrations and baseline corrected area under the curve for both breath hydrogen and GI symptoms were analyzed and compared between treatments. Significance was determined at P < 0.05.ResultsThe positive control resulted in higher breath hydrogen response compared to all three of the low FODMAP ONS beverages at 3 and 4 h after consumption. There were no differences in GI symptom response between treatments.ConclusionsAll treatments were well tolerated in healthy participants. The low FODMAP formulas resulted in a lower breath hydrogen response compared to the positive control, and may be better tolerated in individuals with IBS. More research should be conducted to better understand the GI tolerance of low FODMAP ONS in individuals with IBS.Trial registrationThe protocol for this study was registered on ClinicalTrials.gov in January 2016 (Clinical Trials ID: NCT02667184).
Highlights
There has been increasing interest in utilizing a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) for the treatment of irritable bowel syndrome (IBS), a functional gastrointestinal disease
None of the three low Fermentable oligosaccharides (FODMAP) oral nutrition supplements (ONS) produced an increase in breath hydrogen production in the four hours following consumption
The positive control did produce an increase in breath hydrogen of 9 ppm baseline to peak (Fig. 1)
Summary
There has been increasing interest in utilizing a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) for the treatment of irritable bowel syndrome (IBS), a functional gastrointestinal disease. While studies have indicated that this diet can be effective at symptom reduction, it is a restrictive diet and patients may find it challenging to find low FODMAP products to meet their nutrient needs. Clinical research has focused on diet as a treatment for IBS, since food can be related to symptom expression in many patients [4]. Diets low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) are recommended treatment options in Australia and the United Kingdom to manage the symptoms of IBS [5, 6]. Halmos et al reported clinically significant symptom improvement in 70% of participants with IBS while following a low FODMAP diet [8]
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