Although patients with inflammatory bowel disease may have their disease in objective control, many still experience persistent gut symptoms. A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols may help manage those symptoms, according to study results.
Kevin Whelan, PhD, of the department of nutritional sciences at King’s College in London, and colleagues wrote that it is unclear why these symptoms persist, but they could be due to lingering inflammation or even the psychological impact of IBD.
“These persistent gut symptoms impact health-related quality of life and pose a treatment dilemma because escalating immune-modulating agents is likely to be ineffective,” they wrote. “Limited evidence exists to support the pharmacological management of persistent gut symptoms in quiescent IBD.”
Whelan and colleagues conducted a randomized-controlled trial to assess the impact of a low-FODMAP diet on these persistent gut symptoms of quiescent IBD, as well as how it affects the gut microbiome. They randomly assigned 52 patients with quiescent Crohn’s disease or ulcerative colitis to follow either a low-FODMAP diet (n = 27) or a control diet with sham dietary advice (n = 25) for 4 weeks.
Investigators assessed gut symptoms and quality of life using validated questionnaires and collected stool and blood samples at baseline and the end of the trial.
After 4 weeks, more patients who followed a low-FODMAP diet reported adequate relief of gut symptoms (14/27, 52%) compared with patients on the control diet (4/25, 16%; P = .007). Patients on the low-FODMAP diet also had higher health-related quality of life scores than patients on the control diet (81.9±1.2 vs. 78.3±1.2; P = .042).
Although the low-FODMAP diet did not significantly impact the diversity of the microbiome, patients on the diet had a lower abundance of Bifidobacterium adolescentis, Bifidobacterium longum and Faecalibacterium prausnitzii.
“We propose that a 4-week low-FODMAP diet with expert advice and intensive follow-up is safe and effective in the management of persistent gut symptoms in quiescent IBD, but caution should be taken in longer-term use,” Whelan and colleagues wrote. – by Alex Young
Disclosure: Whelan reports receiving consulting fees from Clasado and Danone. He also invented a mobile application that assists patients following the low-FODMAP diet. Please see the full study for all other authors’ relevant financial disclosures.