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Low FODMAPs diet safe, effective under guide of expert nutritionist

CHICAGO — Researchers found that while a low FODMAP diet is safe and effective in patients with irritable bowel syndrome, patients were often unable to recognize which specific foods triggered their symptoms. An expert here at Digestive Disease Week advised that the diet should be administered and carried out by an expert nutritionist.

“Not all FODMAPs are troublesome to all IBS patients. The question is, are patients really able to recognize which fodmaps are troublesome or dangerous for them?” Massimo Bellini, MD, from the University of Pisa, Italy, said in a presentation. “There are some other questions to be verified. Most physicians agree that the FODMAP diet is not a ‘one size fits all’ approach. The big problem is the food reintroduction: what, how, when we have to start with a more relaxed and less restrictive fodmap diet.”

The researchers enrolled 66 patients with IBS to analyze the effects of the FODMAP reintroduction and whether patient perception about trigger foods was accurate. Patients were monitored by a nutritionist to verify compliance. Mean age was 44.8 years (range, 22-77 years) and 54 were women. The study periods included diet start to the end of the 8-weeks diet and the end the 8-week diet to the end of a 40- to 70-day reintroduction period.

During the first period, researchers saw a reduction in mean IBS Symptom Severity Score (320 vs. 165.9; P < .0001), including the following symptoms: abdominal pain (53.5 vs. 25.6; P < .0001), abdominal bloating (62.7 vs. 26.4; P < .0001), dissatisfaction with bowel habits (76.8 vs. 54.7; P < .0001) interference with daily life activities (66.8 vs. 28.6; P < .0001).

In the second period, there was a reduction in mean IBS Symptom Severity Score to 159.7, including a further reduction of abdominal pain to 22.5, steady score of 24.5 for abdominal pain, minor increase in dissatisfaction with bowel habits to 5.68 and near same score for interference with daily life activities (P < .0001).

The researchers saw a threefold increase in patients achieving normal feces on the Bristol stool scale during the second phase. Sleep quality did not change.

Also during the second phase, lactose was detected in 71% of the patients, galactans in 37.5%, polyols in 25%, fructose in 37.5% and fructans in 29% as real triggers, whereas 67% of patients perceived lactose as a trigger, galactans in 17%, polyols in 4%, fructose in 17% and fructans in 25%.

“We are confident that our results show [patients under nutritionists] with the FODMAP diet improved IBS symptoms. Patients were satisfied with their improvement and with the diet. Patients should maintain all the benefits gained during the previous [reintroduction] period while the diet is still ongoing,” Bellini said. “Tailor the diet more specifically to the individual patient’s needs, only as restrictive as their symptoms require.” – by Talitha Bennett

References:

Bellini M, et al. Abstract 132. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.

Disclosure: Bellini reports no relevant financial disclosures.

CHICAGO — Researchers found that while a low FODMAP diet is safe and effective in patients with irritable bowel syndrome, patients were often unable to recognize which specific foods triggered their symptoms. An expert here at Digestive Disease Week advised that the diet should be administered and carried out by an expert nutritionist.

“Not all FODMAPs are troublesome to all IBS patients. The question is, are patients really able to recognize which fodmaps are troublesome or dangerous for them?” Massimo Bellini, MD, from the University of Pisa, Italy, said in a presentation. “There are some other questions to be verified. Most physicians agree that the FODMAP diet is not a ‘one size fits all’ approach. The big problem is the food reintroduction: what, how, when we have to start with a more relaxed and less restrictive fodmap diet.”

The researchers enrolled 66 patients with IBS to analyze the effects of the FODMAP reintroduction and whether patient perception about trigger foods was accurate. Patients were monitored by a nutritionist to verify compliance. Mean age was 44.8 years (range, 22-77 years) and 54 were women. The study periods included diet start to the end of the 8-weeks diet and the end the 8-week diet to the end of a 40- to 70-day reintroduction period.

During the first period, researchers saw a reduction in mean IBS Symptom Severity Score (320 vs. 165.9; P < .0001), including the following symptoms: abdominal pain (53.5 vs. 25.6; P < .0001), abdominal bloating (62.7 vs. 26.4; P < .0001), dissatisfaction with bowel habits (76.8 vs. 54.7; P < .0001) interference with daily life activities (66.8 vs. 28.6; P < .0001).

In the second period, there was a reduction in mean IBS Symptom Severity Score to 159.7, including a further reduction of abdominal pain to 22.5, steady score of 24.5 for abdominal pain, minor increase in dissatisfaction with bowel habits to 5.68 and near same score for interference with daily life activities (P < .0001).

The researchers saw a threefold increase in patients achieving normal feces on the Bristol stool scale during the second phase. Sleep quality did not change.

Also during the second phase, lactose was detected in 71% of the patients, galactans in 37.5%, polyols in 25%, fructose in 37.5% and fructans in 29% as real triggers, whereas 67% of patients perceived lactose as a trigger, galactans in 17%, polyols in 4%, fructose in 17% and fructans in 25%.

“We are confident that our results show [patients under nutritionists] with the FODMAP diet improved IBS symptoms. Patients were satisfied with their improvement and with the diet. Patients should maintain all the benefits gained during the previous [reintroduction] period while the diet is still ongoing,” Bellini said. “Tailor the diet more specifically to the individual patient’s needs, only as restrictive as their symptoms require.” – by Talitha Bennett

References:

Bellini M, et al. Abstract 132. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.

Disclosure: Bellini reports no relevant financial disclosures.

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