November 29, 2017
3 min read

Low FODMAPS offers superior symptom relief in IBS-D vs. general dietary advice

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Both low FODMAP diet and general dietary advice offered improved gastrointestinal symptoms at 6 weeks in patients with irritable bowel syndrome with diarrhea, though low FODMAP diet demonstrated greater symptom-relieving benefits. Quality of life between the groups saw similar decline, researchers reported.

“We found that following a low FODMAP diet improves significantly gastrointestinal symptoms (abdominal pain, bloating and bowel movement) vs. general dietary advices (GDA) group,” Mohammad Javad Zahedi, MD, from the Kerman University of Medical Sciences, Iran, and colleagues wrote. “Although, the GDA group has shown a significant reduction in GI symptoms after 6 weeks, but this reduction is greater in low FODMAP diet group.”

From February to August 2016, Zahedi and colleagues enrolled into their study adult patients with IBS-D who did not have confounding medical conditions such as celiac disease or inflammatory bowel disease. At baseline, patients completed food questionnaires for daily dietary habits and the Irritable Bowel-Severity Scoring System questionnaire (IBS-SSS).

The researchers randomly assigned patients to follow either a low FODMAP diet (n = 50) or GDA (n = 51) for 6 weeks.

Patients in the low FODMAP group received a pamphlet with suitable foods, unsuitable foods and their substitutes, shopping guide, strategies for eating out and information about cooking foods without onion and garlic.

The GDA were based on recommendations from the British Dietetic Association and focused on limited intake of caffeine, alcohol, spicy food, fatty food and carbonated drinks; small, frequent meals; eating slowly; and avoiding chewing gums and sweeteners containing polyols.

After 3 weeks, researchers evaluated patient adherence to diet and severity of symptoms according to IBS-SSS questionnaire results and reported difficulties.

At the end of 6 weeks, patients returned to the gastroenterology care clinic to provide daily stool diaries and diet records and to complete the IBS-SSS questionnaire, the Irritable Bowel Syndrome-Quality of Life questionnaire and the Hospital Anxiety and Depression Scale questionnaire.

At baseline, both groups had similar intake of energy, nutrients and FODMAPs. At 6 weeks, energy intake in the low FODMAP group (2,388 vs. 2,037 kcal; P = .03) and the GDA group (2,417 vs. 2,185 kcal; P = .04) and carbohydrate intake in the low FODMAP group (342.95 vs. 266.07 gr; P < .001) and the GDA group (384.07 vs. 360.9 gr; P =. 04) decreased significantly.

Between the two groups, the decrease in carbohydrate consumption was significantly larger in the low FODMAP group (P < .001), whereas fat consumption decreased more significantly among those in the GDA group at 6 weeks (51.36 vs. 65.16 gr; P = .04).


“The assessment of nutritional data from our study shows calorie intake decreased in both intervention groups after 6 weeks, despite the fact that we did not recommend the low-calorie diet to patients,” the researchers noted. “This result can relate to limitation of specified unsuitable foods intake in low FODMAP group and some advices in general dietary advices group which leads to lower calorie intake.”

Total IBS-SSS scores decreased significantly in both groups at 6 weeks (P < .001). Compared with the GDA group, however, individual IBS-SSS item scores decreased more significantly among patients in the low FODMAP group, including abdominal pain intensity (P = .001), abdominal pain frequency (P = .017), abdominal distension (P < .001), dissatisfaction of intestinal transit (P = .001), interference of daily life (P = .005), stool consistency (P = .003) and stool frequency (P < .001)

At the end of the study, quality of life score decreased for both patients in the low FODMAP group (–7.3; P < .001) and the GDA group (–5.35; P = .001) from baseline. The researchers observed no significant difference in decreased quality of life between the two groups.

“The present study demonstrated that adherence to low FODMAP diet among the patients with IBS for 6 weeks had beneficial effects on gastrointestinal symptoms ... however, it did not influence quality of life compared with the general dietary advices group,” the researchers concluded. “In our study, the assessment of food record questionnaire showed that FODMAP restriction via dietary advice (suitable and unsuitable foods) can reduce the amount of FODMAP in daily intakes without significant change in calorie intake. But in the long-time use, it needs to be monitored because of the possibility of malnutrition.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.