Low FODMAP diet leads to improvements in IBS-D symptoms
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A short-term strict low FODMAP diet and long-term ‘modified’ low FODMAP diet was linked to improvements in symptoms and quality of life in irritable bowel syndrome-diarrhea predominant patients, according to study results.
“Compared to [traditional dietary advice (TDA)], [low FODMAP (LFD)] leads to significantly greater improvement in abdominal pain frequency, abdominal distention, bowel habit satisfaction, quality of life and significant reduction in intake of IBS medications,” Omesh Goyal, MD, associate professor, department of gastroenterology Dayanand Medical College and Hospital, Ludhiana, Punjab, India, and colleagues wrote. “With adequate guidance and motivation, nutritional adequacy and good compliance can be achieved.”
Goyal and colleagues screened 166 patients with IBS-D and an IBS Severity Scoring System score of 175. They randomly assigned patients to the strict low FODMAP diet group (n = 52) or the traditional dietary advice group (n = 49) during phase 1. The low FODMAP diet group received instruction for systematic reintroduction of FODMAPs or the ‘modified’ FODMAP diet from weeks 4 to 16. Investigators defined response as a greater than 50-point reduction in IBS-SSS.
The total IBS-SSS and IBS quality of life scores were significantly reduced in both groups at weeks 4 and 16. However, the low FODMAP diet group had a significantly higher reduction. By intention-to-treat, responses were higher in the low FODMAP diet group compared with the traditional dietary advice group [4 weeks: 62.7% vs. 40.8%; P = .0448; 16 weeks: 52.9% vs. 30.6%; P = .0274]. At 4 weeks, compliance to the low FODMAP diet was 93% and 64% at 16 weeks.
According to researchers, at 4 weeks energy, carbohydrate, fat and fiber intake decreased in the low FODMAP diet group and improved through week 16.
“These results encourage us to advise that formulating a LFD plan using available data is an excellent option to effectively treat IBS-D patients, rather than depriving them of this therapeutic advantage due to lack of comprehensive local FODMAP data,” the researchers wrote.
Perspective
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Stacy Cavagnaro, RD
This study provides data that reinforce what we have been seeing in our clinical experience: Our patients with IBS-D show a significant improvement in symptoms and quality of life with the low FODMAP Diet, which should be one of the first lines of treatment in patients with IBS-D. We should note that food intolerances by group can only be identified if the diet is followed perfectly in the first phase, and foods are introduced in a very systematic way in the second phase. Patients need a lot of education, resources and support to successfully adhere to this restrictive diet, so any patient being prescribed the low FODMAP diet should be referred to a dietitian.
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