Low FODMAP powders aid in IBS control, detection of triggers
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Utilization of low FODMAP powders aided in control of symptom severity, somatization and depression for patients with irritable bowel syndrome in a tertiary care setting, according to findings presented at the UEG Week Virtual 2021.
“Blinded reintroduction using powders allows the most objective identification of individual FODMAP triggers,” Karen Van den Houte, PhD, researcher at KU Leuven in Leuven, Belgium, said in her presentation.
Previous studies have determined the efficacy of a low FODMAP diet for symptom control in IBS, but none have created a structured phase for the reintroduction of food.
Van den Houte and colleagues observed 60 patients with IBS (34.9 ± 0.2 years; 82% women; BMI, 24.9 ± 0.1 kg/m²) to develop a blinded reintroduction using low FODMAP powders.
“We wanted to investigate the impact of the strict diet, not only on the symptoms, but also on quality of life, somatization, depression and anxiety,” Van den Houte said in the presentation.
Researchers assessed changes in body weight, quality of life, somatization, depression and anxiety using the IBS-Quality of Life questionnaire, Patient Health Questionnaire and Visceral Sensitivity Index. Additionally, they required patients to complete daily symptom diaries and questionnaires at baseline, after 2 weeks, 4 weeks and 6 weeks of dietary intervention, as well as at the end of each reintroduction week. A dietitian explained the low FODMAP diet to patients.
Patients entered a 9-week reintroduction phase which entailed six daily FODMAP powders (20 g fructans, 60 g fructose, 12 g galacto-oligosaccharides, 60 g lactose, 15 g mannitol, 15 g sorbitol) or a control (30 g glucose) for 7 consecutive days in a randomized blinded order.
IBS-Severity Scoring System scores improved from baseline at 2 weeks (195 ± 14 vs. 306 ± 13), 4 weeks (153 ± 14 vs. 306 ± 13) and 6 weeks (107 ± 13 vs. 306 ± 13; all P < .0001) with an 88% responder rate. Quality of life (19.9 ± 2.1 vs. 32.3 ± 2.7; P < .0001), somatization (8.5 ± 0.5 vs. 12.4 ± 0.8; P < .0001), depression (4.4 ± 0.6 vs. 6 ± 0.3; P = .001) and anxiety (60.5 ± 2.4 vs. 51.7 ± 2.9; P = .005) also improved, and a significant drop in body weight was observed (65.8 ± 2.6 kg vs. 64.7 ± 2.5 kg; P = .001).
Among those who entered the reintroduction phase, 84% experienced symptom reoccurrence and the most prevalent triggering FODMAPs were fructans (52%) and mannitol (52%).
“A blinded FODMAP reintroduction revealed a personalized pattern of symptom recurrence with fructans and mannitol as the most prevalent triggers. Significant symptom recurrence occurred in the majority already within the first 3 days of intake of trigger FODMAPs,” Van den Houte said.
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Van den Houte K, et al. Abstract OP175. Presented at: UEG Week; Oct. 3-5, 2021 (virtual meeting).
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