Managing irritable bowel syndrome: The low-FODMAP diet

Dugum, Mohannad; Barco, Kathy; Garg, Samita

doi:10.3949/ccjm.83a.14159

Cited by 20 publications

(17 citation statements)

References 38 publications

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“…The last phase is the stabilisation phase, in which the patient tries to find a balance between intake of FODMAP‐rich food and the control of IBS symptoms. Dietary counselling during the three phases is strongly advised .…”

Section: Introductionmentioning

confidence: 99%

The long‐term effect and adherence of a low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in patients with irritable bowel syndrome

Weynants

Goossens

Genetello

et al. 2019

J Human Nutrition Diet

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Background Short‐term trials with a low‐FODMAP (fermentable oligosaccharides disaccharides monosaccharides and polyols) diet (LFD) show promising results in the symptomatic management of irritable bowel syndrome (IBS). The present study investigated the long‐term adherence to an LFD diet, factors associated with adherence, and associations between LFD and quality of life (QOL), IBS symptoms and disease course on a long‐term basis. Methods A retrospective cross‐sectional study was conducted. Two hundred and thirty‐four patients were enrolled from Ghent University hospital. Health‐related QOL, long‐term adherence to the LFD, disease course and IBS symptoms were assessed using a validated and self‐developed questionnaire. Results Ninety (38.5%) patients completed the questionnaires. The median time span between the first dietary consultation and completion of the questionnaires was 99.5 weeks (approaching 2 years). The predominant disease course was mild IBS with an indolent course (43.0%). Eighty percent reported still following a diet in which certain FODMAP‐rich food types are avoided. Eighty patients (88.9%) were satisfied that they follow or had followed the diet. The IBS‐QOL did not differ between patients following the diet strictly and patients deviating from the diet (P = 0.669). Patients still following the LFD experienced less severe abdominal pain than patients who stopped following the diet (P = 0.044). Conclusions The long‐term adherence and satisfaction with the LFD is high in patients with IBS. Nevertheless, patients indicated that it was difficult to follow the LFD in daily life. Practical issues, social factors and the absence of symptoms were indicated as the main reasons for a drop in adherence.

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Section: Introductionmentioning

confidence: 99%

The long‐term effect and adherence of a low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in patients with irritable bowel syndrome

Weynants

Goossens

Genetello

et al. 2019

J Human Nutrition Diet

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“…A restriction phase of minimum 3 or 4 wk is usually sufficient to obtain a clinical response[12,84]. Then, FODMAP foods should be reintegrated in the diet to find the level of food restriction that the patient requires to properly control symptoms[12,90]; and (3) If no symptom improvement occurs within 4 wk of strict adherence to the low FODMAP diet, then the intervention should be stopped and other therapeutic options considered[12]. …”

Section: Second-line Dietary Approach In Ibs: the Low Foodmap Dietmentioning

confidence: 99%

Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!

Cozma-Petruț

Loghin

Miere

et al. 2017

WJG

121

131

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A substantial proportion of patients with irritable bowel syndrome (IBS) associate their symptoms with the ingestion of specific foods. Therefore, in recent years, scientific research has increasingly focused on the role of diet in IBS and dietary management is now considered an important tool in IBS treatment. This article reviews the main dietary approaches in IBS emphasizing evidence from experimental and observational studies and summarizing the main diet and lifestyle recommendations provided by dietary guidelines and scientific literature. Despite the limited evidence for a beneficial role, general advice on healthy eating and lifestyle is recommended as the first-line approach in the dietary management of IBS. Standard recommendations include adhering to a regular meal pattern, reducing intake of insoluble fibers, alcohol, caffeine, spicy foods, and fat, as well as performing regular physical activity and ensuring a good hydration. Second-line dietary approach should be considered where IBS symptoms persist and recommendations include following a low FODMAP diet, to be delivered only by a healthcare professional with expertise in dietary management. The efficacy of this diet is supported by a growing body of evidence. In contrast, the role of lactose or gluten dietary restriction in the treatment of IBS remains subject to ongoing research with a lack of high-quality evidence. Likewise, further clinical trials are needed to conclude the efficacy of probiotics on IBS symptoms.

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“…Diagnostic investigation will be facilitated by both the awareness of these disorders and the careful analysis of the records and food anamnesis. It is important to emphasize that self-report of gluten sensitivity by the patient does not confirm the diagnosis of NCGS and that the prescription of a gluten-free diet for gastrointestinal and other symptoms may lead to underdiagnoses of CD (80)(81)(82)(83)(84) . Recently, Picarelli et al developed an oral mucosal contact test for gluten (GOMPT), which seems to be a reliable and rapid tool to confirm the diagnosis of NCGS, although additional investigations are necessary since the population evaluated was small and the tests performed in a single diagnostic center (44) .…”

Section: Iv-clinical and Therapeutic Aspects Of Ibs And Ncgs Overlapmentioning

confidence: 99%

“…However, prospective studies show that restriction to lactose alone is a trigger for IBS symptoms is not sufficient for the effective relief of symptoms in functional GI disease. Treatment of lactose intolerance should involve reduction of lactose intake rather than exclusion or even enzyme replacement for primary adult lactase deficiency, which has many available diagnostic tests characterized by different principles, availability, sensitivity, specificity, and cost (50,51,80,84,86,88) . Finally, in spite of the controversies, small Intestine Bacterial Overgrowth (SIBO) should always be considered as a differential diagnosis in patients with IBS, since the reported prevalence of SIBO in patients with IBS is generally high, varying from 4% to 64% and involving mainly patients with IBS-D.…”

Section: Iv-clinical and Therapeutic Aspects Of Ibs And Ncgs Overlapmentioning

confidence: 99%

Irritable Bowel Syndrome, Food Intolerance and Non- Celiac Gluten Sensitivity. A New Clinical Challenge

Soares

2018

Arq. Gastroenterol.

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Approximately 80% of irritable bowel syndrome (IBS) patients report that their symptoms are triggered after ingesting one or specific food groups. Gluten, wheat and related proteins (e.g., amylase-trypsin inhibitors, and fermentable oligo-di-mono-saccharides and polyols (FODMAPs) are the most relevant IBS symptom triggers, although the true ‘culprit(s)’ is/are still not well established. The concept of causal relationship between gluten intake and the occurrence of symptoms in the absence of celiac disease and wheat allergy was termed non-celiac gluten sensitivity (NCGS). The borderline between celiac disease, wheat allergy, IBS and NCGS is not always clearly distinguishable, and the frequency and clinical identity of NGCS are still unclear. An overlap between IBS and NCGS has been detected. The incomplete knowledge of the etiopathogenesis of these clinical conditions, lack of data on their real epidemiology, as well as the absence of a gold standard for their diagnosis, make the overall picture difficult to understand “It is crucial to well define the interaction between IBS, food intolerance and NGCS, since the role of diet in IBS and its dietary management is an essential tool in the treatment of a large number of these patients”. The objective of the present review is to provide an overview highlighting the interaction between IBS, food intolerance and NCGS in order to unravel whether gluten/wheat/FODMAP sensitivity represents ‘facts’ and not ‘fiction’ in IBS symptoms.

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Managing irritable bowel syndrome: The low-FODMAP diet

Cited by 20 publications

References 38 publications

The long‐term effect and adherence of a low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in patients with irritable bowel syndrome

The long‐term effect and adherence of a low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in patients with irritable bowel syndrome

Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!

Irritable Bowel Syndrome, Food Intolerance and Non- Celiac Gluten Sensitivity. A New Clinical Challenge

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