Randomised clinical trial: low‐FODMAP rye bread vs. regular rye bread to relieve the symptoms of irritable bowel syndrome

Abstract

SummaryBackgroundGrains are high in FODMAPs (Fermentable Oligo‐, Di‐, Monosaccharides And Polyols) and often considered as triggers of IBS symptoms.AimTo evaluate if rye bread low in FODMAPs would be better tolerated than regular rye bread in subjects with IBS.MethodsThe study was conducted as a randomised double blind controlled cross‐over study (n = 87). Participants were supplied with both regular rye bread and low‐FODMAP rye bread for 4 weeks. Symptoms were measured with a symptom severity scoring system (IBS‐SSS) and visual analogue scale (VAS) assessments of individual symptoms. Quality of life was monitored. Colonic fermentation was measured by the breath hydrogen test and dietary intake by food diaries.ResultsDietary fibre intake increased during both study periods compared to baseline. Many signs of IBS i.e. flatulence, abdominal pain, cramps and stomach rumbling were milder on the low‐FODMAP rye bread (P‐values: 0.04; 0.049; 0.01 and 0.001). The mean of VAS measurements was favourable towards LF bread [−3 (95% CI): −6 to −1, P = 0.02] but no differences were detected in IBS‐SSS or quality of life. The AUC of breath hydrogen values was significantly lower during the low‐FODMAP bread period (median 52.9 vs. 72.6; P = 0.01).ConclusionsLow‐FODMAP rye bread helps IBS patients to control their symptoms and reduces gastrointestinal gas accumulation. However, replacing regular rye bread by low‐FODMAP bread without concomitant broader dietary changes does not improve quality of life or IBS‐SSS. Nonetheless, inclusion of low‐FODMAP rye bread in diet might be one way that IBS patients could increase their fibre intake.

Low fermentable oligo‐di‐mono‐saccharides and polyols diet versus general dietary advice in patients with diarrhea‐predominant irritable bowel syndrome: A randomized controlled trial

“…Hydrogen and methane breath tests consider as a marker of colonic fermentation. So breath hydrogen/methane production is lower during low FODMAP diet …”

“…But it has been proven that these recommendations are often ineffective for IBS sufferers. In fact, current standard dietary advices are not based on evidence from controlled clinical trials and offer general dietary advices (GDA) for the management of disease . A new approach suggests that intake of fermentable oligo‐di‐mono‐saccharides and polyols (FODMAPs) can aggravate the GI symptoms of IBS.…”

The Low FODMAP Diet: Many Question Marks for a Catchy Acronym

“…Table 1 reports the clinical trials that are available in the literature on the effect of a low-FODMAP diet in IBS patients [3,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. In general, most studies and one meta-analysis [6] have shown that IBS symptoms, particularly bloating and abdominal pain, may benefit from this treatment.…”

Low-FODMAP diet in the management of irritable bowel syndrome

“…Among the nonpharmacological measures, it is possibly highlighting the actions taken to reduce stress (a factor strongly associated with crises) and food adequacy through the restriction of certain food (i.e., FODMAPs) associated with the onset of symptoms [10][11][12][13]. The distension caused by unabsorbed and/or fermented FODMAPs can be the basis for the most common symptoms in IBS [1,14]. Table 1 [15] presents the main sources and maximum intake dose of FODMAPs not associated with the onset of symptoms in individuals with IBS.…”