Tolerability of FODMAP – reduced diet in irritable bowel syndrome – efficacy, adherence, and body weight course

Abstract

Background FODMAP reduced diet (fermentable oligo-, di-, monosaccharide, and polyols) belongs to the established therapy strategies in irritable bowel syndrome (IBS). However, disadvantages of this diet are significant and may lead to weight loss and insufficient patient adherence. Reports from Germany are not available yet. Material and methods In a prospective study, 93 patients with IBS according to Rom III were investigated. Sixty-three patients were recruited for the study and received standardized investigation, informed consent, and structured dietary instructions about the FODMAP reduced diet. Patients complaints were documented by a validated questionnaire and a standardized Lickert scale before and 8 weeks after the start of the diet. Stool characteristics were documented by the Bristol stool form scale. Results Patients adherence was low because 30 patients (47 %) stopped the diet. Of the remaining 33 patients, 36 % (n = 12) developed significant weight loss during the FODMAP therapy. Patients completing the study reported significant global improvement of symptoms in 79 % of cases (abdominal pain 85 %, meteorism 79 %, flatulence 69 %, borbogymi 69 %, nausea 46 %, fatigue 69 %). In addition, the severity of symptoms was significantly reduced. Fourteen patients developed changes of their stool characteristics according to the Bristol stool form scale, 11 of whom improved diarrhea and 3 improved constipation. Conclusion FODMAP reduced diet is an efficient therapy in IBS. However, adherence of the patients is poor and the therapy bears the risk of significant weight loss.

Prospective, double-blind diagnostic multicentre study of confocal laser endomicroscopy for wheat sensitivity in patients with irritable bowel syndrome

“…This proportion was even higher than reported earlier 33 and well in line with responses to LFDs which have been recommended by some associations for patients with IBS, 15 although a German study reported low patient adherence. 40 The detection rate of WS among patients with IBS in our study is in good accordance with the proportion of patients described elsewhere. 21 22 However, not only CLE-positive patients, but a large proportion of CLE-negative patients also responded to GFD in our study.…”

Gluten and FODMAPS—Sense of a Restriction/When Is Restriction Necessary?

“…Although patient’s complaints significantly improved, the adherence to an eight-week low FODMAP diet was rather low in another study with 93 patients with IBS; 47% of participants stopped the diet because it was too restrictive. Remarkably, 36% of patients who finished the study showed significant weight loss [85]. Thus, appropriate nutritional advice is necessary to avoid insufficient nutrient intake and unintended weight loss.…”

Role of gut microbiota via the gut-liver-brain axis in digestive diseases

“…Among the many factors that have been proposed, intolerance to malabsorptive dietary carbohydrates has become a major cause of IBS, therefore dietary interventions is important[ 27 ]. Many studies have found that low-fermented oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diets significantly improve symptoms[ 28 , 29 ], Zhou et al[ 30 ] fed rats with high doses of FODMAP feed, and observed elevated fecal Gram-negative bacteria and serum lipopolysaccharide levels, as well intestinal inflammation, barrier dysfunction, and visceral allergies response, and these symptoms can be prevented by antibiotics and reversed by a low FODMAP diet; (2) fecal microbiota transplantation (FMT), one of the effective methods for treating IBS, high-dose transplantation or repeated FMT can improve the response rate and intensity of FMT[ 31 ]. Use of FMT shortly after disturbance of the gut microbiota in IBS may improve efficacy[ 32 ], but the current evidence from randomized controlled trials does not suggest that FMT is beneficial for global IBS symptoms[ 33 ].…”