Dataset Information

Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies.

ABSTRACT:

Background

Irritable bowel syndrome (IBS) and functional digestive tract disorders, e.g. functional bloating, carbohydrate maldigestion and intolerances, are very common disorders frequently causing significant symptoms that challenge health care systems. A low Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAP) diet is one of the possible therapeutic approaches for decreasing abdominal symptoms and improving quality of life.

Objectives

We aimed to meta-analyze data on the therapeutic effect of a low-FODMAP diet on symptoms of IBS and quality of life and compare its effectiveness to a regular, standard IBS diet with high FODMAP content, using a common scoring system, the IBS Symptom Severity Score (IBS-SSS).

Methods

A systematic literature search was conducted in PubMed, EMBASE and the Cochrane Library as well as in the references in a recent meta-analysis. Adult patients diagnosed with IBS according to the Rome II, Rome III, Rome IV or NICE criteria were included in the analysis.

Statistical methods

Mean differences with 95% confidence intervals were calculated from studies that contained means, standard deviation (SD) or mean differences and SD of differences and p-values. A random effect model was used because of the heterogeneity (Q test (?2) and I2 indicator). A p-value of less than 0.05 was chosen to indicate a significant difference.

Results

The literature search yielded 902 publications, but only 10 were eligible for our meta-analysis. Both regular and low-FODMAP diets proved to be effective in IBS, but post-diet IBS-SSS values were significantly lower (p = 0.002) in the low-FODMAP group. The low-FODMAP diet showed a correlation with the improvement of general symptoms (by IBS-SSS) in patients with IBS.

Conclusions

This meta-analysis provides high-grade evidence of an improved general symptom score among patients with irritable bowel syndrome who have maintained a low-FODMAP diet compared to those on a traditional IBS diet, therefore showing its superiority to regular IBS dietary therapy. These data suggest that a low-FODMAP diet with dietitian control can be a candidate for first-line therapeutic modality in IBS. Because of a lack of data, well-planned randomized controlled studies are needed to ascertain the correlation between improvement of separate key IBS symptoms and the effect of a low-FODMAP diet.

SUBMITTER: Varju P

PROVIDER: S-EPMC5555627 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies.

Varjú Péter P Farkas Nelli N Hegyi Péter P Garami András A Szabó Imre I Illés Anita A Solymár Margit M Vincze Áron Á Balaskó Márta M Pár Gabriella G Bajor Judit J Szűcs Ákos Á Huszár Orsolya O Pécsi Dániel D Czimmer József J

PloS one 20170814 8

<h4>Background</h4>Irritable bowel syndrome (IBS) and functional digestive tract disorders, e.g. functional bloating, carbohydrate maldigestion and intolerances, are very common disorders frequently causing significant symptoms that challenge health care systems. A low Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAP) diet is one of the possible therapeutic approaches for decreasing abdominal symptoms and improving quality of life.<h4>Objectives</h4>We aimed to me ...[more]

PMID: 28806407

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Project description:Endurance athletes commonly experience lower gastrointestinal (GI) symptoms similar to those of irritable bowel syndrome (IBS). Previous research on the restriction of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP), a diet-based mitigation strategy initially developed for IBS, has shown promise for application in athlete populations. Athlete's dietary strategies surrounding exercise have not been formally assessed in relation to FODMAP content of foods or sports nutrition products. Additionally, the FODMAP content of athlete's habitual diets has not been examined in larger sample sizes. This research aims to investigate the FODMAP content of endurance athlete diets by examining these three areas, in conjunction with GI symptoms. Dietary habits surrounding exercise and GI symptoms were examined in 430 endurance athletes using a previously validated Endurance Athlete Questionnaire. A subset of athletes (n = 73) completed a FODMAP-specific food frequency questionnaire for habitual intake. The most commonly reported sports nutrition products were analyzed for FODMAP content using standardized analytical methods. Mean habitual intakes were compared to previous FODMAP studies and medians were compared between those with and without lower GI symptoms. Athletes commonly consumed high FODMAP foods during pre-race dinners and breakfasts, with over 60% reporting specific high FODMAP foods. More frequent nutrition product use, particularly solid, gel/gummy, and homemade products, was often related to increased frequency of GI symptoms. Of the sixteen commonly used sports nutrition products tested, seven were high FODMAP in one serving. All but one of the remaining products became high FODMAP when consumed in multiple servings, as is likely the case during endurance exercise. Average habitual FODMAP intake was 26.1 g (±15.9 g), similar to intakes classified as high FODMAP in previous research on FODMAPs and IBS or GI symptoms. Only 15.1% of athletes consumed a diet that would be considered low in FODMAP. Exploratory analyses showed higher intake of some FODMAP types among athletes exhibiting various lower GI symptoms. Overall, this study demonstrated that FODMAP intake by endurance athletes is high both surrounding exercise and habitually, and may be contributing to GI symptoms experienced during exercise. This information can be utilized when analyzing athlete diets and selecting foods to decrease GI symptoms.

Project description:BackgroundFibromyalgia (FM) has been associated with dysbiosis and low-grade inflammation. Studies have reported that diet influences clinical features in FM.ObjectiveTo evaluate the effect of an anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols (FODMAP) diet on clinical outcomes of patients with FM.MethodsThis two arms Randomized Controlled Trial (NCT04007705) included 46 female patients with FM. The intervention group (n = 22) adopted an anti-inflammatory diet for 3 months, excluding gluten, dairy, added sugar, and ultra-processed foods, along with a low FODMAPs diet in the first month. The control group (n = 24) followed general healthy eating recommendations. Both diets were applied by a certified dietitian. Before and after the intervention, participants were assessed regarding pain, fatigue, gastrointestinal symptoms, quality of sleep, and quality of life, through the Revised Fibromyalgia Impact Questionnaire (FIQR), Visual Analogue Pain Scale (VAS), Visual Analog Scale from gastrointestinal symptoms (VAS GI), Brief Pain Inventory (BPI), Pittsburg Sleep Quality Index (PSQI), Fatigue Severity Survey (FSS), and The Short Form Health Survey (SF-36). A blood sample was collected and high-sensitive C-Reactive Protein and Erythrocyte Sedimentation Rate were quantified. Paired Samples t-test/Wilcoxon and independent samples t-test/Mann-Whitney were used to compare variables between groups.ResultsAfter intervention, there was an improvement in intervention group scores of FIQR (p = 0.001), VAS (p = 0.002), BPI (p = 0.011), FSS (p = 0.042), VAS_GI (p = 0.002), PSQI (p = 0.048), and SF36 (p = 0.045) compared to control group. Inflammatory biomarkers (hs-CRP, ESR) did not change in both groups. The intervention was beneficial in the intervention group, regardless of age, disease duration, body mass index variation, and body fat change between baseline and post-intervention.ConclusionAn anti-inflammatory and low-FODMAP diet improved clinical features in patients with FM and may be useful as a complement to pharmacological therapy.Clinical trial registration[https://clinicaltrials.gov/ct2/show/NCT04007705], identifier [NCT04007705].

Project description:BackgroundIrritable bowel syndrome (IBS) has been associated with diets rich in fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs), and gluten. Most previous studies have been single-blind and have focused on the elimination of FODMAPs or provocation with single FODMAPs. The effect of gluten is unclear, large trials isolating the effect of gluten from that of FODMAPs are needed.ObjectivesThe aims of this study were to ensure high intakes of a wide range of FODMAPs, gluten, or placebo, and to evaluate the effects on IBS symptoms using the IBS-severity scoring system (IBS-SSS).MethodsThe study was carried out with a double-blind, placebo-controlled, randomized 3-way crossover design in a clinical facility in Uppsala from September 2018 to June 2019. In all, 110 participants fulfilling the IBS Rome IV criteria, with moderate to severe IBS, were randomly assigned; 103 (90 female, 13 male) completed the trial. Throughout, IBS participants maintained a diet with minimal FODMAP content and no gluten. Participants were block-randomly assigned to 1-wk interventions with FODMAPs (50 g/d), gluten (17.3 g/d), or placebo, separated by 1-wk washout. All participants who completed ≥1 intervention were included in the intention-to-treat analysis.ResultsIn participants with IBS (n = 103), FODMAPs caused higher IBS-SSS scores (mean 240 [95% CI: 222, 257]) than placebo (198 [180, 215]; P = 0.00056) or gluten (208 [190, 226]; P = 0.013); no differences were found between the placebo and gluten groups (P = 1.0). There were large interindividual differences in IBS-SSS scores associated with treatment. No adverse events were reported.ConclusionIn participants with IBS, FODMAPs had a modest effect on typical IBS symptoms, whereas gluten had no effect. The large interindividual differences in responses to the interventions warrant further detailed studies to identify possible underlying causes and enable individual prediction of responses. This trial was registered at www.clinicaltrials.gov as NCT03653689.

Dataset Information

Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies.

Background

Objectives

Methods

Statistical methods

Results

Conclusions

Publications

Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies.

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