IBS Patients May Benefit from a Low FODMAP Diet

Patients with irritable bowel syndrome (IBS) benefited from a diet low in fermentable carbohydrates (FODMAP), according to the findings of a recent study.

In a 2x2 factorial trial, the researchers enrolled 104 patients with IBS and randomly assigned them to 4 different diets for 4 weeks: a sham diet and placebo (n=27), a sham diet and probiotic (n=26), a low FODMAP diet and placebo (n=24), and a low FODMAP diet and probiotic (n=27). Both diets had similar degrees of difficulty to follow and the sham diet restricted the same number of foods as the FODMAP diet. In addition, all participants received dietary counselling.
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The incidence and severity of 15 gastrointestinal symptoms and overall symptoms were measured 7 days before the study, at baseline, and at 4 weeks. Fecal samples were collected at baseline and after 4 weeks, as well as assessments of generic and disease-specific health-related quality of life. Adequate symptom relief as reported by patients, and stool Bifidobacterium species abundance were assessed as the co-primary end points.

Overall, there was no significant interaction between the interventions in adequate relief of symptoms or Bifidobacterium species abundance.

A higher proportion of patients consuming a low FODMAP diet experienced adequate symptom relief (57%) compared with patients who consumed the sham diet (38%) in intention-to-treat analysis, but the difference was not statistically significant.

However, the per-protocol analysis showed a significantly higher proportion of patients on the low FODMAP diet had adequate symptom relief (61%) compared with the shame diet (39%). The mean IBS-Severity Scoring System score was significantly lower for patients consuming a low FODMAP diet compared to patients consuming the sham diet, but no difference was observed between the probiotic and placebo groups.

Fecal samples from patients consuming a low FODMAP diet had lower abundance of Bifidobacterium species compared with those on the sham diet, and the low FODMAP diet had no effect on microbiota diversity. Among patients on the low FODMAP diet, patients who received the probiotic had a greater abundance of Bifidobacterium species compared with those in the placebo group.

“In a placebo-controlled study of patients with IBS, a low FODMAP diet associates with adequate symptom relief and significantly reduced symptom scores compared with placebo,” the researchers concluded. “It is not clear whether changes resulted from collective FODMAP restriction or removal of a single component, such as lactose.”

“Co-administration of the probiotic VSL#3 increased numbers of Bifidobacterium species, compared with placebo, and might be given to restore these bacteria to patients on a low FODMAP diet.”

—Melissa Weiss

Reference:

Staudacher HM, Lomer MCE, Farquharson FM, et al. Diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and probiotic restores bifidobacterium species: a randomized controlled trial [published online June 15, 2017]. Gastroenterology. http://dx.doi.org/10.1053/j.gastro.2017.06.010.