Abstract
Background
The low FODMAP diet (LFD) is effective in managing irritable bowel syndrome (IBS)
in the short term. This study assessed the long-term effect of the LFD on symptoms,
nutritional composition and socialising.
Methods
Patients with IBS who received dietetic-led LFD advice were approached at long term
follow up (>6 months post LFD advice) from six centres across the United Kingdom.
Participants completed questionnaires assessing gastrointestinal symptoms, adherence,
nutritional intake, dietary acceptability and food related quality of life (QOL).
Results
205 participants completed the study, with a mean follow up of 44 months (3.7 years).
Adequate symptom relief was noted in 60% of individuals at long term follow up, with
76% being on the personalisation phase of the LFD (pLFD). Mean nutritional intake
did not differ between individuals on the pLFD versus habitual diet, with no difference
in fructan intake (2.9 g/d vs 2.9 g/d, p = 0.96). The majority (80%) of individuals on the pLFD consumed specific ‘free-from’
products at the long term, with the purchase of gluten or wheat free products being
the commonest (68%).
Conclusion
The majority of patients follow the pLFD in the long term, with a large proportion
purchasing gluten or wheat free products to manage their symptoms.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom.Gastroenterology. 2020; 158 (04): 1262-1273
- worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome foundation global study.Gastroenterology. Apr 2020; https://doi.org/10.1053/j.gastro.2020.04.014
- Bowel disorders.Gastroenterology. Feb 2016; https://doi.org/10.1053/j.gastro.2016.02.031
- Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis.Clin Gastroenterol Hepatol. Jul 2012; 10: 712-721
- Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV.Gastroenterology. Feb 2016; https://doi.org/10.1053/j.gastro.2016.02.032
- Irritable Bowel Syndrome.N Engl J Med. 2017; 376 (06): 2566-2578
- Food-related gastrointestinal symptoms in the irritable bowel syndrome.Digestion. 2001; 63: 108-115
- Perceived food intolerance in subjects with irritable bowel syndrome– etiology, prevalence and consequences.Eur J Clin Nutr. May 2006; 60: 667-672
- Nutrient intake in patients with irritable bowel syndrome compared with the general population.Neurogastroenterol Motil. Jan 2013; 25: 23-30
- Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life.Am J Gastroenterol. May 2013; 108: 634-641
- British Dietetic association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update).J Hum Nutr Diet. Oct 2016; 29: 549-575
- Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research.Aliment Pharmacol Ther. Jan 2019; 49: 124-139
- Use of dietary management in irritable bowel syndrome: results of a survey of over 1500 United States gastroenterologists.J Neurogastroenterol Motil. Jul 2018; 24: 437-451
- The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice.J Hum Nutr Diet. Jan 2018; https://doi.org/10.1111/jhn.12530
- Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome.J Nutr. Aug 2012; 142: 1510-1518
- A diet low in FODMAPs reduces symptoms of irritable bowel syndrome.Gastroenterology. Jan 2014; 146: 67-75
- Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial.Gastroenterology. Nov 2015; 149: 1399-1407
- A randomized controlled trial comparing the low FODMAP diet vs. modified NICE guidelines in US adults with IBS-D.Am J Gastroenterol. Dec 2016; 111: 1824-1832
- FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial.Gut. Jul 2017; 66: 1241-1251
- Effects of varying dietary content of fermentable short-chain carbohydrates on symptoms, fecal microenvironment, and cytokine profiles in patients with irritable bowel syndrome.Neurogastroenterol Motil. Apr 2017; 29https://doi.org/10.1111/nmo.12969
- Diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and probiotic restores bifidobacterium species: a randomized controlled trial.Gastroenterology. Jun 2017; https://doi.org/10.1053/j.gastro.2017.06.010
- 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.J Gastroenterol Hepatol. Jun 2018; 33: 1192-1199
- Long-term impact of the low-FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome.Neurogastroenterol Motil. Jan 2018; 30https://doi.org/10.1111/nmo.13154
- Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs.World J Gastroenterol. Jul 2017; 23: 4632-4643
- Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome.Aliment Pharmacol Ther. 2016; 44 (09): 447-459
- Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet.World J Gastroenterol. Apr 2016; 22: 4009-4019
- The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study.Int J Clin Pract. Sep 2013; 67: 895-903
- The long-term effect and adherence of a low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in patients with irritable bowel syndrome.J Hum Nutr Diet. Apr 2020; 33: 159-169
- The impact of a 4-week low-FODMAP and mNICE diet on nutrient intake in a sample of US adults with irritable bowel syndrome with diarrhoea.J Acad Nutr Diet. Apr 2020; 120: 641-649
- Nutrient intake, diet quality, and diet diversity in irritable bowel syndrome and the impact of the low FODMAP diet.J Acad Nutr Diet. Apr 2020; 120: 535-547
- Design of treatment trials for functional gastrointestinal disorders.Gastroenterology. May 2016; 150: 1469-1480
- An irritable bowel syndrome-specific symptom questionnaire: development and validation.Scand J Gastroenterol. Sep 2003; 38: 947-954
- Clinical effectiveness and economic costs of group versus one-to-one education for short-chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome.J Hum Nutr Diet. Dec 2015; 28: 687-696
- Using focus groups to determine what constitutes quality of life in clients receiving medical nutrition therapy: first steps in the development of a nutrition quality-of-life survey.J Am Diet Assoc. Jul 2003; 103: 844-851
- Development and validation of a comprehensive semi-quantitative food frequency questionnaire that includes FODMAP intake and glycemic index.J Am Diet Assoc. Oct 2010; 110: 1469-1476
- Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis.Eur J Nutr. Apr 2016; 55: 897-906
- Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon.Aliment Pharmacol Ther. Apr 2010; 31: 874-882
- The evidence base for efficacy of the low FODMAP diet in irritable bowel syndrome: is it ready for prime time as a first-line therapy?.J Gastroenterol Hepatol. Mar 2017; 32: 32-35
- Dietary assessment methods in epidemiologic studies.Epidemiol Health. 2014; 36e2014009https://doi.org/10.4178/epih/e2014009
- Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity.Gastroenterology. Nov 2017; https://doi.org/10.1053/j.gastro.2017.10.040
- Implementation of the low FODMAP diet in functional gastrointestinal symptoms: a real-world experience.Neurogastroenterol Motil. 2020; 32 (01): e13730https://doi.org/10.1111/nmo.13730
- Cost and availability of gluten-free food in the UK: in store and online.Postgrad Med J. Nov 2015; 91: 622-626
- Gluten-free diet and quality of life in celiac disease.Gastroenterol Hepatol Bed Bench. 2014; 7: 139-143
- A diet low in fermentable oligo-, Di-, and monosaccharides and polyols improves quality of life and reduces activity impairment in patients with irritable bowel syndrome and diarrhoea.Clin Gastroenterol Hepatol. Dec 2017; 15: 1890-1899
- The role of diet in irritable bowel syndrome: implications for dietary advice.J Intern Med. Nov 2019; 286: 490-502
- Health benefits and adverse effects of a gluten-free diet in non-celiac disease patients.Gastroenterol Hepatol (N Y). Feb 2018; 14: 82-91
Article info
Publication history
Published online: May 31, 2021
Accepted:
May 5,
2021
Received:
February 17,
2021
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
