Tools for Practice Outils pour la pratique


#142 The Low FODMAP Diet: Food for thought or just an irritable idea?


CLINICAL QUESTION
QUESTION CLINIQUE
 Does the low FODMAP diet improve symptoms for patients with irritable bowel syndrome?

BOTTOM LINE
RÉSULTAT FINAL
 A low FODMAP diet may improve symptoms for patients with primarily diarrhea subtype irritable bowel syndrome (IBS). However, most studies were low quality (small numbers and short duration), and therefore more high quality studies are needed.  


CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

 Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session


EVIDENCE
DONNÉES PROBANTES
 Four meta-analyses1-4 (4-8 randomized controlled trials, 293-596 participants, ROME II/III entry criteria), mainly young females. Compared with control, low FODMAP diet improved:  
  • Symptoms of abdominal pain1-3 and bloating1-2 
  • Quality of life - small to moderate effect3 
  • Global IBS symptoms4: 28% had ongoing symptoms vs 59% control, NNT 4 
  • Severity of symptoms2 
  • Limitations: short follow-up (range: 10 days – 3months); small number of trials.  Poor use of statistics (eg. odds ratios (without event rates) and/or standard mean differences) limit clinical interpretation of data. 
A systematic review assessed the quality of RCTs of LFD for IBS (9 trials, 542 patients) and found all trials were at high risk of bias, often due to lack of blinding and choice of control group;5  Example of actual symptom changes: Largest, high-quality, 6-week, open-label RCT of 123 Danish IBS patients, under specialist care.6 
  • 500-point symptom scale (minimal clinically important difference=50):7 
    • Low FODMAP diet improved ~150 points, probiotic ~80, normal diet ~30 points. 
  • Sub-group analysis: Only diarrhea patients improved.  
  • Limitations: Pre-enrollment investigations: colonoscopy, genetic lactase deficiency testing; per-protocol analysis. 
Context:  
  • Cohort studies demonstrate LFD benefit2,8 but IBS patients have high placebo response rate9 (even when told getting placebo).10  
  • IBS guidelines suggest offering patients a “low Fodmap diet trial.”11,12 Adherence to the diet13 is approximately 40%. 
  • Patients who initially improve on LFD, worsen with reintroduction of fructose or fructans.14  
  • Low FODMAP diet is restrictive, limiting many fruits, dairy products, wheat, legumes, and artificial sweeteners.15 Examples available online.15 

Latest Tools for Practice
Derniers outils pour la pratique
program image
December 6, 2024

#379 Bumpin’ Up the Protection? RSV Vaccine in Pregnancy

How effective and safe is the respiratory syncytial virus (RSV) vaccine (AbrysvoTM) when given during pregnancy?
Read Lire 0.25 credits available Crédits disponibles
program image
November 22, 2024

#378 Tony Romo-sozumab: Winning touchdown in osteoporosis or interception for the loss?

What is the efficacy and safety of romosozumab in postmenopausal women with osteoporosis?
Read Lire 0.25 credits available Crédits disponibles
program image
November 8, 2024

#377 How to slow the flow IV: Combined oral contraceptives

In premenopausal heavy menstrual bleeding due to benign etiology, do combined oral contraceptives (COC) improve patient outcomes?
Read Lire 0.25 credits available Crédits disponibles
July 6, 2015

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session
Author(s)
Auteur(s)
  • Cian Hackett BSc MD
  • G. Michael Allan MD CCFP
  • Michael R Kolber BSc MD CCFP MSc
  • Samantha Moe PharmD

1. Altobelli, E, Del Negro V, Angeletti P, et al. Nutrients. 2017; 9: 940.

2. Marsh A, Eslick EM, Eslick GD. Eur J Nutr. 2016; 55: 897.

3. Schumann D, Klose P, Lauche R, et al. Nutrition. 2018; 45: 24.

4. Dionne J, Ford AC, Yuan Y, et al. Am J Gastroenterol. 2018; 113: 1290.

5. Krogsgaard LR, Lyngesen M, Bytzer P. Aliment Pharmacol Ther. 2017; 45(12): 1506-13.

6. Pedersen N, Andersen NN, Végh Z, et al. World J Gastroenterol. 2014; 20(43):16215-26.

7. Francis CY, Morris J, Whorwell PJ. Aliment Pharmacol Ther. 1997; 11:395-402.

8. Rao SCC, Yu S, Fedew A. Aliment Pharmacol Ther. 2015; 41:1256-70.

9. Ford AC, Moayyedi P. Aliment Pharmacol Ther. 2010; 32:144-58.

10. Kaptchuk TJ, Friedlander E, Kelley JM, et al. PLoS One. 2010; (12):e15591.

11. Ford AC, Moayyedi P, Chey WD, et al. Am J Gastroenterol. 2018; 113 (Suppl 2): 1-18.

12. Moayyedi P, Andrews CN, MacQueen G, et al. J Can Assoc Gastrenterol. 2019; 2(1): 6-29.

13. Mari A, Hosadurg D, Martin L, et al. Eur J Gastroenterol Hepatol 2019; 31(2): 178-182.

14. Shepherd SJ, Parker FC, Muir JG, et al. Clin Gastro Hepatol. 2008; 6:765-71.

15. Low Fodmap Diet. https://stanfordhealthcare.org/medical-treatments/l/low-fodmapdiet.html Accessed Oct 3, 2019

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.