#142 The Low FODMAP Diet: Food for thought or just an irritable idea?
CLINICAL QUESTION
Does the low FODMAP diet improve symptoms for patients with irritable bowel syndrome?
BOTTOM LINE
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.
Reading Tools for Practice Article can earn you MainPro+ Credits
Join NowAlready a CFPCLearn Member? Log in
EVIDENCE
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.
- 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
#403 A Whiff of Prevention: Treating Male Partners to Reduce Bacterial Vaginosis Recurrence
Does treating male sexual partners of females undergoing treatment for bacterial vaginosis infection decrease recurrence?
#402 Nipple Confusion or Nonsense? Pacifiers and Breastfeeding Duration
In term infants, does restricting early use of pacifiers result in higher rates of breastfeeding up to 6 months of age?
#401 Vape Expectations: Are electronic cigarettes the real deal for smoking cessation? (Update)
Are nicotine-containing e-cigarettes more effective than other available options for smoking cessation?
this type of diet is restrictive and may interfere with proper nutrition.