Evidence-based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach

Peter R Gibson; Susan J Shepherd

Disclosures

J Gastroenterol Hepatol. 2010;25(2):252-258. 

In This Article

Efficacy of the Low FODMAP Diet

Efficacy of restricting dietary fructose and/or sorbitol has been reported in several observational studies[35–38] and the benefits appeared to be durable.[36] The nature of the diets used, however, was generally poorly defined. Using a well-defined diet, restriction of fructose and fructans, together with general avoidance of other FODMAPs led to impressive global symptoms response in three out of four patients with IBS and fructose malabsorption in a retrospective study.[39] Efficacy was durable and was closely related to dietary compliance. That the efficacy of the low FODMAP diet was due to restriction of fructose and/or fructans in the diet was convincingly shown in a subsequent double-blinded randomized quadruple-arm placebo-controlled re-challenge trial.[40] Further evaluation of the diet in other groups with functional gut symptoms has shown consistent benefit in patients with quiescent inflammatory bowel disease and ileal pouch. An evaluation of patients who did not have a breath hydrogen test supported the efficacy of the diet in those with complete fructose absorption.[41] Of importance is that efficacy is not restricted to patients with diarrhea-predominant IBS, but applies equally to any bowel habit. Thus, the evidence base for efficacy of the diet is now substantial.

The ability of those instructed in the low FODMAP diet to adhere to it is remarkably good. More than 75% of patients were judged to be completely or mostly compliant with the diet in a retrospective review median 14 months (range 2–40 months) after implementation of the diet. In patients with inflammatory bowel disease, dietary compliance and efficacy of the diet were associated with more time availability, higher education status, and the use of specific cookbooks. These findings suggested that an understanding of the dietary principles and allocation of time to work on applying the diet were important to ensure success. These findings are not surprising.

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