Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs
Open accessAbstract
AIM: To investigate the long-term effect of dietary education on a low fermentable oligosaccharide, disaccharide and polyol (FODMAP) diet on irritable bowel syndrome (IBS) symptoms and quality of life (QoL). METHODS: Participants with IBS (Rome III) were randomized to two groups. Group I commenced a low FODMAP diet at baseline. At three months, group II, so far a comparator group, crossed over to a low FODMAP diet while group I started re-challenging foods. All patients completed the IBS SSS (IBS symptom severity scoring system, 0-500 points increasing with severity), IBS QoL questionnaire (0-100 increasing with QoL), a FODMAP specific food frequency questionnaire and provided a stool sample at baseline, three and six months for microbiome analysis. RESULTS: < 0.01) and after re-introducing FODMAP containing foods increased again to 27 ± 9 g/d. There was no change seen in the intestinal microbiome when participants adopted a low FODMAP diet. CONCLUSION: This study demonstrated that a reduction in FODMAPs improves symptoms in IBS and this improvement can be maintained while reintroducing FODMAPs.
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The effect of FODMAP reintroduction to tolerance on IBS symptoms is unclear.
“The effect of FODMAP reintroduction to tolerance on IBS symptoms is therefore unclear, although there have been open-label studies reporting the long-term efficacy of an adapted low FODMAP diet ranges somewhere between 50% and 60%.177 203”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [177]
The Introduction says evidence on reintroduction was previously unavailable, but this paper then studies it. Its Discussion reports that reintroduction to tolerance improved fiber intake without significant worsening of IBS symptoms; the Results report that reduced symptom severity was sustained at six months. Thus the paper does not present symptom outcomes after reintroduction as unclear. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredBeans, cruciferous vegetables and other high fodmap foods are more prone to gas formation.
“Beans, cruciferous vegetables and other high fodmap foods that are more prone to gas formation may be reduced in the diet and can be reintroduced slowly if patients are experiencing bloating or cramping similar to IBS [102].”
From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [102]
The Introduction says reducing fermentable carbohydrates in a low-FODMAP diet should produce less gas. The Discussion identifies legumes and some vegetables as sources of FODMAPs, but our copy does not specifically identify cruciferous vegetables as high-FODMAP foods or link them to gas formation. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOpen-label studies report the long-term efficacy of an adapted low FODMAP diet ranges somewhere between 50% and 60%.
“The effect of FODMAP reintroduction to tolerance on IBS symptoms is therefore unclear, although there have been open-label studies reporting the long-term efficacy of an adapted low FODMAP diet ranges somewhere between 50% and 60%.177 203”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [177]
The Results (Effect on symptom severity; page unavailable) report that symptom improvement was sustained at six months after Group I began reintroducing FODMAPs to tolerance. The Methods (Study protocol; page unavailable) describe an unblinded study, but the paper does not report a 50%–60% long-term efficacy rate; its Background instead mentions approximately 70% effectiveness for a low-FODMAP diet without specifying long-term adapted-diet outcomes. (LLM, conf=0.86)
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- Authors
- Harvie, R. M., Chisholm, A. W., Bisanz, J. E., Burton, J. P., Herbison, P., Schultz, K., & Schultz, M.
- Affiliations
- Western University (CA)
- Corresponding author
- Schultz, Michael
- Venue
- World Journal of Gastroenterology
- Publisher
- Baishideng Publishing Group Inc.
- Published
- 2017
- Volume
- 23
- Issue
- 25
- Pages
- 4632
- ISSN
- 1007-9327 (ISSN-L)
- PMC
- PMC5504379
- OpenAlex
- W2730702691
- Cited by
- 143
- References
- 70
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 14 · 2023: 12 · 2022: 21 · 2021: 18 · 2020: 13 · 2019: 23 · 2018: 10 · 2017: 5
- FWCI
- 14.60
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- World Journal of Gastroenterology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Keywords
- irritable bowel syndrome, low FODMAP diet, nutrition education, symptom severity, quality of life, gut microbiota, dietary fiber intake
- MeSH terms
- Gastrointestinal Microbiome, Adult, Colon, Disaccharides, Female, Fermentation, Humans, Male, Middle Aged, Patient Education as Topic, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Sugar Alcohols, Irritable Bowel Syndrome, Diet, Carbohydrate-Restricted
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