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Cited by 143Gastrointestinal motility and disordersGut microbiota and healthInfant Health and Development

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Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs

Open access
Harvie, Ruth M, Chisholm, Alexandra W, Bisanz, Jordan E, Burton, Jeremy P, Herbison, Peter, Schultz, Kim, Schultz, Michael·2017·World Journal of Gastroenterology
DOI 10.3748/wjg.v23.i25.4632PMC PMC5504379
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Abstract

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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Crossref · 10.3748/wjg.v23.i25.4632

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Figure 1 Participant flow.
Figure 1 Participant flow.CC BY-NC · PubMed Central
Figure 2 Comparison of total FODMAP intake between group I who received dietary education immediately after randomisation and began reintroducing FODMAP at three months and group II who received dietary education after the collection of the 3-mo data. Total FODMAP is the sum of galacto-oligosaccharides, fructo-oligosacchardies, lactose, fructose in excess of glucose, sorbitol and mannitol in grams as measured on a FODMAP specific food frequency questionnaire[34]. aP < 0.05, bP < 0.01.
Figure 2 Comparison of total FODMAP intake between group I who received dietary education immediately after randomisation and began reintroducing FODMAP at three months and group II who received dietary education after the collection of the 3-mo data. Total FODMAP is the sum of galacto-oligosaccharides, fructo-oligosacchardies, lactose, fructose in excess of glucose, sorbitol and mannitol in grams as measured on a FODMAP specific food frequency questionnaire[34]. aP < 0.05, bP < 0.01.CC BY-NC · PubMed Central
Figure 3 Change in IBS severity scoring system[35] by group and time period. Participants in Group I received dietary education immediately after baseline measures and started reintroductions to tolerance at 3 mo. Participants in group II received dietary education after collection of data at 3 mo. Scores > 300 indicate severe IBS, 175-300 indicate moderate IBS, 50-175 indicate mild IBS and scores < 50 are similar to those of people without IBS. aP < 0.05, bP < 0.01.
Figure 3 Change in IBS severity scoring system[35] by group and time period. Participants in Group I received dietary education immediately after baseline measures and started reintroductions to tolerance at 3 mo. Participants in group II received dietary education after collection of data at 3 mo. Scores > 300 indicate severe IBS, 175-300 indicate moderate IBS, 50-175 indicate mild IBS and scores < 50 are similar to those of people without IBS. aP < 0.05, bP < 0.01.CC BY-NC · PubMed Central
Figure 4 Maximum number of bowel motions reported per day by participants by time period and group. Group I received their dietary education after the collection of baseline measures and started reintroducing FODMAP to tolerance at 3 mo. Group II received their dietary education after the collection of data at 3 mo. bP < 0.01.
Figure 4 Maximum number of bowel motions reported per day by participants by time period and group. Group I received their dietary education after the collection of baseline measures and started reintroducing FODMAP to tolerance at 3 mo. Group II received their dietary education after the collection of data at 3 mo. bP < 0.01.CC BY-NC · PubMed Central
Figure 5 Days in ten when participants were experiencing pain by time period and group. Participants in Group I received dietary education after collection of baseline measures and at 3 mo were encouraged to reintroduce FODMAP foods to tolerance. Participants in Group II received dietary education after the collection of data at 3 mo. bP < 0.01.
Figure 5 Days in ten when participants were experiencing pain by time period and group. Participants in Group I received dietary education after collection of baseline measures and at 3 mo were encouraged to reintroduce FODMAP foods to tolerance. Participants in Group II received dietary education after the collection of data at 3 mo. bP < 0.01.CC BY-NC · PubMed Central
Figure 6 Change in severity of pain (A) and abdominal distension (B) by group and time period. Increasing scores represent increasing severity. This is a subscale of the irritable bowel syndrome symptom severity scoring system[34]. Participants in group I received dietary education immediately after collecting baseline measures and after 3 mo were reintroducing FODMAPs to tolerance. Participants in Group II received dietary education after the data collection at 3 mo.
Figure 6 Change in severity of pain (A) and abdominal distension (B) by group and time period. Increasing scores represent increasing severity. This is a subscale of the irritable bowel syndrome symptom severity scoring system[34]. Participants in group I received dietary education immediately after collecting baseline measures and after 3 mo were reintroducing FODMAPs to tolerance. Participants in Group II received dietary education after the data collection at 3 mo.CC BY-NC · PubMed Central
Figure 7 Change in irritable bowel syndrome related quality of life[36] by time period and group. Participants in group I received dietary education after the collection of baseline measures and started reintroducing FODMAP to tolerance after collecting of data at 3 mo. Group II received their dietary education after the collection of data at 3 mo. aP < 0.05, bP < 0.01.
Figure 7 Change in irritable bowel syndrome related quality of life[36] by time period and group. Participants in group I received dietary education after the collection of baseline measures and started reintroducing FODMAP to tolerance after collecting of data at 3 mo. Group II received their dietary education after the collection of data at 3 mo. aP < 0.05, bP < 0.01.CC BY-NC · PubMed Central
Figure 8 Comparison of total fiber intake between group I who received dietary education immediately after randomisation and began reintroducing FODMAP at three months and group II who received dietary education after the collection of the 3-mo data. Fiber intake was measured on a food frequency questionnaire[34] previously validated for estimating fibre intakes. Recommended fiber intakes for NZ adult males are 30 g per day and for adult NZ females are 25 g per day as represented by the horizontal lines, bP < 0.01.
Figure 8 Comparison of total fiber intake between group I who received dietary education immediately after randomisation and began reintroducing FODMAP at three months and group II who received dietary education after the collection of the 3-mo data. Fiber intake was measured on a food frequency questionnaire[34] previously validated for estimating fibre intakes. Recommended fiber intakes for NZ adult males are 30 g per day and for adult NZ females are 25 g per day as represented by the horizontal lines, bP < 0.01.CC BY-NC · PubMed Central
Figure 9 Diversity of samples measured by the Shannon index. Participants in Group I commenced the low FODMAP diet after collection of the baseline measures and in Group II after the collection of data at three months. Each sample is represented by one dot.
Figure 9 Diversity of samples measured by the Shannon index. Participants in Group I commenced the low FODMAP diet after collection of the baseline measures and in Group II after the collection of data at three months. Each sample is represented by one dot.CC BY-NC · PubMed Central

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  1. Shepherd SJ, Gibson P. Food intolerance management plan Australia: Penguin Group; 2011;.

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Metadata

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
ORCID
Venue
World Journal of Gastroenterology
Publisher
Baishideng Publishing Group Inc.
Published
2017
Volume
23
Issue
25
Pages
4632
ISSN
1007-9327 (ISSN-L)
DOI
10.3748/wjg.v23.i25.4632
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
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 › Medicine › Pediatrics, Perinatology and Child Health › 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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