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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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![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.](/paper-figures/3e3e591f6cca4d538439384deef01c90/long-term-irritable-bowel-syndrome-symptom-control-with-reintroduction-of-figure-2.jpg)
![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.](/paper-figures/17f017167ce143e4b677937c08876596/long-term-irritable-bowel-syndrome-symptom-control-with-reintroduction-of-figure-3.jpg)
![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.](/paper-figures/f44a96078ccd4a08ab51d30241bc24a4/long-term-irritable-bowel-syndrome-symptom-control-with-reintroduction-of-figure-6.jpg)
![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.](/paper-figures/ceb0ae7e3e8d4b30990eb6464ad2ef59/long-term-irritable-bowel-syndrome-symptom-control-with-reintroduction-of-figure-7.jpg)
![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.](/paper-figures/7f7d091b209b495a94e738a60f4c6669/long-term-irritable-bowel-syndrome-symptom-control-with-reintroduction-of-figure-8.jpg)
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“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]
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“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]
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“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]
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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
- 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 › 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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