Low FODMAP Diet Improves GI Symptoms in IBS
Low FODMAP Diet Improves GI Symptoms in IBS
Ninety (46.9%) of 192 patients with IBS, who had received dietary intervention and had performed hydrogen breath tests, completed the follow-up questionnaire. We describe the symptom change in these 90 patients, with a mean follow up of 15.7 (±9.0) months. The characteristics of the patient groups are described in Table 1.
There were no significant differences between the repliers and the non-repliers with regard to age, outcome of the hydrogen breath tests and the presenting symptoms. However, more women replied to the invitation to take part in the study than men (female repliers 84.4%, non-repliers 64.7%, p = 0.003). Sixty-eight (75.6%), 34 (37.9%) and 12 (13.3%) patients had fructose, lactose malabsorption and SIBO respectively.
There was a significant positive change in almost all of the reported symptoms between baseline and follow up (Table 2). 'Feeling full even long after stopping eating' (p = 0.051), 'burping' (p = 0.275) and 'passage of mucus' (p = 0.890) did not improve significantly. To determine if the results of dietary intervention could be explained purely on the basis of the characteristics of those who replied to the questionnaire, we repeated the analysis including non-repliers, assuming that none of them had improved with the intervention (i.e. they were assigned the same follow-up symptom scores as their baseline assessment). Table 2 shows that the same symptoms remain significant across the whole cohort.
Table 3 shows the degree of improvement for each symptom as a function of the absolute difference in scores along the Likert scale used for each symptom (as opposed to Table 2, which only shows whether or not there has been an improvement). Not only did most patients' symptoms improve but also the magnitude of the improvement was usually significant (Table 3).
Although the patients completed the baseline and follow-up symptom questionnaire independently, we were also interested whether each patient thought that symptoms had improved on the diet (using questionnaires utilised by other investigators who had assessed the low FODMAP diet retrospectively). Figure 1 shows that the majority report an improvement on the symptoms assessed.
(Enlarge Image)
Figure 1.
Percentage of patients that report self-experienced improvement (based on a dichotomised Likert scale)
Patients with fructose malabsorption were significantly more likely to report an improvement in bloating, abdominal pain/discomfort, flatulence/wind, diarrhoea and constipation following dietary intervention than those without breath test evidence of fructose malabsorption (Table 4). For most symptoms, there were no demographic differences between non-responders and responders except for abdominal pain, where male patients were less likely than female patients to improve (p = 0.015).
Most patients described ongoing adherence to the diet (n = 68, 75.6%). Describing those most to least adherent, 32 (35.6%) patients followed the diet as taught at all times except on some occasions; 11 (12.2%) followed the diet at all times; 12 (13.3%) patients also at all times except when eating away from home; 13 (14.4%) of the patients consider themselves as being adherent to the diet for at least 50% of the time; 22 (24.4%) participants were non-adherent; 13 (14.4%) followed the diet for up to 3 months, but not anymore; five (5.6%) followed the diet as taught immediately, but less than 50% of the time now; four (4.4%) never followed the diet.
There was a significant positive correlation between adherence and improvement in bloating (rs(83)= 0.273, p = 0.011), abdominal pain/discomfort (rs(87) = 0.271, p = 0.010), flatulence/wind (rs(85) = 0.374, p = 0.000), diarrhoea (rs(72) = 0.310, p = 0.007), constipation (rs(63) = 0.296, p = 0.017) and energy levels (rs(81) = 0.271, p = 0.013).
At follow up, 62 (72.1%) patients were satisfied with their overall symptoms. In total, 77 (89.5%) thought that the written information was easy to understand, while 66 (75.9%) believed that having had breath testing made the diet easier to understand and adhere to. Fifty-one (60%) patients stated that the diet was easy to follow, 56 (65.1%) could easily find suitable products and 37 (43.5%) were able to incorporate the diet easily into their life. The overall taste was liked by 47 (54.7%) patients, although 21 (24.4%) thought that the diet was too expensive. Sixteen (18.2%) believed that simply being given a list of foods to avoid, it would have been as effective as seeing the dietitian for a consultation while 37 (44.6%) patients would have liked to have seen the dietitian for a further follow-up appointment.
Patients were asked to rank five variables that were associated with efficacy and adherence to the diet. Written information (mean rank 1.73 (±0.76)) and dietitian consultation (1.89 (±1.09)) were ranked highest while the support of family and friends (3.33 (±1.15)), low FODMAP cookbooks (3.89 (±1.00)) and online information (4.11 (±1.00)) were thought to be less important. The association between adherence to and aspects of the diet was explored. Patients who were most likely to adhere to the diet were those who liked the overall taste of the diet (p = 0.001), found the diet easy to follow (p = 0.004), found the breath test results helped to understand the role of the diet (p < 0.001) and found the diet easy to incorporate into their life (p = 0.016). Understanding of written information given to patients about the diet, ease of identifying suitable foods and the expense of the diet were not significantly associated with good or poor adherence to the diet.
Results
Ninety (46.9%) of 192 patients with IBS, who had received dietary intervention and had performed hydrogen breath tests, completed the follow-up questionnaire. We describe the symptom change in these 90 patients, with a mean follow up of 15.7 (±9.0) months. The characteristics of the patient groups are described in Table 1.
There were no significant differences between the repliers and the non-repliers with regard to age, outcome of the hydrogen breath tests and the presenting symptoms. However, more women replied to the invitation to take part in the study than men (female repliers 84.4%, non-repliers 64.7%, p = 0.003). Sixty-eight (75.6%), 34 (37.9%) and 12 (13.3%) patients had fructose, lactose malabsorption and SIBO respectively.
Improvement of Symptoms
There was a significant positive change in almost all of the reported symptoms between baseline and follow up (Table 2). 'Feeling full even long after stopping eating' (p = 0.051), 'burping' (p = 0.275) and 'passage of mucus' (p = 0.890) did not improve significantly. To determine if the results of dietary intervention could be explained purely on the basis of the characteristics of those who replied to the questionnaire, we repeated the analysis including non-repliers, assuming that none of them had improved with the intervention (i.e. they were assigned the same follow-up symptom scores as their baseline assessment). Table 2 shows that the same symptoms remain significant across the whole cohort.
Table 3 shows the degree of improvement for each symptom as a function of the absolute difference in scores along the Likert scale used for each symptom (as opposed to Table 2, which only shows whether or not there has been an improvement). Not only did most patients' symptoms improve but also the magnitude of the improvement was usually significant (Table 3).
Although the patients completed the baseline and follow-up symptom questionnaire independently, we were also interested whether each patient thought that symptoms had improved on the diet (using questionnaires utilised by other investigators who had assessed the low FODMAP diet retrospectively). Figure 1 shows that the majority report an improvement on the symptoms assessed.
(Enlarge Image)
Figure 1.
Percentage of patients that report self-experienced improvement (based on a dichotomised Likert scale)
Associations With Symptom Change
Patients with fructose malabsorption were significantly more likely to report an improvement in bloating, abdominal pain/discomfort, flatulence/wind, diarrhoea and constipation following dietary intervention than those without breath test evidence of fructose malabsorption (Table 4). For most symptoms, there were no demographic differences between non-responders and responders except for abdominal pain, where male patients were less likely than female patients to improve (p = 0.015).
Adherence to the Diet
Most patients described ongoing adherence to the diet (n = 68, 75.6%). Describing those most to least adherent, 32 (35.6%) patients followed the diet as taught at all times except on some occasions; 11 (12.2%) followed the diet at all times; 12 (13.3%) patients also at all times except when eating away from home; 13 (14.4%) of the patients consider themselves as being adherent to the diet for at least 50% of the time; 22 (24.4%) participants were non-adherent; 13 (14.4%) followed the diet for up to 3 months, but not anymore; five (5.6%) followed the diet as taught immediately, but less than 50% of the time now; four (4.4%) never followed the diet.
Adherence and Symptom Change
There was a significant positive correlation between adherence and improvement in bloating (rs(83)= 0.273, p = 0.011), abdominal pain/discomfort (rs(87) = 0.271, p = 0.010), flatulence/wind (rs(85) = 0.374, p = 0.000), diarrhoea (rs(72) = 0.310, p = 0.007), constipation (rs(63) = 0.296, p = 0.017) and energy levels (rs(81) = 0.271, p = 0.013).
Satisfaction With Symptom Improvement, Dietary Advice and Diet
At follow up, 62 (72.1%) patients were satisfied with their overall symptoms. In total, 77 (89.5%) thought that the written information was easy to understand, while 66 (75.9%) believed that having had breath testing made the diet easier to understand and adhere to. Fifty-one (60%) patients stated that the diet was easy to follow, 56 (65.1%) could easily find suitable products and 37 (43.5%) were able to incorporate the diet easily into their life. The overall taste was liked by 47 (54.7%) patients, although 21 (24.4%) thought that the diet was too expensive. Sixteen (18.2%) believed that simply being given a list of foods to avoid, it would have been as effective as seeing the dietitian for a consultation while 37 (44.6%) patients would have liked to have seen the dietitian for a further follow-up appointment.
Variables Associated With Adherence
Patients were asked to rank five variables that were associated with efficacy and adherence to the diet. Written information (mean rank 1.73 (±0.76)) and dietitian consultation (1.89 (±1.09)) were ranked highest while the support of family and friends (3.33 (±1.15)), low FODMAP cookbooks (3.89 (±1.00)) and online information (4.11 (±1.00)) were thought to be less important. The association between adherence to and aspects of the diet was explored. Patients who were most likely to adhere to the diet were those who liked the overall taste of the diet (p = 0.001), found the diet easy to follow (p = 0.004), found the breath test results helped to understand the role of the diet (p < 0.001) and found the diet easy to incorporate into their life (p = 0.016). Understanding of written information given to patients about the diet, ease of identifying suitable foods and the expense of the diet were not significantly associated with good or poor adherence to the diet.
