Low FODMAP Diet Helps IDB Patients

December 18, 2019
A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) food could help lower guy symptoms for patients suffering from quiescent inflammatory bowel disease (IBD).

A team, led by Selina R. Cox, PhD, Department of Nutritional Sciences, King’s College London, conducted a randomized, controlled trial investigating the impact of a low FODMAP diet on persistent gut symptoms, the intestinal microbiome, and circulating markers of inflammation in patients with quiescent IBD or ulcerative colitis and persistent gut symptoms.

“We conclude that a 4-week diet low in FODMAPs is safe and effective for managing persistent gut symptoms in patients with quiescent IBD,” the authors wrote.

The 52-patient study was conducted at a pair of large gastroenterology clinics in the UK. Each patient was randomly assigned to either a group that followed a diet low in FODMAPs (n=27) or a controlled diet (n+25), with dietary advice, for 4 weeks.

The investigators measured gut symptoms and analyzed health-related quality of life features using validated questionnaires. They also collected stool and blood samples at baseline, as well as at the end of the trial and assessed fecal microbiome composition and function using shotgun metagenomics sequencing and phenotypes of T cells in blood using flow cytometry.   

A higher proportion of patients reported adequate relief of gut symptoms following a low FODMAP diet (52%) than the control group (16%, P =.007).

Patients had a greater reduction in irritable bowel syndrome severity scores following the low FODMAP diet (mean reduction of 67, standard error, 78) than the control diet (mean reduction of 34; standard error, 50), but the difference was not statistically significant (P =.075).

Patients also had higher quality of life scores (81.9 ± 1.2) following a low FODMAP diet than patients on the control diet (78.3 ± 1.2, P = .042).

The targeted analysis revealed in stool samples collected at the conclusion of the study that patients on the low FODMAP diet had significantly lower abundance of Bifidobacterium adolescentis, Bifidobacterium longum, and Faecalibacterium prausnitzii than patients on control diet.

On the other hand, microbiome diversity and markers of inflammation did not differ significantly between groups.

“In a trial of the low FODMAP diet vs a control diet in patients with quiescent IBD, we found no significant difference after 4 weeks in change in irritable bowel syndrome severity scores, but significant improvements in specific symptom scores and numbers reporting adequate symptom relief,” the authors wrote. “The low FODMAP diet reduced fecal abundance of microbes believed to regulate the immune response, compared with the control diet, but had no significant effect on markers of inflammation.”

Approximately 35% of patients with IBD experience gut symptoms despite having quiescent disease with minimal objective evidence of gastrointestinal inflammation.

The etiology of the gut symptoms in quiescent IBD is not well-known, but many investigators believe they relate to coexistent irritable bowel syndrome. 

The study, “Effects of Low FODMAP Diet on Symptoms, Fecal Microbiome, and Markers of Inflammation in Patients With Quiescent Inflammatory Bowel Disease in a Randomized Trial,” was published online in Gastroenterology.
 
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