Advertisement

European Journal of Nutrition

, Volume 55, Issue 3, pp 897–906 | Cite as

Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis

  • Abigail Marsh
  • Enid M. Eslick
  • Guy D. Eslick
Original Contribution

Abstract

Background

Functional gastrointestinal symptoms such as abdominal pain, bloating, distension, constipation, diarrhea and flatulence have been noted in patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). The diversity of symptoms has meant that finding an effective treatment has been challenging with most treatments alleviating only the primary symptom. A novel treatment option for IBS and IBD currently generating much excitement is the low fermentable, oligo-, di-, mono-saccharides and polyol (FODMAP) diet. The aim of this meta-analysis was to determine the evidence of the efficacy of such a diet in the treatment of functional gastrointestinal symptoms.

Methods

Electronic databases were searched through to March 2015 to identify relevant studies. Pooled odds ratios (ORs) and 95 % confidence intervals were calculated for the effect of a low FODMAP diet on the reduction in IBS [Symptoms Severity Score (SSS)] score and increase in IBS quality of life (QOL) score for both randomized clinical trials (RCTs) and non-randomized interventions using a random-effects model.

Results

Six RCTs and 16 non-randomized interventions were included in the analysis. There was a significant decrease in IBS SSS scores for those individuals on a low FODMAP diet in both the RCTs (OR 0.44, 95 % CI 0.25–0.76; I 2 = 35.52, p = 0.00) and non-randomized interventions (OR 0.03, 95 % CI 0.01–0.2; I 2 = 69.1, p = 0.02). In addition, there was a significant improvement in the IBS-QOL score for RCTs (OR 1.84, 95 % CI 1.12–3.03; I 2 = 0.00, p = 0.39) and for non-randomized interventions (OR 3.18, 95 % CI 1.60–6.31; I 2 = 0.00, p = 0.89). Further, following a low FODMAP diet was found to significantly reduce symptom severity for abdominal pain (OR 1.81, 95 % CI 1.13–2.88; I 2 = 0.00, p = 0.56), bloating (OR 1.75, 95 % CI 1.07–2.87; I 2 = 0.00, p = 0.45) and overall symptoms (OR 1.81, 95 % CI 1.11–2.95; I 2 = 0.00, p = 0.4) in the RCTs. In the non-randomized interventions similar findings were observed.

Conclusion

The present meta-analysis supports the efficacy of a low FODMAP diet in the treatment of functional gastrointestinal symptoms. Further research should ensure studies include dietary adherence, and more studies looking at greater number of patients and long-term adherence to a low FODMAP diet need to be conducted.

Keywords

FODMAP Diet Functional gastrointestinal disorders FGID Symptoms Meta-analysis 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Russo MW, Gaynes BN, Drossman DA (1999) A national survey of practice patterns of gastroenterologists with comparison to the past two decades. J Clin Gastroenterol 29(339):43Google Scholar
  2. 2.
    Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM (2009) An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 104:S1–S35Google Scholar
  3. 3.
    Andrews EB, Eaton SC, Hollis KA, Hopkins JS, Ameen V, Hamm LR et al (2005) Prevalence and demographics of irritable bowel syndrome: results from a large web-based survey. Aliment Pharmacol Ther 22(10):935–942CrossRefGoogle Scholar
  4. 4.
    Horwitz BJ, Fisher RS (2001) The irritable bowel syndrome. N Engl J Med 344:1846–1850CrossRefGoogle Scholar
  5. 5.
    Anastasi JK, Capili B, Chang M (2013) Managing irritable bowel syndrome. AJN Am J Nurs 113(7):42–52CrossRefGoogle Scholar
  6. 6.
    Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM (2009) American college of gastroenterology task force on irritable bowel syndrome—an evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 104(Suppl 1):S1–S35Google Scholar
  7. 7.
    Eswaran S, Muir J, Chey WD (2013) Fiber and functional gastrointestinal disorders. Am J Gastroenterol 108:718–727CrossRefGoogle Scholar
  8. 8.
    Eswaran S, Tack J, Chey WD (2011) Food: the forgotten factor in the irritable bowel syndrome. Gastroenterol Clin N Am 40(1):141–162CrossRefGoogle Scholar
  9. 9.
    Shepherd SJ, Halmos E, Glance S (2014) The role of FODMAPs in irritable bowel syndrome. Curr Opin Clin Nutr Metab Care 17(6):605–609CrossRefGoogle Scholar
  10. 10.
    Gibson PR, Shepherd SJ (2005) Personal view: food for thought–western lifestyle and susceptibility to Crohn’s disease—the FODMAP hypothesis. Aliment Pharmacol Ther 21(12):1399–1409CrossRefGoogle Scholar
  11. 11.
    Parker K, Salas M, Nwosu VC (2010) High fructose corn syrup: production, uses and public health concerns. Biotechnol Mol Biol Rev 5(5):71–78Google Scholar
  12. 12.
    Barrett JS, Gearry RB, Muir JG, Irving PM, Rose R, Rosella O, Haines ML, Shepherd SJ, Gibson PR (2010) Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther 31(8):874Google Scholar
  13. 13.
    Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR et al (2010) Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol 25(8):1366CrossRefGoogle Scholar
  14. 14.
    Halmos E, Chrstopherrsen CT, Bird AR, Shepard SJ, Gibson PR, Muir JG (2015) Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut 64(1):93–100CrossRefGoogle Scholar
  15. 15.
    Huamán JW, Felip A, Guedea E, Jansana M, Videla S, Saperas E (2014) The diet low in fermentable carbohydrates short chain and polyols improves symptoms in patients with functional gastrointestinal disorders in Spain. Gastroenterol Hepatol 6(14):00245Google Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269CrossRefGoogle Scholar
  17. 17.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRefGoogle Scholar
  18. 18.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ Br Med J 327(7414):557–560CrossRefGoogle Scholar
  19. 19.
    Egger M, Davey S, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. Br Med J 1(315):629–634CrossRefGoogle Scholar
  20. 20.
    Orwin R (1983) A fail-safe N for effect size in meta-analysis. J Educ Stat 8:157–159CrossRefGoogle Scholar
  21. 21.
    Staudacher HM, Lomer MCE, Anderson JL, Barrett JS, Muir JG, Irving PM, Whelan K (2012) Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr 142(8):1510CrossRefGoogle Scholar
  22. 22.
    Pedersen N, Ankersen DV, Felding M, Vegh Z, Burisch J, Munkholm P (2014) Mo1210 low FODMAP diet reduces irritable bowel symptoms and improves quality of life in patients with inflammatory bowel disease in a randomized controlled trial. Gastroenterology 146(5):S-587CrossRefGoogle Scholar
  23. 23.
    Pedersen N, Andersen NN, Végh Z, Jensen L, Ankersen DV, Felding M, Simonsen M, Burisch J, Munkholm (2014) Ehealth: low FODMAP diet vs Lactobacillus rhamnosus GG in irritable bowel syndrome. World J Gastroenterol WJG 20(43):16215CrossRefGoogle Scholar
  24. 24.
    Harvie R, Schultz M, Chisholm A (2013) A reduction in FODMAP intake correlates strongly with a reduction in IBS symptoms–the FIBS study. J Gastroenterol Hepatol 28(Suppl. 3):23–693Google Scholar
  25. 25.
    Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG (2013) A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 146(1):67CrossRefGoogle Scholar
  26. 26.
    Staudacher HM, Whelan K, Irving PM, Lomer MCE (2011) Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 24(5):487–495CrossRefGoogle Scholar
  27. 27.
    Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR (2013) No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 145(2):320CrossRefGoogle Scholar
  28. 28.
    Chumpitazi BP, Tsai CM, McMeans AR, Shulman RJ (2014) A low fodmaps diet ameliorates symptoms in children with irritable bowel syndrome: a double blind, randomized crossover trial. Gastroenterology 146(5):S-144CrossRefGoogle Scholar
  29. 29.
    Pedersen N, Vegh Z, Burisch J, Jensen L, Ankersen DV, Felding M, Simonsen M, Burisch J, Munkholm P (2014) Ehealth monitoring in irritable bowel syndrome patients treated with low fermentable oligo-, di-, mono-saccharides and polyols diet. World J Gastroenterol 20(21):6680–6684CrossRefGoogle Scholar
  30. 30.
    Roest RH, Dobbs BR, Chapman BA, Batman B, O’Brien LA, Leeper JA, Hebblethwaite CR, Gearry RB (2013) The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Int J Clin Pract 67(9):895–903CrossRefGoogle Scholar
  31. 31.
    Zubek J, White R (2012) An audit investigating the efficacy of the low FODMAP diet in improving symptoms in patients with functional gastro-intestinal symptoms. Gut 61:A86–A86CrossRefGoogle Scholar
  32. 32.
    Mcgeoch V, Blackwell V, Wigham L, Hoare JM (2014) PWE-170: an audit of clinical response in patients with Ibs treated with the low Fodmap diet at St Mary’s Hospital. Gut 63(Supp 1):A199–A200CrossRefGoogle Scholar
  33. 33.
    O’Meara C, Craig OF, Mahmud N, McKiernan S, Maccarthy F (2013) A pilot study on the introduction of a low FODMAP diet in a subgroup of symptomatic IBS patients referred by the gastroenterology service in an Irish Tertiary Referral Centre. Gut 62(Suppl 2):A3–A4CrossRefGoogle Scholar
  34. 34.
    Ones M, Morken MH, Hatlebakk JG (2014) PP112-MON: effects of a Fodmap-restricted diet in a Scandinavian population with irritable bowel syndrome. Clin Nutr 33:S171CrossRefGoogle Scholar
  35. 35.
    Van Megen F, Kahrs GE (2014) Effects of a FODMAP-restricted diet on irritable bowel symptoms in patients with inflammatory bowel disease. United Eur Gastroenterol J 2(Suppl 1):P0342Google Scholar
  36. 36.
    Chevillat D, Neff S, Maghdessian R, Kiss C, Maissen S (2014) P091: L’approche FODMAP améliore la symptomatologie gastro-intestinale chez les patients adultes souffrant d’un syndrome de l’intestin irritable: une étude pilote. Nutrition Clinique et Métabolisme. UEG Week 28: S116Google Scholar
  37. 37.
    Zanini B, Marullo M, Ricci C, Lanzarotto F, Lanzini A (2014) Sa1989 non celiac gluten sensitivity (NCGS) is outnumbered by FODMAPs sensitivity in patients spontaneously adhering to gluten free diet (GFD): a two stage double blind prospective study. Gastroenterology 146(5):S-348CrossRefGoogle Scholar
  38. 38.
    Joyce T, Staudacher H, Whelan K, Irving P, Lomer M (2014) PWE-092 symptom response following advice on a diet low in short-chain fermentable carbohydrates (fodmaps) for functional bowel symptoms in patients with Ibd. Gut 63(Suppl 1):A164CrossRefGoogle Scholar
  39. 39.
    Mazzawi T, Hausken T, Gundersen D, El-Salhy M (2013) Effects of dietary guidance on the symptoms, quality of life and habitual dietary intake of patients with irritable bowel syndrome. Mol Med Rep 8(3):845–852Google Scholar
  40. 40.
    Gearry RB, Irving PM, Barrett JS, Nathan DM, Shepherd SJ, Gibson PR (2009) Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease—a pilot study. J Crohn’s Colitis 3(1):8–14CrossRefGoogle Scholar
  41. 41.
    Azpiroz F, Guyonnet D, Donazzolo Y, Gendre D, Tanguy J, Guarner F (2014) Digestive symptoms in healthy people and subjects with irritable bowel syndrome: validation of symptom frequency questionnaire. J Clin Gastroenterol 1Google Scholar
  42. 42.
    Francis CY, Morris J, Whorwell PJ (1997) The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther 11(2):395–402CrossRefGoogle Scholar
  43. 43.
    Patrick DL, Drossman DA, Frederick IO, DiCesare J, Puder KL (1998) Quality of life in persons with irritable bowel syndrome: development and validation of a new measure. Dig Dis Sci 43(2):400CrossRefGoogle Scholar
  44. 44.
    Drossman D, Morris CB, Hu Y, Toner BB, Diamant N, Whitehead WE et al (2007) Characterization of health related quality of life (HRQOL) for patients with functional bowel disorder (FBD) and its response to treatment. Am J Gastroenterol 102(7):1442–1453CrossRefGoogle Scholar
  45. 45.
    Christodoulides S (2014) PWE-184 the effect of fibre on chronic constipation in adults: a systematic review. Gut 63(suppl 1):A206–A207CrossRefGoogle Scholar
  46. 46.
    James SL et al (2009) FODMAP but not fibre intake is associated with IBS-like symptoms in patients with IBD. J Gastroenterol Hepatol 24:A313–A314Google Scholar
  47. 47.
    Rome F (2006) Guidelines-Rome III diagnostic criteria for functional gastrointestinal disorders. J Gastrointest Liver Dis 15(3):307–312Google Scholar
  48. 48.
    Buono JL, Tourkodimitris S, Sarocco P, Johnston JM, Carson RT (2014) Impact of linaclotide treatment on work productivity and activity impairment in adults with irritable bowel syndrome with constipation: results from 2 randomized, double-blind, placebo-controlled phase 3 trials. Am Health Drug Benefits 7(5):289Google Scholar
  49. 49.
    Muir JG, Rose R, Rosella O, Liels K, Barrett JS, Shepherd SJ et al (2009) Measurement of short-chain carbohydrates in common australian vegetables and fruits by high-performance liquid chromatography (HPLC). J Agric Food Chem 57(2):554–565CrossRefGoogle Scholar
  50. 50.
    Staudacher HM, Lomer MCE, Anderson JL, Barrett JS, Muir JG, Irving PM et al (2010) Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr 142(8):1510CrossRefGoogle Scholar
  51. 51.
    Tuck CJ (2014) Fermentable oligosaccharides, disaccharides, monosaccharides and polyols: role in irritable bowel syndrome. Expert Rev Gastroenterol Hepatol 8(7):819–834CrossRefGoogle Scholar
  52. 52.
    Azpiroz F, Malagelada J (2005) Abdominal bloating. Gastroenterology 129(3):1060–1078CrossRefGoogle Scholar
  53. 53.
    Spiegel BMR, Bolus R, Harris LA, Lucak S, Chey WD, Sayuk G et al (2010) Characterizing abdominal pain in IBS: guidance for study inclusion criteria, outcome measurement and clinical practice. Aliment Pharmacol Ther 32(9):1192CrossRefGoogle Scholar
  54. 54.
    Houghton LA, Lea R, Agrawal A, Agrawal A, Reilly B, Whorwell PJ (2006) Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology 131(4):1003CrossRefGoogle Scholar
  55. 55.
    Böhn L, Störsrud S, LiIjebo T, Collin L, Törnblom H, Simrén M (2014) A Multi-center, randomized, controlled, single-blind, comparative trial: low-FODMAP diet versus traditional dietary advice in IBS. United Eur Gastroenterol J 2(1S):A1–A131Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Abigail Marsh
    • 1
  • Enid M. Eslick
    • 1
  • Guy D. Eslick
    • 1
  1. 1.The Whiteley-Martin Research Centre, Discipline of SurgeryThe University of Sydney, Nepean HospitalPenrithAustralia

Personalised recommendations