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A diet low in fermentable sugars and polyols improves symptoms in diarrhoea predominant irritable bowel syndrome

Published online by Cambridge University Press:  20 May 2014

A. C. O. Okonkwo ,
B. Davidson  and
N. P. Thompson
A. C. O. Okonkwo
Affiliation:
Newcastle University Medical School, Newcastle, UK, NE2 4HH
B. Davidson
Affiliation:
Department of Dietetics, Newcastle Hospitals, UK, NE4 5PL
N. P. Thompson
Affiliation:
Department of Gastroenterology, Newcastle Hospitals, UK, NE4 5PL
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Abstract

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Proceedings of the Nutrition Society , Volume 73 , Issue OCE1: Winter Meeting, 11–12 December 2013, Diet, gut microbiology and human health , 2014 , E27
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Copyright © The Authors 2014 

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that has a prevalence of 10–15% in industrialised countries( Reference Maxion-Bergemann, Thielecke and Abel 1 ). Diarrhoea predominant irritable bowel syndrome (IBS-D) primarily effects the working population (females 20–40 years old)( Reference Maxion-Bergemann, Thielecke and Abel 1 ). Fermentable oligosaccharides, monosaccharides and polyols (FODMAPs) cause bloating and loose stools through increased hydrogen gas and an osmotic gradient for increased water entry into the gut lumen( Reference Gibson and Shepherd 2 ). A low FODMAP diet has been proven to reduce IBS-D symptoms; however, these reductions have not been quantified( Reference Gibson and Shepherd 2 ).

Observe if the symptomatic benefit demonstrated in the literature could be reproduced in the North-East of England and to quantify the efficacy of a low FODMAP diet in IBS-D.

Symptom change according to the Birmingham IBS Symptom Questionnaire was recorded after 4 weeks( Reference Roalfe, Roberts and Wilson 3 ). Symptom severity was numerated for analysis: all of the time = 6; most of the time = 5; a good bit of the time = 4; some of the time = 3; a little of the time = 2; none of the time = 1. Statistical significance was calculated using Prism 6.0 (GRAPHPAD) by unpaired t-test.

Of 42 suitable patients 21 responded to the questionnaire, all were compliant with the diet for a minimum of 4 weeks. 10 reported complete resolution of symptoms. 15 patients saw an improvement in questionnaire symptom category in abdominal discomfort (−1.8 ± 0.5, p < 0.01), 11 whilst sleeping (−0.9 ± 0.4, p < 0.05) and 14 after eating (−1.4 ± 0.6, p < 0.05). 13 experienced fewer loose bowel motions (−1.4 ± 0.5, p < 0.05) and 13 experienced less urgency (−1.2 ± 0.4, p < 0.001).

Antispasmodics and antidepressants improve IBS-D symptoms in 37% and 53% of patients respectively compared to the 71% of patients in this study implying that a low FODMAP diet is not only a safer treatment but also a more effective treatment( Reference Ruepert, Quartero and de Wit 4 ). However, due to the 50% response rate responder bias might have been present. The low diet is most effective at reducing abdominal discomfort it also significantly reduces loose bowel motions and urgency in IBS-D. The low FODMAP diet has been translated to clinical practice in the Northern region of England.

References

1. Maxion-Bergemann, S, Thielecke, F, Abel, F et al. (2006) Costs of irritable bowel syndrome in the UK and US. Pharmacoeconomics. 24(1), 21–37.CrossRefGoogle Scholar
2. Gibson, PR & Shepherd, SJ (2010) Evidence-based dietary management of functional gastrointestinal symptoms: FODMAP approach. Journal of Gastroenterology and Hepatology 252–258.CrossRefGoogle ScholarPubMed
3. Roalfe, A, Roberts, L, Wilson, S Birmingham IBS Symptom Questionnaire. [Online]. Available from: http://www.biomedcentral.com/content/supplementary/1471-230x-8-30-s2.pdf.Google Scholar
4. Ruepert, L, Quartero, A, de Wit, N, et al. (2011) Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database Systematic Review. August 10; 8: p. CD003460.Google Scholar