FODMAP Elimination Diet?

[lmggallagher]

Jeff

Do you have experience with the LOWFODMAP Diet for IBS.

I was told about it for my fibromylagia and IBS. So far, it has wiped out my fibro pain (which has not ever happened before - very encouraging) and the tummy issues are resolving some too, but more slowly. This is my 3rd day on. I understand it can resolve IBS symptoms in 7 days often.

I will see my doc and get a referral to a RD soon - I just jumped in because I was in a desperate place with both the above.

If you use this, do your any of your clients notice headache and nausea iinitially?

Is this like a detox reaction?

Thanks - Michelle

[JeffN]

Jeff Do you have experience with the LOWFODMAP Diet for IBS.

I have quite a bit of successful experience with this program and standard elimination diets in working with IBS & fibro.

In fact, this was posted on my wall this morning from someone I worked with who had, amongst several issues, IBS (which was fairly quickly resolved), though sometimes it takes time.

"Today's gratitude: .... Grateful for my health and for Jeff Novick who revolutionized the way I eat over 25 yrs ago. I know I'm receiving the dividends today! "

In Health
Jeff

[lmggallagher]

Thanks Jeff

I did get a good reduction of my FMS symptoms early on ( two years on now) but it's back with strong IBS symptoms, as well . Given that I thought I'd try the elimination diet - I have found through this WOE some foods I am intolerant too. As I was phasing into the ED Dr. McDougall has on the site here - I actually got worse.

So someone here recommended the Monash University Melbourne - FODMAP and I am doing it in conjunction with my regular MWL. It seems to be doing the ticket - at least lowering the fibro pain so far. I was reacting to the ED fruits and seeing this article below I now understand why that could be.

http://www.medicine.virginia.edu/clinic ... Dec_12.pdf

This is an interesting article in "Annuals of the Rheumatic Diseases" - seems some FMS folk (as waste basket diagnosis no telling how many fit this) have this bacteria in their small intestine - which causes the symptoms. So I'll pursue that too.

http://m.ard.bmj.com/content/63/4/450.full

As for the lucky guy below, fantastic - and I am so glad he posted that today. I have relieved myself of lots of other problems here - so, I join him in the high praise too. It's so well deserved for all you have done for all of us here and out there in the bigger universe too!

Thanks - Michelle

[JeffN]

Does a low FODMAP diet help IBS?
http://dtb.bmj.com/content/early/2015/0 ... 6.abstract
DTB doi:10.1136/dtb.2015.8.0346


Abstract
Irritable bowel syndrome (IBS) is a common condition that can have a significant impact on a person's quality of life.1 The cause of IBS is unknown but several mechanisms have been proposed including visceral hypersensitivity, central sensitisation, abnormal gut motility and altered gut microbiota.2,3 IBS is challenging to manage and many patients report insufficient symptomatic relief from treatment.2 Approximately 60% of patients identify food as a trigger for their symptoms,2 and there has been interest in exclusion diets for managing IBS.4 Dietary adaptation is a common self-management strategy for patients with IBS, with many self-diagnosing intolerance to specific foods. This may lead to patients adopting over-restrictive or inappropriate diets.5

In recent years, a diet low in poorly absorbed short-chain carbohydrates, known collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), has been advocated for the treatment of IBS.2 Here, we discuss the background to the FODMAP diet and review the evidence supporting its use for people with IBS.



Press Release

Very little evidence for cutting out certain carbs to ease irritable bowel
Value of FODMAP diet, developed in Australia to curb symptoms, questioned
PUBLIC RELEASE: 6-AUG-2015

There is very little evidence to recommend avoiding certain types of dietary carbohydrate, known as the FODMAP diet, to ease the symptoms of irritable bowel syndrome, or IBS for short, concludes a review of the available data in Drug and Therapeutics Bulletin (dtb).

IBS is characterised by abdominal pain/discomfort and altered bowel frequency in the absence of any obvious gut abnormalities. Symptoms can include abdominal bloating, which eating can worsen.

Up to one in five of the population is thought to be affected, with women twice as likely to develop IBS symptoms as men.

Treatment options include dietary and lifestyle advice, psychotherapy, and drugs to curb painful spasms and associated diarrhoea and/or constipation.

Dietary advice usually includes the recommendation to reduce intake of insoluble fibre, limit fresh fruit to three portions a day, take regular meals, avoid rushing food or eating on the go, and to steer clear of the artificial sweetener sorbitol.

The low FODMAP diet, which was developed in Australia, is based on the observation that certain types of short chain carbs are poorly absorbed by the small intestine and that IBS symptoms worsen when these are eaten.

These short chain carbs are present in wheat, onions, and legumes; milk; honey, apples, and high fructose corn syrup; and the artificial sweeteners used in confectionery (sorbitol and mannitol). They are rapidly fermented in the gut, increasing water volume and gases.

After assessing the available published evidence and the three UK guidelines on the management of IBS, dtb says that all the trials provide some evidence that patients feel the diet reduces some of the symptoms.

And one study indicates that the diet changes the profile of the bacteria in the gut, although what the clinical implications of this are, or, indeed, what the long term effects might be, are unclear, says dtb.

But data to back the use of a low FODMAP diet as an effective treatment to control symptoms "is based on a few relatively small, short term unblinded or single blinded controlled trials of varying duration," it cautions.

And dietary manipulation is not without its drawbacks as some people fail to maintain a balanced diet when trying dietary exclusions, says dtb.

While some guidelines suggest that a low FODMAP diet might be appropriate for motivated patients for whom other treatments have failed to relieve symptoms, this should only be done under the supervision of a dietitian with specialist expertise in this type of dietary intervention, it recommends.

And it concludes: "However, we believe that patients should be advised that there is very limited evidence for its use, the ideal duration of treatment has not been assessed in a clinical trial, and its place in the management of IBS has not been fully established."


Also


Diet low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome as Well as Traditional Dietary Advice: A Randomized Controlled Trial.
Gastroenterology. 2015 Aug 5. pii: S0016-5085(15)01086-0. doi: 10.1053/j.gastro.2015.07.054.

http://www.ncbi.nlm.nih.gov/pubmed/26255043


METHODS:We performed a multi-center, parallel, single-blind study of 75 patients who met the Rome III criteria for IBS, enrolled at gastroenterology outpatient clinics in Sweden. Subjects were randomly assigned to groups that ate specific diets for 4 weeks: a diet low in FODMAPs (n=38) or a diet frequently recommended for patients with IBS (a regular meal pattern; avoidance of large meals; and reduced intake of fat, insoluble fibers, caffeine and gas-producing foods such as beans, cabbage, and onions), with greater emphasis on how and when to eat rather than on what foods to ingest (n=37). Symptom severity was assessed using the IBS severity scoring system, and patients completed a 4 day food diary before and at the end of the intervention.RESULTS:A total of 67 patients completed the dietary intervention (33 completed the diet low in FODMAPs, 34 completed the traditional IBS diet). The severity of IBS symptoms was reduced in both groups during the intervention (P<.0001 in both groups, before vs at the end of the 4 week diet), without a significant difference between the groups (P=.62). At the end of the 4 week diet period, 19 patients (50%) in the low FODMAP group had reductions in IBS severity scores ≥50, compared with baseline, vs 17 patients (46%) in the traditional IBS diet group (P=.72). Food diaries demonstrated good adherence to the dietary advice.CONCLUSIONS:A diet low in FODMAPs reduces symptoms of IBS symptoms as well as traditional IBS dietary advice. Combining elements from these 2 strategies might further reduce symptoms of IBS.

[JeffN]

An excellent review on the topic

American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation
The American Journal of Gastroenterology
VOLUME 109 | SUPPLEMENT 1 | AUGUST 2014

http://gi.org/wp-content/uploads/2014/0 ... g_2014.pdf

[JeffN]

A Systematic Review and Meta-Analysis Evaluating the Efficacy of a Gluten-Free Diet and a Low FODMAPs Diet in Treating Symptoms of Irritable Bowel Syndrome.
Am J Gastroenterol. 2018 Sep;113(9):1290-1300. doi: 10.1038/s41395-018-0195-4. Epub 2018 Jul 26.

Dionne J1, Ford AC2,3, Yuan Y1, Chey WD4, Lacy BE5, Saito YA6, Quigley EMM7, Moayyedi P8,9.
Author information
Abstract

OBJECTIVE:
Dietary triggers such as gluten and highly fermentable oligo-, di- and monosaccharides and polyols (FODMAP)-containing foods have been associated with worsening irritable bowel syndrome (IBS) symptoms. However, the true impact of dietary restriction on IBS symptoms has remained unclear. The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the efficacy of exclusion diets (we focused on low FODMAP and gluten-free diets (GFD)) in IBS.

METHODS:
We conducted a search of the literature using the electronic databases MEDLINE (1946 to November 2017), EMBASE (1974 to November 2017), Cochrane Central Register of Controlled Trials (November 2017), and Cochrane Database of Systematic Reviews (2005 to November, 2017) for RCTs of exclusion diets in IBS. Two independent reviewers screened citations and a third reviewer resolved disagreement. Two independent reviewers performed eligibility assessment and data abstraction. For inclusion, RCTs that evaluated an exclusion diet versus an alternative or usual diet and assessed improvement in either global IBS symptoms or abdominal pain were required. Data were synthesized as relative risk of symptoms remaining using a random effects model. Quality of evidence was assessed using GRADE methodology.

RESULTS:
A total of 1726 citations were identified. After full-text screening a total of nine studies were eligible for the systematic review. There were two RCTs of a GFD, involving 111 participants. Both selected patients who responded to a GFD and then randomized them to continue the diet or have the diet "spiked" with gluten. A GFD was associated with reduced global symptoms compared with a control diet (RR = 0.42; 95% CI 0.11 to 1.55; I2 = 88%), although this was not statistically significant. There were seven RCTs comparing a low FODMAP diet with various control interventions in 397 participants. A low FODMAP diet was associated with reduced global symptoms compared with control interventions (RR = 0.69; 95% CI 0.54 to 0.88; I2 = 25%). The three RCTS that compared low FODMAP diet with rigorous control diets had the least heterogeneity between studies, but also the least magnitude of effect. The overall quality of the data was "very low" according to GRADE criteria.

CONCLUSIONS:
There is insufficient evidence to recommend a GFD to reduce IBS symptoms. There is very low quality evidence that a low FODMAP diet is effective in reducing symptoms in IBS patients.

PMID: 30046155 DOI: 10.1038/s41395-018-0195-4