Monday, 3 April 2017

A low FODMAP diet in inflammatory bowel disease (IBD)

By Dr. Jane Varney


Ever wondered if a low FODMAP diet could be used to manage gastrointestinal conditions other than IBS?  Here is a brief summary of a review paper published by Professor Peter Gibson from the Monash FODMAP Team on the use of a low FODMAP diet in IBD, namely Crohn’s disease and ulcerative colitis.

  • IBS-like symptoms are common  in people with quiescent (inactive) IBD, affecting around 1/3 of patients
  • These symptoms confer worse quality of life, so effective treatments are needed
  • A gluten free diet is commonly used to relieve symptoms in this population, but there is a lack of evidence to support its use
  • Three observational studies and one small randomised controlled trial (RCT) have suggested that a low FODMAP diet may improve functional symptoms, including abdominal pain, bloating, wind, diarrhoea, stool consistency and stool frequency. However, more RCTs that recruit larger numbers of patients are needed to confirm these findings
  • More research is needed to determine whether increasing FODMAP intake may reduce intestinal inflammation in IBD. The small number of studies that have been conducted have produced mixed results and failed to control background prebiotic intake
  • The potential benefits of reducing FODMAP intake (on functional symptoms), must be balanced with the potential risks. Risks include placing people at risk of undernutrition on a restrictive diet and inducing adverse changes to gut bacterial populations.
 
Take home message:
Research in this area is in its infancy. While a low FODMAP diet may improve functional symptoms in patients with quiescent IBD, these benefits must be balanced with the potential risks and patients should seek the advice of a dietitian to navigate the research and find a diet suitable for their particular situation.
 
The full paper can be viewed here

http://onlinelibrary.wiley.com/doi/10.1111/jgh.13695/full

 
Gibson, P. R. (2017). "Use of the low-FODMAP diet in inflammatory bowel disease." J Gastroenterol Hepatol 32 Suppl 1: 40-42

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