Tuesday, 18 April 2017

Research Update: The evidence base for efficacy of the Low FODMAP diet in IBS: is it ready for prime time as a first line therapy?

By Erin Dwyer (Research Dietitian)

Professor Peter Gibson from the Department of Gastroenterology at Monash University, recently published a review article in the Journal of Gastroenterology and Hepatology, questioning whether a low FODMAP diet should be used as a first line treatment for IBS?

The paper reviewed 9 studies, including:
  • Placebo controlled, randomized controlled trials (RCTs) that used the gold standard technique of providing all food (either low or high in FODMAPs) to participants
  • Placebo controlled RCTs that tested the more ‘real world’ effect of dietitian-led low FODMAP diet education
  • Studies that compared the effect of a low FODMAP diet with other therapies, including the National Institute for Health and Care Excellence (NICE) Guidelines diet and gut-directed hypnotherapy
The paper reports that all studies found that between 50 and 72% of participants improved in response to a low FODMAP diet. It also notes that the potential benefits of using a low FODMAP diet (for symptom control and quality of life) should be balanced against the risks, these being:
  • The possible adverse effects of a low FODMAP diet on the gut microbiota
  • The implications of using a restrictive diet in people at risk of disordered eating
Take home messages:
  • The low FODMAP diet is effective in approximately 70% of patients and is ready to be used as a first line therapy for IBS
  • The low FODMAP diet works best when it is dietitian-led
  • When dietitian-led, the effectiveness of the diet is still maintained even when re-challenging
  • More research is needed to monitor the long term efficacy and implications of the diet

Gibson P. R. (2017). “The evidence base for efficacy for the low FODMAP diet in irritable bowel syndrome: is it ready for prime time as a first-line therapy?” J Gastroenterol Hepatol. 32 Suppl.1: 32-35