The FODMAP

Diet and IBS

PRP Presentation- August 5, 2015
Julia Brandt, Sodexo Dietetic Intern

Why the FODMAP diet?

Kristys EPIC call in MayFODMAP diet and its
efficacy was brought up.
Questions about the FODMAP diet
It has been suggested that the FODMAP diet
should be a first-line intervention for IBS patients
placing the RD at the top of the IBS patients
care.

Lets break the ice!

Ice Breaker

Where do you Fall On Da MAP?

Identify where your family comes from on the
world map.
Tell the group about your favorite family recipe
indigenous to your ancestors motherland.

What is the FODMAP diet?

History of the FODMAP Diet

Dr. Sue Shepherd
Australian RD
Diagnosed with celiac disease while studying to
become an RD
Developed FODMAP diet in 1999
Dietitian Association of Australias Award for
Achievement for Excellence in Contribution to
the Profession
Gastroenterological Society of Australias
Young Investigator of the Year Award
The FIRST non-medical health professional to win this
award!!

Shepherd Works-Private practice specializing

in gastrointestinal nutritional conditions.
For more information:
http://shepherdworks.com.au/services/about-sue-shepherd

FODMAP
The FODMAP diet focuses on limiting
FODMAP foods to relieve IBS:
Fermentable
Oligo
Diand

Mono-saccharides
And
Polyols

FODMAP Foods
High FODMAP foods include:
Excess Fructose:Honey, Apples, Mango, Pear, Watermelon, High
Fructose Corn Syrup
Fructans:Artichokes (Globe), Artichokes(Jerusalem),Garlic (in large
amounts), Leek, Onion (brown, white, Spanish, onion powder), Spring
Onion (white part), Shallots, Wheat (in large amounts), Rye (in large
amounts), Barley (in large amounts), Inulin, Fructo-oligosaccharides.
Lactose:Milk, ice-cream, custard, dairy desserts, condensed and
evaporated milk, milk powder, yoghurt, soft unripened cheeses (eg.
ricotta, cottage, cream, marscarpone).
Galacto-Oligosaccharides (GOS):Legume beans (eg. baked
beans, kidney beans, bortolotti beans), Lentils, Chickpeas
Polyols:Apples, Apricots, Avocado, Cherries, Nectarines, Pears,
Plums, Prunes, Mushrooms, sorbitol (420), mannitol (421), xylitol
(967), maltitol (965) and isomalt (953).
(Shepherd Works, 2015)

Types of
IBS
IBS-D: diarrhea
predominant
IBS-C:
constipation
predominant
IBS-M or A: preexisting diarrhea
and constipation
IBS-U: neither
diarrhea not
constipation

Research
1. Camilleri, M., & Acosta, A. (2014). Re: Halmos
etal, A Diet Low in FODMAPs Reduces Symptoms
of Irritable Bowel Syndrome. Gastroenterology,
146(1), 1829-1830. Retrieved July 28, 2015.
2. Halmos, E., Christophersen, C., Bird, A.,
Shepherd, S., Gibson, P., & Muir, J. (2014). Diets
that differ in their FODMAP content alter the
colonic luminal microenvironment. Gut, 93-100.
3. Pedersen, N., Andersen, N., Vegh, Z., Jensen, L.,
Ankersen, D., Felding, M., . . . Munkholm, P.
(2014). Su1128 e-Health: Web-Based Treatment
Solution in Irritable Bowel Syndrome: Low
FODMAP vs. Lactobacillus rhamnosus GG.
Gastroenterology.

Article 1
A Diet Low in FODMAPs Reduces Symptoms
of Irritable Bowel Syndrome.
Goal: To provide more evidence as to the effectiveness of the
FODMAP diet in the symptoms management of IBS patients.
Methods:
Participants:
38 participants
30 with IBS
8 healthy controls

Plan:
Randomized either 21 days low FODMAP or 21 days normal
Australian diet with FODMAPs included
Participants blinded to diets
All food was provided3 meals and 3 snacks
Assessment:
GI symptoms using VAS (Visual Analogue Scale) score:
0 (no symptoms)100 (worst symptoms ever had)
Fecal Frequency using Kings Stool Chart:
frequency, consistency and weight

Article 1
A Diet Low in FODMAPs Reduces Symptoms
of Irritable Bowel Syndrome.
Results:
80% of IBS participants were able to remain
compliant with low FODMAP diet
IBS participants following 21 day low FODMAP diet
GI symptoms (*bloating, abdominal pain,
flatulence) decreased after 7 days and
maintained.
Large improvement (>10mm VAS score
difference) in 21 of 20 IBS participants
No change in 8 healthy controls with FODMAPs or
low FODMAP diet
Reduction in stool frequency on low FODMAP diet

Article 1 Discussion
IBS participants symptoms were more than halved with low
FODMAP diet.
70% of IBS participants with GI relief following the FODMAP diet
had different types of IBS.
No difference in GI symptoms with healthy controls no matter
what diet was followedindicating FODMAP diets efficacy in IBS
population specifically.
These results support the notion that the low FODMAP diet has efficacy
in the vast majority of patients with IBS and support its use as a first-line
therapy (Halmos, et. al, 2014, p.74)

Reality of the situation

Food is not provided
Patients need to learn this diet and how to remain compliant

Article 2
Diets that differ in their FODMAP content
alter the colonic luminal microenvironment.
Goal: To determine the effects of a low FODMAP diet on colonic health.
Methods:
Participants:
33 participants
27 with IBS
6 healthy controls

Plan:
Randomized either 21 days low FODMAP or 21 days normal Australian diet
with FODMAPs included
Participants blinded to diets
All food was provided3 meals and 3 snacks
Assessment:
Prior to fecal collection, participants swallowed a capsule with 24 radiopaque markers
Each stool collected in supplied plastic container
Sealed and stored in freezer immediately
Stools were X-rayed and radiopaque markers counted to determine whole gut transit time
(WGTT)

Article 2
Diets that differ in their FODMAP content
alter the colonic luminal microenvironment.
Results:
Total bacterial abundance was reduced in
low FODMAP diet participants
Reduction in prebiotic bacteria in low
FODMAP diet participants
Higher FODMAP diet stimulated growth of
probiotic bacterial groups

Article 2 Discussion
Liberalizing FODMAP restriction to
the level of adequate symptoms
control should be exercised. The low
FODMAP diet should not be
recommended for asymptomatic
populations (Halmos et. al., 2014, p.
98).

Article 3
Su1128 e-Health: Web-Based Treatment Solution in
Irritable Bowel Syndrome: Low FODMAP vs.
Lactobacillus rhamnosus GG.
Goal: To determine and compare the effects of a low FODMAP diet
versus probiotic Lactobacillus rhamnosus GG (LGG) in IBS.
Method
Participants
108 IBS patients from Herlev Hospital, University of Copenhagen, Denmark
Sub-classified based on stool habits
IBS-D
IBS-C
IBS-A: alternating diarrhea and constipation

Plan
6 week randomized, unblinded controlled trial
3 groups
LFD (Low FODMAP Diet): Instructed on LFD with an RD during a 1 hour session
and a list of high FODMAP foods to avoid was provided
LGG (Lactobacillus rhamnosus GG): Instructed to follow a normal
Danish/Western diet while ingesting 2 Dicoflor60 capsules daily for 2 weeks
Control group with no intervention: Instructed to follow a normal
Danish/Western diet

Assessment
Scored symptoms weekly using IBS-severity scoring system (IBS-SSS) and IBS
quality of life (IBS-QOL) questionnaires online

Article 3
Su1128 e-Health: Web-Based Treatment
Solution in Irritable Bowel Syndrome: Low
FODMAP vs. Lactobacillus rhamnosus GG.
Results
Significant reduction in IBS-SSS observed in
both LFD and LGG groups with IBS-D and
IBS-A
No significant reduction in IBS-SSS found in
patients with IBS-C with either intervention
IBS-D statistically significant improvement in IBS-QOL
with LFD only

Article 3 Discussion
a significant reduction in IBS-SS from baseline to week 6
were found in patients with IBS-D and IBS-A when treated
with LFD and LGG. This indicates that the effect of the diet
is dependent upon the IBS subtype-being most effective in
patients with the IBS diarrheal type, and this should be
taken into account when recommending the diet to IBS
patients (Pederson et. al., 2014, p. 16222)
In conclusion, both LFD and LGG are efficacious when
treating IBS patients, especially in the IBS-D and IBS-A
subtypes. Further evaluation of adherence to LFD,
satisfaction with dietitians advice, and symptom
improvement, short and long term, is needed (Pederson et. al., 2014,
p.16224).

Comparing the
Research
Similarities

Differences

LFD is effective in IBS

symptom management
No change in
symptoms in healthy
(non-IBS) participants
with low FODMAP
versus usual diet.
Stresses the
importance of
individualization

IBS-D and IBS-A reaped

symptom management
benefits of LFD and
LGG per article 3.
Low FODMAP diet
resulted in reduction of
colonic bacteria.
LGG seen just as
effective in IBS
management as LFD.

Conclusion
Low FODMAP diet can reduce IBS symptoms
Proper instruction is necessary
Compliance is key

LGG probiotic just as effective as LFD in relief of

IBS-D and IBS-A symptoms.
BUT the low FODMAP diet can also reduce healthy
colonic bacteria

INDIVIDUALIZATION IS KEY

What do you
think?

Questions?