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Wheat, garlic,

onions and

prebiotics

FRUCTANS

Products made

of animal milk

– cows, sheep

and goat

LACTOSE

Some fruits,

honey and jams

FRUCTOSE

Some fruit

and sugar-free

products

POLYOLS

Baked beans

and chickpeas

GALACTO-

OLIGOSACCHARIDES (GOS)

Irritable Bowel Syndrome

FIFTEEN

Irritable Bowel Syndrome

A relatively new diet therapy known as

the low FODMAP diet, first developed

in Australia, is now fast becoming a

renowned therapy in the management of

IBS in the UK.The ‘low FODMAP’ diet is

an acronym for a diet low in fermentable

oligosaccharides, disaccharides,

monosaccharides and polyols; which

are more commonly known as fructans,

polyols, galacto-oligosaccharides, fructose

and lactose. The diet therapy is segmented

into two parts; a) the low FODMAP

diet, involving restriction of fermentable

carbohydrates and b) a reintroduction

phase, used to help identify foods

contributing to an individual’s symptoms.

The low FODMAP diet involves the

avoidance of fermentable carbohydrates

for a period of eight weeks.Though

symptom relief can be experienced

earlier, individuals need to allow up to

eight weeks for the diet to take effect.

During the eight weeks a trained dietitian

supports patients, encouraging optimal

compliancy and a healthy balanced diet.

(Refer to Figure 2 on the right).

On completion of the eighth week, a

review appointment is carried out to

reassess patients’ symptom profiles and

dietary intake. On achieving satisfactory

relief from bowel symptoms, patients

are taught the reintroduction phase of

the diet therapy.This process enables

patients to trial restricted fermentable

carbohydrates and identify foods that

are contributing to the onset of their IBS

symptoms.The reintroduction method

also enables patients to gauge the

quantity in which these foods, otherwise

known as ‘triggers’ can be consumed

without provoking symptoms.This

process prevents long-term unnecessary

restriction of foods and encourages

a varied, balanced diet without the

aggravation of bowel symptoms.

Studies to date have found the low

FODMAP diet to be ‘more effective than

standard dietary advice for symptom

control in IBS’ (Staudacher et al 2011) and

has been encompassed within the British

Dietetic Association’s (BDA) guidelines for

the management of IBS in adults (BDA,

2010).The use of the low FODMAP diet

is now part of the recommended second

line diet therapy, which follows the initial

NICE guidance, which focuses on the

adjustment of fibre, fat, fluid, caffeine

and alcohol intakes.

A recent study comparing the

effectiveness of the low FODMAP

diet against the standard therapy,

found that 76% of patients following

the low FODMAP diet reported

satisfactory relief from their

symptoms, compared to 54% of

patients who had been following the

standard therapy. Similarly, significantly

more patients found relief from

bloating, abdominal pain and flatulence

when following the low FODMAP

diet, compared to those following

standard therapy advice alone.

At London Bridge Hospital (LBH),

our trained specialist dietitians have

been teaching the low FODMAP diet

since March 2010, and have recorded

promising results.

On analyses of our first 50 patients to

complete the diet therapy, 76% of IBS

patients reported satisfactory relief

from their symptoms on following the

low FODMAP diet. In comparison,

only 24% of these patients answered

‘no’ to the question ‘do you currently

have satisfactory relief of your gut

symptoms?’ when asked on patients’

review appointments. Possible reasons

for this statistic include patients’

low compliancy with the dietary

restrictions, or the influence of other

contributing factors to the patients’

IBS symptoms, such as stress or

anxiety.

The results analysed to date at LBH indicate

that IBS patients are achieving a reduction in

their symptoms on following the low FODMAP

diet, and the Dietetic Department continues

to teach new referrals this seemingly successful

diet therapy in the management of IBS.

The Dietetic Department at LBH are continuing

to follow the development of this diet therapy

and equip members of their team with the

appropriate training.

Dietetic outpatient clinics are held on a daily basis at the London Bridge Hospital and appointments are accessible via

a referral from GPs and Consultants. For further information, please contact Louise Gankerseer (Specialist Dietitian)

T: 020 7234 2282

or email

[email protected] .

Figure 2

Group of Fermentable

Carbohydrates

(FODMAPs)

Examples of foods & drinks

rich in FODMAPs

Figure 4

Compares evaluation of abdominal discomfort on initial

appointment and that after the low FODMAP diet

Evaluation of abdominal

discomfort on initial appointment

Evaluation of abdominal discomfort

after the low FODMAP diet

Figure 3

Compares evaluation of bloating symptom on initial

appointment and that after the low FODMAP diet

Evaluation of bloating symptom

on initial appointment

Evaluation of bloating symptom

after the low FODMAP diet

Key

None Mild Moderate Severe

6%

12%

40%

42%

2%

38%

48%

12%

6%

2%

44%

48%

12% 10%

36%

42%