Low FODMAP diet improves health-related quality of life in patients with IBS-D

Liz Meszaros, MDLinx

Digestive Disease Week® (DDW)

San Diego, California, United States | May 21-24, 2016

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San Diego, CA, May 21, 2016—In patients with irritable bowel syndrome and diarrhea (IBS-D), a diet-based therapy that incorporates low fermentable oligo-di-monosaccharides and polyols (FODMAPs) may improve symptoms, as well as improve health-related quality of life (HRQOL), according to researchers here at Digestive Disease Week 2016. Such improvements are important in IBS-D patients, who are at risk for more psychological comorbidities, sleep disturbances, and lower HRQOL and work productivity compared with the general population.

Take-home messages

  • A low fermentable oligo-di-monosaccharides and polyols (FODMAPs) diet improves not only symptoms, but health-related quality of life in patients with irritable bowel syndrome and diarrhea.
  • The low fermentable oligo-di-monosaccharides and polyols (FODMAPs) diet in these patients also led to a trend towards improvement in anxiety, and significant improvements in activity impairment.

“IBS is a very common disease. It affects 15% to 20% of the population. Unlike other chronic diseases, like diabetes or hypertension, for example, IBS really affects your quality of life. You have active symptoms often really limiting your work and social activities, leading to decreased intimacy, poor sleep. IBS patients report a lot more fatigue than healthy controls. And it can lead to some social isolation,” explained lead author Shanti Lynne Eswaran, MD, assistant professor, internal medicine, University of Michigan, Ann Arbor, MI. “That is something that is not necessarily seen in other GI diseases, or definitely not in most other chronic diseases,” she added.

Dr. Eswaran and colleagues conducted this prospective, single-center, single-blind, randomized, controlled trial in patients with IBS-D, a mean daily abdominal pain score ≥ 4, and a Bristol stool scale score of ≥ 5, to determine whether a low FODMAP diet (LFD) has any effects on HRQOL, psychological distress, work productivity, and sleep quality measures compared with a control diet. Both the FODMAP diet and the control diet were administered by experienced research dietitians.

Patients completed a 2-week screening period, and were then randomized to 4 weeks of a low FODMAP diet (LFD) or a control diet that was based on modified National Institute for Health and Care Excellence (NICE) guidelines. They initially randomized 92 patients (median age: 42.6 years [range: 19-75 years], 74% Caucasian; 71% women), of whom 83 completed the study (45 LFD, 38 controls).

Before and after the dietary intervention, researchers measured HRQOL (IBS-QOL), psychosocial distress via the Hospital Anxiety and Depression Scale (HADS), work productivity via the Workplace Activity Impairment (WPAI), and sleep quality. Daily assessments of fatigue and sleep quality were also completed.

At 4 weeks, significantly more patients in the LFD group had > 10-point improvements in IBS-QOL score compared with controls (58% vs 24%; P=0.0032). At this same time point, the LFD group exhibited a significantly higher mean total IBS-QOL score compared with the control group (P=0.0228), with significant improvements in several IBS-QOL domains (see Table 1).

Table 1. IBS QOL means after dietary intervention.

 

Low FODMAP Diet

Control IBS Diet

P value

Total IBS-QOL

68.87

59.04

0.0228

Dysphoria

73.05

62.58

0.0449

Interference with Activity

49.54

37.98

0.0058

Body Image

70

54.22

0.0040

Health Worry

72.92

73.42

0.9054

Food Avoidance

32.71

35.14

0.6432

Social Reaction

72.50

65.88

0.1813

Sexual

80.63

67.23

0.0430

Relationship

79.17

68.47

0.0250

Dr. Eswaran and colleagues also saw a trend towards improvements in anxiety in the LFD group, but this did not reach statistical significance (7.73 vs 9.26 in controls; P=0.0679). In measures of WPAI, the only significant improvements were seen in activity impairment (29.29 in LFD vs 41.90 in controls; P=0.0398). Researchers found no between-group differences in fatigue, but sleep quality was improved in the LFD group compared with controls (6.33 vs 7.46, respectively; P=0.0336).

“An LFD helps some IBS symptoms tremendously, but it also has a lot of benefits outside the GI tract. When patients are coming to you for treatment of their IBS, they have real symptoms, but they are usually coming to you because the IBS has taken over their lives in some way—leading them to miss social events, places to go with their family. If you can give them back that element of control, which we have shown that you can do with this diet, that is a real gift to them,” concluded Dr. Eswaran.

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