Het FODMAP-beperkte dieet

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Literatuur verwijzing

First experience with the low FODMAP diet in patient with IBS

L.A. van der Waaij, J. Stevens, L. Korstanje

The Low FODMAP diet is an effective therapy for patients with IBS. Randomised trials show that 70-87% of the patients experience a significant reduction in symptoms. The diet was developed in Australia. In 2012 we have translated it into Dutch and adapted it to the local eating habits. Since the beginning of 2013 we treat IBS patients with the Low FODMAP diet. The concept of the diet is that FODMAPs (nonabsorbable small molecules abundantly present within the diet that can be fermented in the colon) cause symptoms within the ileum and colon via an increase of luminal pressure due to their (1) osmotic action and (2) gas production as a side product of bacterial fermentation. The four FODMAP groups are: lactose, fructose, polyols and oligosaccharides. The diet consists of an exclusion phase of 6 weeks in which a diet low in FODMAPs is followed. If a significant symptom reduction is achieved during the first phase, it is followed by a second phase of at least 5 weeks in which the FODMAPs are stepwise reintroduced into the diet. Here, we present our first results.

Until now, 30 pain predominant IBS patients (5 men, average age 30 years), some of them experiencing severe invalidating chronic symptoms, have started the exclusion phase of the Low FODMAP diet. 2 patients stopped preliminary because of constipation. 22 of the remaining 28 patients (79%, intention to treat 73%) experienced a significant symptom reduction, especially bloating and pain, and an increase in quality of life: the VAS score increased from 4.9 to 6.7 (n=26, P<0.001). 53% of the patients considered the low FODMAP diet as not difficult (1/19) or little bit difficult (9/19) to follow. Acquiring the food ingredients in the shops was considered difficult by 53% of the patients. Of the 22 patients that experienced a significant reduction in symptoms 10 patients have started and some have completed the reintroduction phase: 4 experienced intolerance for lactose, 2 for polyols and 1 for fructose. 6 Patients refused reintroduction: 2 because of unexpected pregnancy, 3 did not respond to telephone calls and 1 because she had relapse of symptoms.

Conclusions: 73% of the IBS patients experienced a significant reduction of symptoms when they were on the Low FODMAP diet. Therefore, the Low FODMAP diet may be effective in the Dutch population. Because constipation is an adverse event a laxative should be considered at start of the diet.