Original ArticleFunctional DisordersSupplementing Dietary Fibers With a Low FODMAP Diet in Irritable Bowel Syndrome: A Randomized Controlled Crossover Trial
Graphical abstract
Section snippets
Participants
Participants 18–65 years of age with IBS according to Rome IV criteria8 were recruited via social media and word of mouth between June 2019 and September 2020. They were required to have overall gastrointestinal symptoms that averaged >30 mm over a 5-day prescreening via a 100-mm visual analog scale (VAS) as previously applied,9 in which 0 mm indicated no symptoms and 100 mm represented the worst symptoms experienced. Additional exclusion criteria are outlined in the Supplementary Material.
Trial Protocol
In a
Participants
Twenty-six participants were recruited. The median age was 34 (range, 18–61) years, 25 were female, and median body mass index was 22.8 (range, 16.2–30.7) kg/m2. Seven participants were self-classified as constipation-predominant, 8 were diarrhea-predominant, 8 were mixed, and 3 were unknown as per Rome IV criteria. An a priori interim analysis of the primary endpoint was performed by an independent statistician using the data available at that time (n = 16 completed) without unblinding;
Discussion
This trial is the first to evaluate the effects of concomitant fiber supplementation with initiation of a low FODMAP diet in patients with IBS. The primary findings were that a minimally fermented fiber, sugarcane bagasse, alone and in combination with fermentable RS, augmented stool output compared with low FODMAP diet alone and did not diminish the clinical efficacy of reducing FODMAP intake. Additionally, post hoc analyses showed that the fibers were associated with normalizing stool water
Acknowledgements
The authors thank the volunteers who participated in this trial. Many thanks to Lyndal Collins, Dr Paul Gill, and Trish Veitch for their assistance with designing the low FODMAP background diet, as well as to the many Nutrition and Dietetic Students and Workplace Integrated Learning interns from Monash University, for cooking the meals for the background diet meals and producing the cereals, respectively. Special thanks to Luke Farrell of Baker’s Delight for developing and producing the bread
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Conflicts of interest All authors work in a department that financially benefits from the sales of a digital application and booklets on the low FODMAP diet. Funds raised contribute to research of the Department of Gastroenterology and to the University. No author receives personal remuneration.
Funding This work was partly funded by the National Health and Medical Research Council of Australia (APP1154969) and partly funded by Tamu Innovations through the Graduate Research Industry Partnership at Monash University. Daniel So was supported by scholarships from Monash University via the Faculty of Medicine, Nursing and Health Science, and the Graduate Research Industry Partnership.