Gastroenterology teamBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1592 (Published 23 March 2016) Cite this as: BMJ 2016;352:i1592
- Nigel Hawkes, freelance journalist
- London, UK
Dietary management of irritable bowel syndrome
“In the past, managing irritable bowel syndrome by controlling the diet has been seen as a wacky idea—one for those who aren’t science driven,” admits Miranda Lomer, senior consultant dietician at Guy’s and St Thomas’ NHS Foundation Trust in London. But many minds have been changed by the success of a dietary regimen originally developed in Australia.
Better care is certainly needed. Irritable bowel syndrome affects 10-15% of adults and causes pain, bloating, and other symptoms. Most patients should be manageable in primary care, Lomer says, yet the condition accounts for 40-60% of gastroenterology referrals. Many patients require repeated follow-ups and less than half benefit from changes in diet.
Enter the low FODMAP (Fermentable Oligo-Di-Monosaccharides and Polyols) diet. FODMAPs are carbohydrates: fructose, lactose, fructans, galactans, and polyols. With help from an Australian dietician, the low FODMAP diet was modified for UK conditions and tested on patients. Satisfaction with symptom improvement rose to 76%, far higher than with other diets. A randomised controlled trial followed, and it showed that 68% of patients had adequate symptom relief compared with 23% continuing their normal diet.
Implementing low FODMAP diets is not simple. “People who try to do it on their own after searching on the internet tend to omit too many foods,” she says. But as the trust’s success became more widely known it was inundated with referrals. So a system of group rather than individual education was devised, with groups of 12 patients doing two sessions, each of 1.5 to 2 hours. “As soon as one patient opens up, they all talk,” she says. “It creates a great self help network.” The low FODMAP diet is now incorporated into official guidelines, 600 dieticians have been trained, and …