Reduction of starch and sucrose intake is associated with less food-triggered symptoms. A randomized clinical trial

Abstract

Background

Patients with irritable bowel syndrome (IBS) often experience food-related symptoms. Both a diet low in fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) and a starch- and sucrose-reduced diet (SSRD) alleviate symptoms.

Aims/Objectives

The aim of this randomized clinical trial was to evaluate the proportion of participants with symptoms and the type of food items triggering symptoms during intervention by either diet.

Methods/Methodology

Patients with IBS according to Rome IV were included for a four-week intervention. Participants completed a three-day food diary, study questionnaire, Rome IV questionnaire, IBS-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS) at baseline, after 4 weeks of either SSRD or low FODMAP, and at a six-month follow-up. The food items that triggered symptoms were registered along with the type of symptoms.

Results/Findings

Totally, 155 participants (84% women), 42 (32–55) years, were included; 77 were randomized to SSRD and 78 to low FODMAP. SSRD rendered a reduction of participants with symptoms triggered by food avoided/modified such as fast food (p < 0.001), snacks/cakes (p = 0.008), pasta (p = 0.034), and fruit (p = 0.046), and the reduction remained at follow-up for fast food (p = 0.021), when also symptoms were reduced for vegetables/legumes (p = 0.002) and potatoes (p = 0.046). In the low FODMAP group, the proportion of participants with symptoms decreased for onion week 4 and coffee/tea at follow-up (both p = 0.046). Trigger symptoms were associated with higher intake and/or impaired psychological well-being.

Conclusion

The proportion of participants with food-triggered symptoms was reduced for six food groups during/after the SSRD intervention and for two food groups during/after low FODMAP.