Randomized Controlled Trial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2017; 23(25): 4632-4643
Published online Jul 7, 2017. doi: 10.3748/wjg.v23.i25.4632
Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs
Ruth M Harvie, Alexandra W Chisholm, Jordan E Bisanz, Jeremy P Burton, Peter Herbison, Kim Schultz, Michael Schultz
Ruth M Harvie, Kim Schultz, Michael Schultz, Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand
Ruth M Harvie, Alexandra W Chisholm, Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand
Jordan E Bisanz, Jeremy P Burton, Departments of Surgery and Microbiology & Immunology, Western University, Ontario N6A 5B8, Canada
Peter Herbison, Department of Preventative and Social Medicine, University of Otago Dunedin 9016, New Zealand
Author contributions: Harvie RM, Chisholm AW and Schultz M designed the research, Bisanz JE and Burton JP designed the microbiome analysis; Harvie RM conducted the research with the exception of the microbiome analysis which was conducted by Bisanz JE; Bisanz JE analyzed the microbiome data, all other data was analyzed by Harvie RM with oversight by Herbison P; Harvie RM, Bisanz JE and Schultz M wrote the paper; Schultz K was responsible for data acquisition and input and proof-read the manuscript; Schultz M had primary responsibility for the final content.
Institutional review board statement: This study was reviewed and approved by the Upper South Regional Ethics Committee, New Zealand (#URA/11/05/2011).
Clinical trial registration statement: This study is registered at http://www.anzctr.org.au/. The registration identification number is ANZCTR342998.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors report no conflicts of interest.
Data sharing statement: Demultiplexed sequence and associated metadata was deposited in the NCBI short read archive with BioProject accession PRJNA392762.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Michael Schultz, Associate Professor, Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9016, New Zealand. michael.schultz@otago.ac.nz
Telephone: +64-3-4740999 Fax: +64-3-4709358
Received: November 15, 2016
Peer-review started: November 18, 2016
First decision: December 19, 2016
Revised: January 6, 2017
Accepted: March 2, 2017
Article in press: March 2, 2017
Published online: July 7, 2017

To investigate the long-term effect of dietary education on a low fermentable oligosaccharide, disaccharide and polyol (FODMAP) diet on irritable bowel syndrome (IBS) symptoms and quality of life (QoL).


Participants with IBS (Rome III) were randomized to two groups. Group I commenced a low FODMAP diet at baseline. At three months, group II, so far a comparator group, crossed over to a low FODMAP diet while group I started re-challenging foods. All patients completed the IBS SSS (IBS symptom severity scoring system, 0-500 points increasing with severity), IBS QoL questionnaire (0-100 increasing with QoL), a FODMAP specific food frequency questionnaire and provided a stool sample at baseline, three and six months for microbiome analysis.


Fifty participants were enrolled into group I (n = 23) or group II (n = 27). Participants in both groups were similar in baseline values but with more men in group I. There was a significantly lower IBS SSS (275.6 ± 63.6 to 128.8 ± 82.5 vs 246.8 ± 71.1 to 203.6 ± 70.1) (P < 0.0002) and increased QoL (68.5 ± 18.0 to 83 ± 13.4 vs 72.9 ± 12.8 to 73.3 ± 14.4) (P < 0.0001) in group I vs group II at 3 mo. The reduced IBS SSS was sustained at 6 mo in group I (160 ± 102) and replicated in group II (124 ± 76). Fiber intake decreased on the low FODMAP diet (33 ± 17 g/d to 21 ± 8 g/d) (P < 0.01) and after re-introducing FODMAP containing foods increased again to 27 ± 9 g/d. There was no change seen in the intestinal microbiome when participants adopted a low FODMAP diet.


This study demonstrated that a reduction in FODMAPs improves symptoms in IBS and this improvement can be maintained while reintroducing FODMAPs.

Keywords: Irritable bowel syndrome, FODMAP, Short chain fermentable carbohydrates, Microbiota, Diet, Microbiome

Core tip: Dietary education by a dietitian on a low FODMAP diet leads to a reduction in symptoms and an improvement in quality of life. Commencing a low FODMAP diet does not appear to alter microbial diversity in patients with irritable bowel syndrome (IBS). Patients with IBS when guided by a dietitian on reintroducing FODMAP containing foods to tolerance are able to increase their intake of fiber to recommended levels without significant worsening of symptoms.