Low fermentable oligo-di-mono-saccharides and polyols diet versus general dietary advice in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled trial

J Gastroenterol Hepatol. 2018 Jun;33(6):1192-1199. doi: 10.1111/jgh.14051. Epub 2018 Feb 21.


Background and aim: Recent evidence indicates that new approach of the diet with low fermentable oligo-di-mono-saccharides and polyols (FODMAPs) may have an effective role in management of the patients with irritable bowel syndrome (IBS). We compared the results of low FODMAP diet with current dietary treatment, general dietary advices (GDA), on the clinical response in patients with diarrhea subtype of IBS (IBS-D).

Methods: In this randomized, controlled, single-blind trial, we included 110 patients with IBS-D in two intervention groups. Participants were randomly assigned to the low FODMAP diet (n = 55) and GDA (n = 55) for 6 weeks after a 10-day screening period. Gastrointestinal symptoms and bowel habit status were evaluated using a symptom severity scoring system and Bristol stool form scale pre-intervention and post-intervention. Patients completed 3-day food diary before and after the intervention.

Results: Of 110 patients, 101 completed the dietary interventions. At the baseline, the nutrient intake, severity of symptoms, and demographic data were similar between two groups. After 6 weeks, the low FODMAP diet improves significantly overall gastrointestinal symptoms scores, stool frequency, and consistency versus GDA group (P < 0.001, P < 0.001, and P = 0.003, respectively). Compared with the baseline, both intervention groups expressed a significant reduction in overall scores of symptom severity scoring system, abdominal pain, distension, consistency, and frequency, but this reduction is greater in low FODMAP diet group.

Conclusions: Both low FODMAP diet and GDA in patients with IBS-D led to adequate improvement of gastrointestinal symptoms for 6 weeks. However, the low FODMAP diet has greater benefits in IBS improvement.

Keywords: abdominal pain; carbohydrates; irritable bowel syndrome; low FODMAP diet.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Diarrhea / diet therapy*
  • Diarrhea / etiology*
  • Diet, Carbohydrate-Restricted / methods*
  • Directive Counseling*
  • Disaccharides / administration & dosage*
  • Female
  • Fermentation
  • Humans
  • Irritable Bowel Syndrome / complications
  • Irritable Bowel Syndrome / diet therapy*
  • Male
  • Middle Aged
  • Monosaccharides / administration & dosage*
  • Polymers / administration & dosage*
  • Severity of Illness Index
  • Single-Blind Method
  • Time Factors
  • Treatment Outcome
  • Young Adult


  • Disaccharides
  • Monosaccharides
  • Polymers
  • polyol