Low FODMAP diet: information for GPs

  • relatively new concept in the UK
  • evidence based approach to managing IBS symptoms
  • significantly better improvements when compared to NICE guidelines for IBS treatment
  • effective for about 75% of people with IBS
  • more GPs and gastroenterologists in the UK are referring patients for advice from a registered dietitian who has experience in advising on a low FODMAP diet

Guy’s & St Thomas’ Hospital:

Researchers at King’s College London have implemented the low FODMAP diet at Guy’s and St Thomas’ hospitals. They compared it with standard advice based on National Institute for Health and Clinical Excellence guidelines and found it reduced symptoms in at least six out of seven patients, compared with half following the NICE- based advice.

“We have been using the low-Fodmap diet in the U.K. since 2009 and have very good success,” said Dr Miranda Lomer, a consultant dietitian with Guy’s and St Thomas’ NHS Foundation Trust. “The diet is used quite widely now across the U.K.”

What are FODMAPs?

FODMAPs (stands forFermentable Oligo-saccharides,Disaccharides, Mono-saccharides and Polyols) are malabsorbed carbohydrates which are fermented by gut bacteria to produce gas. Current research strongly suggests that this group of carbohydrates contributes to IBS symptoms. FODMAPs are found in a wide range of foods.

What healthcare professionals are able to give low FODMAP dietary advice? 

The evidence shows that patients should be seen on a one-on-one basis by a specifically trained dietitian. The dietitian should obtain a full patient history, an understanding of the IBS symptom(s) experienced and assess the diet in detail. The patient is then taught about how the FODMAP system in a step-by-step process. The diet is individualised for each patient, providing suitable alternatives for foods they need to avoid. Menu plans and appropriate information on label reading, eating out and recipe adaptation should be provided. Patients will often have many questions and require reassurance. A full hour is usually needed for each patient.

Is the diet easy and how long should it be followed?
Patients often report that aspects of the diet are difficult to follow, but compliance rates are high, with 77% following the diet most of the time. Skilled dietitians will be able to individualise the diet accordingly for patients who may struggle with certain aspects of the diet. It is likely that the more strictly the diet is followed the quicker the symptom response will be, but most people take between 2-8 weeks to improve.

 

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