Long-term impact of the low-FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome

Background: The low-FODMAP diet is a frequently used treatment for irritable bowel syndrome (IBS). Most research has focused on short-term FODMAP restriction; however, guidelines recommend that high-FODMAP foods are reintroduced to individual tolerance. This study aimed to assess the long-term effectiveness of the low-FODMAP diet following FODMAP reintroduction in IBS patients. Methods: Patients with IBS were prospectively recruited to a questionnaire study following completion of dietitian-led low-FODMAP education. At baseline and following FODMAP restriction (short term) only, gastrointestinal symptoms were measured as part of routine clinical care. Following FODMAP reintroduction, (long term), symptoms, dietary intake, acceptability, food-related quality of life (QOL), and healthcare utilization were assessed. Data were reported for patients who continued long-term FODMAP restriction (adapted FODMAP) and/or returned to a habitual diet (habitual). Key Results: Of 103 patients, satisfactory relief of symptoms was reported in 12% at baseline, 61% at short-term follow-up, and 57% at long-term follow-up. At long-term follow-up, 84 (82%) patients continued an ‘adapted FODMAP’ diet (total FODMAP intake mean 20.6, SD 14.9\ua0g/d) compared with 19 (18%) of patients following a ‘habitual’ diet (29.4, SD 22.9\ua0g/d, P=.039). Nutritional adequacy was not compromised for either group. The ‘adapted FODMAP’ group reported the diet cost significantly more than the ‘habitual’ group (

Most frequent words in YouTube comments.

<p>Probability density function of words from all YouTube comments analyzed in this paper. The frequency of occurrence was calculated after removing stopwords.</p

Most frequent words in YouTube comments stratified by plateau.

<p>Most frequent words in YouTube comments stratified by plateau.</p

Extraction of YouTube Comments for Analysis.

<p>Extraction of YouTube Comments for Analysis.</p

Representing sentences as vectors.

<p>The left panel shows the representation of two sentences, “Dogs run and dogs run.” and “Cats run.” as vectors. The “Dogs run” vector is twice the length of “Cats run” because each term in the former is repeated. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0082452#pone.0082452.e005" target="_blank">Equation 1</a> illustrates how the cosine of the angle between the two vectors, , quantifies the similarity between the two sentences.</p

Example WordNet hierarchy.

<p>Spreading out from the root concept of drugs are progressive refinements or <i>hyponyms</i>. Counting each path as 1 and starting from the root node, Drugs, one may calculate the path similarity of any two concepts (see text).</p

Range of dxm dosages discussed on YouTube.

<p>The histogram (bin size = 200mg) shows the distribution of dosages mentioned in the YouTube comments. All doses were converted to milligrams.</p

Signs and symptoms associated with dextromethorphan ingestions.

<p>Adapted from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0082452#pone.0082452-Boyer2" target="_blank">[25]</a>.</p

Words specific to each plateau.

<p>The table shows the words from YouTube comments that had a significantly high tf-idf score and were classified as semantically related to medicine according to the criteria in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0082452#pone-0082452-t003" target="_blank">Table 3</a>.</p

Categories for stratifying words based on semantic relation to drug use.

<p>Categories for stratifying words based on semantic relation to drug use.</p