Secondary Logo

Institutional members access full text with Ovid®

Adherence with a low-FODMAP diet in irritable bowel syndrome

are eating disorders the missing link?

Mari, Amira; Hosadurg, Deepasha; Martin, Leeb; Zarate-Lopez, Nataliaa; Passananti, Valentinaa; Emmanuel, Antona

European Journal of Gastroenterology & Hepatology: February 2019 - Volume 31 - Issue 2 - p 178–182
doi: 10.1097/MEG.0000000000001317
Original Articles: Gastroenterology

Objectives The low-FODMAP diet has emerged as an option for the treatment of irritable bowel syndrome (IBS). This diet is very restrictive, and compliance is usually low. Preliminary findings suggest an association between eating disorders (EDs) and the risk of developing IBS. The aim of this study was to assess the correlation between compliance with a low-FODMAP diet and the risk of ED behaviours among patients with IBS.

Patients and methods A single-centre prospective study was carried out among 233 IBS patients (79.8% females) at University College London Hospital, who commenced a low FODMAPs group programme for IBS (Rome III or IV). Self-reported diet adherence at the end of the 6-week programme was measured. At baseline, and at the 6-week follow-up visit, participants completed the validated IBS-Symptom Severity Score, the SCOFF ED screening questionnaire and the Hospital Anxiety and Depression Scale.

Results Adherence with a low-FODMAP diet was found in 95 (41%) patients. Overall, 54 (23%) patients were classified to be at risk for ED behaviour. Adherence was 57% in the ED group (31/54) versus 35% in the non-ED group (64/179); P<0.05. Adherence with a low-FODMAP diet was highest (51%) in the IBS with diarrhoea subtype and lowest (10%) in IBS with constipation. There was no significant correlation between IBS-Symptom Severity Score and either adherence (P=0.39) or ED behaviour (P=0.28).

Conclusion In this IBS cohort, greater adherence to a low-FODMAP diet is associated with ED behaviour. The implications of our study are important in clinical practice for a clinician to have a high index of suspicion of EDs in IBS patients when a high level of low-FODMAP diet achieved.

aGI Physiology Unit

bNutrition and Dietetics Department, University College London Hospital, London, UK

Correspondence to Amir Mari, MD, GI Physiology Unit, EGA Wing, 25 Grafton Way, WC1 6BD London, UK Tel: +44 972 4214 2070; fax: +44 972 9878 1587; e-mail:

Received July 19, 2018

Accepted November 5, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.