Reduction of starch and sucrose intake is associated with less food-triggered symptoms. A randomized clinical trial

BackgroundPatients with irritable bowel syndrome (IBS) often experience food-related symptoms. Both a diet low in fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) and a starch- and sucrose-reduced diet (SSRD) alleviate symptoms.Aims/ObjectivesThe aim of this randomized clinical trial was to evaluate the proportion of participants with symptoms and the type of food items triggering symptoms during intervention by either diet.Methods/MethodologyPatients with IBS according to Rome IV were included for a four-week intervention. Participants completed a three-day food diary, study questionnaire, Rome IV questionnaire, IBS-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS) at baseline, after 4 weeks of either SSRD or low FODMAP, and at a six-month follow-up. The food items that triggered symptoms were registered along with the type of symptoms.Results/FindingsTotally, 155 participants (84% women), 42 (32-55) years, were included; 77 were randomized to SSRD and 78 to low FODMAP. SSRD rendered a reduction of participants with symptoms triggered by food avoided/modified such as fast food (<i>p</i> < 0.001), snacks/cakes (<i>p</i> = 0.008), pasta (<i>p</i> = 0.034), and fruit (<i>p</i> = 0.046), and the reduction remained at follow-up for fast food (<i>p</i> = 0.021), when also symptoms were reduced for vegetables/legumes (<i>p</i> = 0.002) and potatoes (<i>p</i> = 0.046). In the low FODMAP group, the proportion of participants with symptoms decreased for onion week 4 and coffee/tea at follow-up (both <i>p</i> = 0.046). Trigger symptoms were associated with higher intake and/or impaired psychological well-being.ConclusionThe proportion of participants with food-triggered symptoms was reduced for six food groups during/after the SSRD intervention and for two food groups during/after low FODMAP.