Effects of a low FODMAP diet and specific carbohydrate diet on symptoms and nutritional adequacy of patients with irritable bowel syndrome: Preliminary results of a single-blinded randomized trial

Massimo Vincenzi; Irene Del Ciondolo; Elisa Pasquini; Katia Gennai; Barbara Paolini

Journal & Issue Details

Journal of Translational Internal Medicine

Journal Details

Format: Journal
eISSN: 2224-4018
First Published: 31 Dec 2013
Publication timeframe: 4 times per year
Languages: English

IBS is the most common functional disease of the low gastrointestinal tract. Recently, the interest towards a diet approach has increased, for example, a diet with low content of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). The aim of the present study is to evaluate the efficacy of a low FODMAP diet and a specific carbohydrate diet (SCD) conducted for 3 months on symptoms and to evaluate the deficiencies of vitamin D and folic acid in patients affected by IBS, matching the Rome IV criteria.

We evaluated 73 patients divided into 2 groups: one submitted to low FODMAP diet and one to SCD, for 3 months. Patients were assigned to one of the 2 groups randomly and blinded. All the patients filled a visual analogue scale (VAS) to evaluate the severity of symptoms and a diary to evaluate the number of days with symptoms, and this was repeated after 3 months. Final evaluation was made by a blinded investigator.

In the end, the patients with low FODMAP diet had a significant improvement in bloating and distension (P = 0.000); the group with SCD instead had a low but not a significant improvement. One way ANOVA showed comparable severity of symptoms in the 2 groups pre-diet (P = 0.215), but a difference in the same symptoms after 12 days (P = 0.000). Tukey test showed a significant improvement in the low FODMAP diet group and only a trend of improvement in the second group of SCD. The vitamin D mean value in both groups at the time of enrollment was 38 ng/mL; in the end, the mean value in the low FODMAP diet group was 32 ng/mL and in the SCD group was 22 ng/mL, with a statistically significant difference. The folic acid mean value at the time of enrollment was 18 mg/dL; in the end, the mean value in the low FODMAP diet group was 15 mg/dL and in the SCD group was 8 mg/dL, with a statistically significant difference.

Patients affected by IBS seem to have benefitted from a low FODMAP diet but not from an SCD, and a low FODMAP diet doesn’t seem to cause vitamin D and folic acid deficiencies.

Key words

FODMAP
irritable bowel syndrome
diet
specific carbohydrate diet
bloating

Article

Introduction

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder with a pathophysiology only partially understood. It is characterized by abdominal discomfort or pain in combination with altered bowel habit, without any pathological abnormality of the gut wall.^[1]

Abdominal pain and bloating are the main symptoms of IBS and they often improve after evacuation. Abdominal pain is associated with altered bowel habit, ranging from diarrhea to constipation. Symptoms can modify over time, sometimes they can be very severe, sometimes they can disappear completely.^[2]

Pathophysiology is not completely known, it is probably linked to abnormal GI motility, altered brain-gut communication, visceral hypersensitivity, low-grade inflammation and also, psychosocial factors can contribute to it.^[3] As a consequence of poor understanding of factors underlying the symptoms of IBS, only a few effective treatment alternatives are actually available, but new therapeutic approaches are ongoing.^[4-5]

Many patients often refer to symptoms worsening after the consumption of certain foods,^[6] so they try different exclusion diets. Recently, many different dietetic approaches have been tried for IBS treatment, but there are only few clinical trials.^[7-10] Different exclusion diets or diets with low content of fat have been tried with controversial and inconsistent results.^[11,12] A diet with increasing evidence of efficacy for the management of IBS is the low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet.^[13-15] FODMAPs can pass unabsorbed to the colon, where they increase the luminal water through osmotic activity and induce gas production (H2, CH4) due to fermentation by colonic bacteria, and lead to luminal distension and GI symptoms in susceptible individuals.^[16-19]

Another approach is the Specific Carbohydrate Diet (SCD) proposed by the Gastroenterologist Sidney Hass in 1951. The diet allows carbohydrate foods consisting of monosaccharides only, and excludes disaccharides and most polysaccharides (such as linear or branch-chained multiple sugars or starches). The diet is supplemented with homemade yogurt fermented for 24 hours to minimize lactose, a disaccharide that is not allowed in the SCD.[^20-23] The SCD allows almost all fruits, vegetables containing more amylose (a linear-chain polysaccharide) than amylopectin (a branch-chained polysaccharide), nuts, nut-derived flours, dry-curd cottage cheese, meat, eggs, butter and oils. It excludes sucrose, maltose, isomaltose, lactose, grain-derived flours and all true and pseudograins, potatoes, okra, corn, fluid milk, soy, cheeses containing high amounts of lactose, as well as most food additives and preservatives.^[24,25]

Gottschall hypothesized that patients with IBD can only optimally absorb the monosaccharide glucose, galactose and fructose due to a dysfunction of the host’s disaccharidases that are necessary for the digestion and absorption of disaccharides and high amylopectin foodstuffs.^[24] This dysfunction is posited to arise from excessive mucus production, preventing the brush border intestinal enzymes from making contact with the disaccharidases and amylopectin, causing maldigestion and alteration of the microbiota.

SCD diet reduces the inflammation and dysfunction of microbiota and it should be beneficial in IBS patients.^[25]

IBS patients are also at risk to develop nutritional deficiencies because of the frequent exclusion of some kinds of foods that can trigger or worsen their symptoms. The more frequent nutritional deficiencies are: iron, calcium, vitamin B12, folic acid, zinc, magnesium, vitamin D and A.^[26,27]

Subjects and methods

The primary objective of the present study was to assess the efficacy of a low FODMAP diet on IBS symptoms as compared to a specific carbohydrate diet in outpatients with IBS.

A secondary objective was to evaluate the nutritional adequacy of the two diets, and changes in vitamin D and folic acid serum concentration with intervention. In this study (clinical single-blinded randomized trial), we recruited a group of adult patients meeting Rome IV criteria for IBS (Table 1), aged between 18 and 65 years, from the outpatient clinic UOSA Clinical Nutrition Unit of the Hospital in Siena (Azienda Ospedaliera Senese) and the outpatient Unit of Gastroenterology and Digestive Endoscopy of San Pier Damiano Hospital Faenza.

Table 1

Rome IV Criteria

Rome IV Criteria
Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of following criteria Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis :
1. Related to defecation
2. Associated with a change in frequency of stool
3. Associated with change in form (appearance) of stool

Exclusion criteria were the presence of a severe cardiac, liver, neurologic, or psychiatric disease or a GI disease other than IBS (Crohn, diverticular disease, etc.) that could explain the current symptoms.

Coeliac disease was excluded by anti-transglutaminase antibodies and duodenal biopsies.

The use of probiotic products was allowed, but patients who consumed probiotic products were instructed to continue with an unaltered intake during the study period. Other medications were allowed, provided that they used them on a regular basis and were on a stable dose for at least 3 months before inclusion.

All patients were given study-specific verbal and written information before they gave their written consent to participate in the study.

Screening

In the first visit, the patients received verbal and written information about the study and gave informed consent. Patients were informed that the aim was to compare the two different diets with potential benefits for patients by alleviation of IBS symptoms (Table 2).

Table 2

Screening of the patients

Screening at the first evaluation
Dietetic evaluation with measurement of weight, height and BMI
Nutritional and clinical history
Blood test
Visual analogue scale
BMI, body mass index.

All the patients were submitted to a first dietetic evaluation with the measurement of weight, height and the calculation of BMI. Clinical history and nutritional history of the patients were recorded, along with the presence of IBS symptoms and eventual altered bowel habits.

We evaluated the blood levels of vitamin D and folic acid at the first visit and at the end of the observational period.

We evaluated the presence of inclusion and exclusion criteria.

All the patients filled out a visual analogue scale (VAS) from 0 (no or mild bloating) to 10 (severe bloating) to evaluate the severity of symptoms and VAS was repeated every 30 days.

The symptoms evaluated as per the validation questionnaire IBS-SSS (Irritable Bowel Syndrome, Severity Score System) were: abdominal pain intensity, abdominal pain frequency, abdominal distension, dissatisfaction with bowel habits, influence of IBS on life in general (“life interference”) and alterations in stool consistency.

Randomization

After the enrollment, all the patients filled out a diary for 15 days to evaluate the number of days with symptoms and another diary for the complete observation period. Then, the participants were randomized to follow one of the two different diets (Group A: low FODMAP diet and Group B: Specific Carbohydrate diet SCD).

The analysis was performed using Statistica 12. The patients were, as per the instructions by a dietitian, advised to eat a low-FODMAP diet (diet A) or to eat according to SCD diet (diet B), and to follow these diets during the coming 3 months. All the patients were given a manual with specific instructions related to the diet and the substitution of different foods. (Table 3 and 4)

Table 3

High and low FODMAPs food and advices for a low FODMAP diet

	High FODMAP food	Low FODMAP food
High fructose	Fruit (apple, pear, nashi pear, peach, mango, sweet peas, watermelon, natural juice, tinned fruit)	Fruit (banana, blueberry, passion fruit, grapes, grapefruit, melon, kiwi, lemon, lime, tangerine, orange, raspberry, strawberry)
	Honey Sweetener (fructose)	Sweeteners (all of them except polyols: maltitol, xylitol sorbitol, mannitol, found in apples, pears, apricots, watermelon, cherry, mushrooms, chewing gum, cabbage, sweets, cakes without sugar, plum)
Lactose	Milk (cow, goat and sheep)	Milk (without lactose, rice milk)
Lactose and oligosaccharides	Ice cream	Cheese (Brie, Camembert Cheddar, Parmesan)
	Yogurt	Yogurt (without lactose)
	Fresh cheese	Ice cream substitutes (sorbet) butter
Polyols	Vegetables (artichokes, asparagus, red beet, bruxelles sprouts, broccoli, cabbage, leek, fennel, onion, garlic, peas, shallot)	Vegetables (Bamboo shoots, carrots, Chinese cabbage, celery, turnip, aubergine, lettuce, green beans, chard, chives, tomato, pumpkin)
	Cereals (in great amounts)	Cereals (gluten free and spelt bread)
	Legumes (chickpeas, beans, lentils) Fruit (watermelon, white peach, persimmon Kaki)	Substitutes of onion/garlic (flavored oils)
Fructans/or galactans	Fruit (apple, apricot, cherry, litchi, nashi pear, peach, pear, plum, dry plum, watermelon)	Fruit (banana, blueberry, carambola, grapefruit, grapes, melon, kiwi, lemon, orange, tangerine, passion fruit, raspberry)
	Vegetables (avocado, cauliflower, mushrooms, green beans)
	Sweeteners (sorbitol, mannitoo, xylitol, maltitol, isomalt)Sweeteners (glucose, sucrose)

Advices for low FODMAP diet	Plan to cook at home, since it makes it easiest to control ingredients. Drink at least 1.5-2 liters of water daily. It is possible to assume light tea or coffee, infusions without sugar. Use extra virgin olive oil, vinegar or spices to season foods. Check labels when shopping. Consume a serving of vegetables for lunch and for dinner (choosing between the ones included). Vary your diet and respect the quantity if indicated. Make sure to have regular meals and dedicate enough time to eat them. Avoid skipping meals or fasting for long time. Avoid alcohol assumption.

Table 4

Food included and excluded and advices in a specific carbohydrate diet

	Food included in SCD diet	Food not included in SCD diet
Meat, fish	Chicken, eggs, turkey, meat, fish, pork, game, lamb)	Ham, sausage, hot dog, wurstel, processed meats in general
Vegetables	All kind of fresh vegetables (Asparagus, broccoli, cabbage, cauliflower, onion, garlic, carrots, mushrooms, celery, pepper, fennel, pumpkin, aubergine, salad, lettuce …)	Canned veggies with added sugar or ingredients
Fruit	All kind of fresh fruit (apple, banana, kiwi, orange, pear, tangerine …)	Canned fruits with added sugar or ingredients, juices
Dairy	Homemade prebiotic yogurt, goat cheese	Most dairy (milk, most yogurt, cheeses, ice cream …)
Legumes	Beans, lentils, peas	Soy chickpea, broad bean
Spices	All of them
Cereals	/	Wheat, barley, oats, rye, rice, soy, spelt, amaranth, bulgur, quinoa and products made with grain flours
Sweeteners	Honey	Sugar and other sweeteners

Advices for SCD diet	Plan to cook at home, since it makes it easiest to control ingredients. Drink at least 1.5-2 liters of water daily. It is possible to assume light tea or coffee, infusions without sugar. Use extra virgin olive oil, vinegar or spices to season foods. Check labels when shopping. Vary your diet and respect the quantity if indicated. Make sure to have regular meals and dedicate enough time to eat them. Avoid skipping meals or fasting for long fasting. Avoid alcohol assumption. In place of grain flours, use things like almond or coconut flours. Avoid all legumes and reintroduce them gradually (soaked and sprouted first). Prepare your yogurt at home, fermented at least 24 hours.

Follow-up

The patients were evaluated every 30 days with the repetition of dietetic evaluation. We evaluated the compliance to diet with the compilation of a food diary, compilation of VAS scale and eventual side effects. The final evaluation was made by a blind investigator. At the end of the observational period (3 months), we measured the blood values of vitamin D and folic acid in the 2 groups.

Flow chart of the first screening of patients for the study.

Statistical analysis

The baseline socio-demographic and clinical characteristics of the 2 groups were compared with t-test for continuous variables and chi squared test for categorical variables, and these characteristics did not differ between the 2 groups.

The continuous variables were compared with t-test, and the categorical variables with chi squared test. The intragroup differences of IBS symptoms, evaluated before and after the intervention, were assessed with paired t-test, inter groups differences with one way ANOVA with post hoc Tukey multiple comparison test.

Results

A total of 73 patients were screened, including 42 females and 31 males; 13 did not meet the inclusion criteria. Sixty patients consecutively enrolled were randomized in 2 groups, one submitted to low FODMAPs diet and one to specific carbohydrate diet for 3 months.

We randomized 60 patients (38 females, 22 males, aged between 22 and 63 years) and they were divided into 2 groups of 30 patients each, group A followed a low FODMAP diet and group B followed an SCD diet for 3 months. Baseline socio-demographic and clinical characteristics of the 2 groups did not differ significantly (Table 5).

Table 5

Characteristics of the 2 groups at T0

	Group A		Group B
	Female (n =20)	Male (n = 10)	Female (n = 18)	Male (n = 12)
Mean age (years)	35 ± 7.2	37 ± 8.3	41 ± 10.2	41 ± 6.32
Mean BMI (kg/m²)	26.2 ± 4.1	28.2 ± 5.2	25.1± 2.9	29.1 ±4.2
Mean weight (kg)	68.7± 10.1	75.4± 8.3	65.6 ± 7.3	80.3 ± 9.1

During the 3 months of observation there weren’t any adverse effects and all the patients completed all the followups. At t0, the intake of nutrients and of FODMAPs was similar in the 2 groups.

During the observational period, we obviously had a great change in the dietary habits of the participants. In group A, we had a great reduction of the intake of all kinds of FODMAPs, and a reduction in the carbohydrate and fiber intake as well; this result was less evident in group B. We didn’t have any relevant variations on fat and protein intake in the 2 groups (Table 6).

Table 6

Diet quality low FODMAPs and specific carbohydrate diet in two group

Group A (low FODMAP diet)				Group B (specific carbohydrate diet)
	TO (n = 30)	3 months (n = 30)	P value	T0 (n = 30)	3 months (n = 30)	P value
Energy (kcal)	2150± 432	1769±320	<0.001	2245 ± 270	1828 ± 254
Protein (g)	89.2±34.8	84.2±15,8		85.4 ± 25.8	72.0 ± 34.2
Fat (g)	86.5±19.6	65.3±22.1		89.3 ± 18.5	76.3 ± 22.5
Carbohydrates (g)	210.7±34.9	154.9±31.7	<0.001	215.0 ± 32.8	178.1 ± 30.2
Fiber (g)	20.1±3.8	14.2±2.8		22.7 ± 10.1	18.9 ± 3.4
Total FODMAPs	17.6±9.6	2.5±1.2	<0.001	18.3 ± 3.4	14.1 ± 10.2

All patients showed a good compliance to the dietetic therapy and consumed 5 meals per day for almost the complete observational period. Some patients (3 from group A and 11 from group B) complained about the monotony of diet and about the lack of some kinds of foods like soft cheeses and some types of fruit.

At the end of the observational period, the patients with low FODMAP diet had a significant improvement in bloating and distension (P = 0.000); the group with specific carbohydrate diet instead had a low but not statistically significant improvement.

In males of group A, we had a statistically significant reduction of BMI (P = 0.001); in women of group A we had a slight but not statistically significant weight reduction. Mean BMI at t3 in males of Group A was 25.1 kg/m² (SD 2.8), in females of group A was 24.9 kg/m² (SD 3.7); mean BMI at t3 in males of Group B was 29.2 kg/m² (SD 3.8), in females of group B was 24.8 kg/m² (SD 3.5). (Table 7)

Table 7

Characteristics of the 2 groups at T3

	Group A		Group B

	Female (n =20)	Male (n = 10)	Female (n = 18)	Male (n = 12)
Mean BMI (kg/m²)	24.9 ± 3.7	25.1 ±2.8	24.8 ± 3.5	29.2 ± 3.8
Mean weight (kg)	64.3 ± 9.4	71.9 ± 10.1	64.9 ± 8.3	81.2 ± 10.5

One way ANOVA showed comparable severity of symptoms in the 2 groups pre-diet (P = 0.215), but a difference in the same symptoms after 12 days (P = 0.000). Tukey test showed a significant improvement in the low FODMAP diet group and only a trend of improvement in the second group following the specific carbohydrate diet. Vitamin D mean value in both groups at the time of enrollment was 38 ng/mL; at the end of the diet therapy, the mean value of vitamin D in the low FODMAP diet group was 32 ng/mL, and in the specific carbohydrate group was 22 ng/mL with a statistically significant difference; folic acid mean value at the time of enrollment was 18 mg/dL; at the end of the observation, the mean value in the low FODMAP diet group was 15 mg/dL and in the specific carbohydrate diet group was 8 mg/dL with a statistically significant difference.

Discussions

Fiber supplementation remains a critical approach in IBS treatment; however, its optimal application can be quite vague. A recent systematic review and a meta-analysis identified 12 trials that compared the effect of fiber supplementation with controls and they noticed only a marginal difference in the symptoms between the 2 groups.^[28]

Subgroups analysis suggested that the benefit on IBS symptoms was limited to soluble fiber (psyllium/ispaghula husk) and not to the insoluble fiber (bran). Some kinds of fiber like bran can worsen some symptoms like abdominal pain or meteorism.^[29]

The low FODMAP diet is associated with low intestinal fermentation and a significant improvement on symptoms in IBS patients.^[30] Austin reported an improvement on IBS-D with a very low carbohydrate diet (VLCD).^[31]Our data, accordingly with the recent literature confirm that patients affected by IBS seem to benefit from a low FODMAP diet but not from a specific carbohydrate diet; in addition to this, the low FODMAP diet doesn’t seem to cause vitamin D and folic acid deficiencies with respect to the specific carbohydrate diet.

The present study is still ongoing and we will evaluate vitamin D and folic acid blood levels after 6 months.

To conclude, in our opinion, it is very important to monitor the adherence to the low FODMAP diet during the observational period to evaluate the effective improvement of symptoms and to evaluate the role of other different factors (stress, infections, hormones.) not yet examined.

Figures & Tables

Rome IV Criteria

Rome IV Criteria
Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of following criteria Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis :
1. Related to defecation
2. Associated with a change in frequency of stool
3. Associated with change in form (appearance) of stool

Characteristics of the 2 groups at T0

	Group A		Group B
	Female (n =20)	Male (n = 10)	Female (n = 18)	Male (n = 12)
Mean age (years)	35 ± 7.2	37 ± 8.3	41 ± 10.2	41 ± 6.32
Mean BMI (kg/m²)	26.2 ± 4.1	28.2 ± 5.2	25.1± 2.9	29.1 ±4.2
Mean weight (kg)	68.7± 10.1	75.4± 8.3	65.6 ± 7.3	80.3 ± 9.1

Screening of the patients

Screening at the first evaluation
Dietetic evaluation with measurement of weight, height and BMI
Nutritional and clinical history
Blood test
Visual analogue scale
BMI, body mass index.

Characteristics of the 2 groups at T3

	Group A		Group B

	Female (n =20)	Male (n = 10)	Female (n = 18)	Male (n = 12)
Mean BMI (kg/m²)	24.9 ± 3.7	25.1 ±2.8	24.8 ± 3.5	29.2 ± 3.8
Mean weight (kg)	64.3 ± 9.4	71.9 ± 10.1	64.9 ± 8.3	81.2 ± 10.5

Diet quality low FODMAPs and specific carbohydrate diet in two group

Group A (low FODMAP diet)				Group B (specific carbohydrate diet)
	TO (n = 30)	3 months (n = 30)	P value	T0 (n = 30)	3 months (n = 30)	P value
Energy (kcal)	2150± 432	1769±320	<0.001	2245 ± 270	1828 ± 254
Protein (g)	89.2±34.8	84.2±15,8		85.4 ± 25.8	72.0 ± 34.2
Fat (g)	86.5±19.6	65.3±22.1		89.3 ± 18.5	76.3 ± 22.5
Carbohydrates (g)	210.7±34.9	154.9±31.7	<0.001	215.0 ± 32.8	178.1 ± 30.2
Fiber (g)	20.1±3.8	14.2±2.8		22.7 ± 10.1	18.9 ± 3.4
Total FODMAPs	17.6±9.6	2.5±1.2	<0.001	18.3 ± 3.4	14.1 ± 10.2

High and low FODMAPs food and advices for a low FODMAP diet

	High FODMAP food	Low FODMAP food
High fructose	Fruit (apple, pear, nashi pear, peach, mango, sweet peas, watermelon, natural juice, tinned fruit)	Fruit (banana, blueberry, passion fruit, grapes, grapefruit, melon, kiwi, lemon, lime, tangerine, orange, raspberry, strawberry)
	Honey Sweetener (fructose)	Sweeteners (all of them except polyols: maltitol, xylitol sorbitol, mannitol, found in apples, pears, apricots, watermelon, cherry, mushrooms, chewing gum, cabbage, sweets, cakes without sugar, plum)
Lactose	Milk (cow, goat and sheep)	Milk (without lactose, rice milk)
Lactose and oligosaccharides	Ice cream	Cheese (Brie, Camembert Cheddar, Parmesan)
	Yogurt	Yogurt (without lactose)
	Fresh cheese	Ice cream substitutes (sorbet) butter
Polyols	Vegetables (artichokes, asparagus, red beet, bruxelles sprouts, broccoli, cabbage, leek, fennel, onion, garlic, peas, shallot)	Vegetables (Bamboo shoots, carrots, Chinese cabbage, celery, turnip, aubergine, lettuce, green beans, chard, chives, tomato, pumpkin)
	Cereals (in great amounts)	Cereals (gluten free and spelt bread)
	Legumes (chickpeas, beans, lentils) Fruit (watermelon, white peach, persimmon Kaki)	Substitutes of onion/garlic (flavored oils)
Fructans/or galactans	Fruit (apple, apricot, cherry, litchi, nashi pear, peach, pear, plum, dry plum, watermelon)	Fruit (banana, blueberry, carambola, grapefruit, grapes, melon, kiwi, lemon, orange, tangerine, passion fruit, raspberry)
	Vegetables (avocado, cauliflower, mushrooms, green beans)
	Sweeteners (sorbitol, mannitoo, xylitol, maltitol, isomalt)Sweeteners (glucose, sucrose)

Advices for low FODMAP diet	Plan to cook at home, since it makes it easiest to control ingredients. Drink at least 1.5-2 liters of water daily. It is possible to assume light tea or coffee, infusions without sugar. Use extra virgin olive oil, vinegar or spices to season foods. Check labels when shopping. Consume a serving of vegetables for lunch and for dinner (choosing between the ones included). Vary your diet and respect the quantity if indicated. Make sure to have regular meals and dedicate enough time to eat them. Avoid skipping meals or fasting for long time. Avoid alcohol assumption.

Food included and excluded and advices in a specific carbohydrate diet

	Food included in SCD diet	Food not included in SCD diet
Meat, fish	Chicken, eggs, turkey, meat, fish, pork, game, lamb)	Ham, sausage, hot dog, wurstel, processed meats in general
Vegetables	All kind of fresh vegetables (Asparagus, broccoli, cabbage, cauliflower, onion, garlic, carrots, mushrooms, celery, pepper, fennel, pumpkin, aubergine, salad, lettuce …)	Canned veggies with added sugar or ingredients
Fruit	All kind of fresh fruit (apple, banana, kiwi, orange, pear, tangerine …)	Canned fruits with added sugar or ingredients, juices
Dairy	Homemade prebiotic yogurt, goat cheese	Most dairy (milk, most yogurt, cheeses, ice cream …)
Legumes	Beans, lentils, peas	Soy chickpea, broad bean
Spices	All of them
Cereals	/	Wheat, barley, oats, rye, rice, soy, spelt, amaranth, bulgur, quinoa and products made with grain flours
Sweeteners	Honey	Sugar and other sweeteners

Advices for SCD diet	Plan to cook at home, since it makes it easiest to control ingredients. Drink at least 1.5-2 liters of water daily. It is possible to assume light tea or coffee, infusions without sugar. Use extra virgin olive oil, vinegar or spices to season foods. Check labels when shopping. Vary your diet and respect the quantity if indicated. Make sure to have regular meals and dedicate enough time to eat them. Avoid skipping meals or fasting for long fasting. Avoid alcohol assumption. In place of grain flours, use things like almond or coconut flours. Avoid all legumes and reintroduce them gradually (soaked and sprouted first). Prepare your yogurt at home, fermented at least 24 hours.

References

1Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology 2006; 130: 1480-91LongstrethGFThompsonWGCheyWDHoughtonLAMearinFSpillerRC.Functional bowel disordersGastroenterology200613014809110.1053/j.gastro.2005.11.06116678561Search in Google Scholar

2Sheperd SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am diet Assoc 2006; 106:1631-9.SheperdSJGibsonPR.Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary managementJ Am diet Assoc20061061631910.1016/j.jada.2006.07.01017000196Search in Google Scholar

3Ohman L, Simrén M. New insights into the pathogenesis and pathophysiology of irritable bowel syndrome. Dig Liver Dis 2007; 39: 201-15.OhmanLSimrénM.New insights into the pathogenesis and pathophysiology of irritable bowel syndromeDig Liver Dis2007392011510.1016/j.dld.2006.10.01417267314Search in Google Scholar

4Morcos A, Dinan T, Quigley EM. Irritable bowel syndrome: role of food in pathogenesis and management. J Dig Dis 2009; 10:237-46.MorcosADinanTQuigleyEM.Irritable bowel syndrome: role of food in pathogenesis and managementJ Dig Dis2009102374610.1111/j.1751-2980.2009.00392.x19906102Search in Google Scholar

5Dean BB, Aguilar D, Barghout V, Kahler KH, Frech F, Groves D, et al. Impairment in work productivity and helath related quality of life in patients with IBS. Am J manag care 2005; 11 (Suppl): S17-26.DeanBBAguilarDBarghoutVKahlerKHFrechFGrovesDet al.Impairment in work productivity and helath related quality of life in patients with IBSAm J manag care200511S1726Search in Google Scholar

6Sheperd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008; 6:765-71.SheperdSJParkerFCMuirJGGibsonPR.Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidenceClin Gastroenterol Hepatol200867657110.1016/j.cgh.2008.02.05818456565Search in Google Scholar

7Ford AC, Talley NJ, Spiegel BM, Foxx-Orenstein AE, Schiller L, Quigley EM. Effect of fibre, antispasmodics and peppermint oil in the treatment of irritable bowel syndrome. Systematic review and meta-analysis. BMJ 2008; 337: a2313.FordACTalleyNJSpiegelBMFoxx-OrensteinAESchillerLQuigleyEM.Effect of fibre, antispasmodics and peppermint oil in the treatment of irritable bowel syndrome. Systematic review and meta-analysisBMJ2008337a231310.1136/bmj.a2313258339219008265Search in Google Scholar

8Luther J, Chey WD. ACP Journal Club. Psyllium increased symptom relief in patients with the irritable bowel syndrome more than bran or placebo. Ann Intern Med 2010; 152: JC1-11.LutherJCheyWD.ACP Journal Club. Psyllium increased symptom relief in patients with the irritable bowel syndrome more than bran or placeboAnn Intern Med2010152JC11110.7326/0003-4819-152-2-201001190-0201120083814Search in Google Scholar

9Rees G, Davies J, Thompson R, Parker M, Liepins P. Randomized-controlled trial of a fibre supplement on the symptoms of irritable bowel syndrome. J R Soc Health 2005; 125: 30-4.ReesGDaviesJThompsonRParkerMLiepinsP.Randomized-controlled trial of a fibre supplement on the symptoms of irritable bowel syndromeJ R Soc Health200512530410.1177/14664240051250011215712850Search in Google Scholar

10Simrén M, Månsson A, Langkilde AM, Svedlund J, Abrahamsson H, Bengtsson U, et al. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion 2001; 63: 108–15.SimrénMMånssonALangkildeAMSvedlundJAbrahamssonHBengtssonUet al.Food-related gastrointestinal symptoms in the irritable bowel syndromeDigestion2001631081510.1159/00005187811244249Search in Google Scholar

11Niec AM, Frankum B, Talley NJ. Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol 1998; 93: 2184–90.NiecAMFrankumBTalleyNJ.Are adverse food reactions linked to irritable bowel syndrome?Am J Gastroenterol19989321849010.1111/j.1572-0241.1998.00531.x9820394Search in Google Scholar

12Gibson PR. Food intolerance in functional bowel disorders. J Gastroenterol Hepatol 2011; 26(Suppl 3): S128–31.GibsonPR.Food intolerance in functional bowel disordersJ Gastroenterol Hepatol2011263S1283110.1111/j.1440-1746.2011.06650.x21443725Search in Google Scholar

13Barrett JS, Gearry RB, Muir JG, Irving PM, Rose R, Rosella O, et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther 2010; 31: 874–82.BarrettJSGearryRBMuirJGIrvingPMRoseRRosellaOet al.Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colonAliment Pharmacol Ther2010318748210.1111/j.1365-2036.2010.04237.x20102355Search in Google Scholar

14Berrill JW, Green JT, Hood K, Campbell AK. Symptoms of irritable bowel syndrome in patients with inflammatory bowel disease: examining the role of sub-clinical inflammation and the impact on clinical assessment of disease activity. Aliment Pharmacol Ther 2013; 38: 44–51.BerrillJWGreenJTHoodKCampbellAK.Symptoms of irritable bowel syndrome in patients with inflammatory bowel disease: examining the role of sub-clinical inflammation and the impact on clinical assessment of disease activityAliment Pharmacol Ther201338445110.1111/apt.1233523668698Search in Google Scholar

15El Salhy M, Ostgaard H, Gundersen D, Hatlebakk JG, Hausken T. The role of diet in the pathogenesis and management of irritable bowel syndrome. Int J Mol Med 2012; 29: 723-31.El SalhyMOstgaardHGundersenDHatlebakkJGHauskenT.The role of diet in the pathogenesis and management of irritable bowel syndromeInt J Mol Med2012297233110.3892/ijmm.2012.92622366773Search in Google Scholar

16Gibson PR, Shepherd SJ. Personal view: food for thought—Western lifestyle and susceptibility to Crohn’s disease. The FODMAP hypothesis. Aliment Pharmacol Ther 2005; 21: 1399-409.GibsonPRShepherdSJ.Personal view: food for thought—Western lifestyle and susceptibility to Crohn’s disease. The FODMAP hypothesisAliment Pharmacol Ther200521139940910.1111/j.1365-2036.2005.02506.x15948806Search in Google Scholar

17Shepherd SJ, Parker SC, Muir JG, Gibson PR. Randomised, placebocontrolled evidence of dietary triggers for abdominal symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2008; 6:765-71.ShepherdSJParkerSCMuirJGGibsonPR.Randomised, placebocontrolled evidence of dietary triggers for abdominal symptoms in patients with irritable bowel syndromeClin Gastroenterol Hepatol200867657110.1016/j.cgh.2008.02.05818456565Search in Google Scholar

18Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146: 67-75.e5.HalmosEPPowerVAShepherdSJGibsonPRMuirJG.A diet low in FODMAPs reduces symptoms of irritable bowel syndromeGastroenterology20141466775.e510.1053/j.gastro.2013.09.04624076059Search in Google Scholar

19Owczarek D, Rodacki T, Domagala-Rodacka R, Cibor D, Mach T. Diet and nutritional factors in inflammatory bowel diseases. World J Gastroenterol 2016; 22: 895-905.OwczarekDRodackiTDomagala-RodackaRCiborDMachT.Diet and nutritional factors in inflammatory bowel diseasesWorld J Gastroenterol20162289590510.3748/wjg.v22.i3.895471604326811635Search in Google Scholar

20Knight-Sepulveda K, Kais S, Santaolalla R, Abreu MT. Diet and Inflammatory Bowel Disease . Gastroenterol Hepatol 2015; 11: 511-20.Knight-SepulvedaKKaisSSantaolallaRAbreuMT.Diet and Inflammatory Bowel DiseaseGastroenterol Hepatol20151151120Search in Google Scholar

21Obih C, Wahbeh G, Lee D, Braly K, Giefer M, Shaffer ML, et al. Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Nutrition 2016; 32: 418-25.ObihCWahbehGLeeDBralyKGieferMShafferMLet al.Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD centerNutrition2016324182510.1016/j.nut.2015.08.02526655069Search in Google Scholar

22Kakodkar S, Farooqui AJ, Mikolaitis SL, Mutlu EA. The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series. J Acad Nutr Diet 2015; 115: 1226-32.KakodkarSFarooquiAJMikolaitisSLMutluEA.The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case SeriesJ Acad Nutr Diet201511512263210.1016/j.jand.2015.04.01626210084Search in Google Scholar

23Nieves R, Jackson RT. Specific carbohydrate diet in treatment of inflammatory bowel disease. Tenn Med 2004; 97: 407.NievesRJacksonRT.Specific carbohydrate diet in treatment of inflammatory bowel diseaseTenn Med200497407Search in Google Scholar

24Cohen SA, Gold BD, Oliva S, Lewis J, Stallworth A, Koch B, et al. Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2014; 59: 516-21.CohenSAGoldBDOlivaSLewisJStallworthAKochBet al.Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn diseaseJ Pediatr Gastroenterol Nutr2014595162110.1097/MPG.000000000000044924897165Search in Google Scholar

25Suskind DL, Wahbeh G, Gregory N, Vendettuoli H, Christie D. Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. J Pediatr Gastroenterol Nutr 2014; 58: 87-91.SuskindDLWahbehGGregoryNVendettuoliHChristieD.Nutritional therapy in pediatric Crohn disease: the specific carbohydrate dietJ Pediatr Gastroenterol Nutr201458879110.1097/MPG.000000000000010324048168Search in Google Scholar

26Khayyat Y, Attar S. vitamin D Deficiency in patients with irritable bowel syndrome: does it exist? Oman Med J 2015; 30: 115-8.KhayyatYAttarS.vitamin D Deficiency in patients with irritable bowel syndrome: does it exist?Oman Med J201530115810.5001/omj.2015.25441288625960837Search in Google Scholar

27Bohn L, Storsrud S, Simren M. Nutrient intake in patients with irritable bowel syndrome compared with the general population. Neurogastroenterol Motil 2013; 25: 23-e1.BohnLStorsrudSSimrenM.Nutrient intake in patients with irritable bowel syndrome compared with the general populationNeurogastroenterol Motil20132523e110.1111/nmo.1200122937900Search in Google Scholar

28Ford AC, Moayyedi P, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol 2014; 109(Suppl 1); S2-26; quiz S27.FordACMoayyediPLacyBELemboAJSaitoYASchillerLRet al.American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipationAm J Gastroenterol20141091S2-26quiz S2710.1038/ajg.2014.18725091148Search in Google Scholar

29Bijkerk CJ, de Wit NJ, Muris JWM, Whorwell PJ, Knottnerus JA, Hoes AW. Soluble or insoluble fiber in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ 2009; 339: b3154.BijkerkCJde WitNJMurisJWMWhorwellPJKnottnerusJAHoesAW.Soluble or insoluble fiber in irritable bowel syndrome in primary care?Randomised placebo controlled trial. BMJ2009339b315410.1136/bmj.b3154327266419713235Search in Google Scholar

30Moayyedi P, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. The effect dietary intervention on irritable bowel syndrome: a systematic review. Clin Transl Gastroenterol 2015:e107.MoayyediPQuigleyEMLacyBELemboAJSaitoYASchillerLRet al.The effect dietary intervention on irritable bowel syndrome: a systematic reviewClin Transl Gastroenterol2015e10710.1038/ctg.2015.21481627926291435Search in Google Scholar

31Austin GL; Dalton CB; Hu Y; Morris CB; Hankins J; Weinland SR, et al. A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol 2009; 7: 706-8.AustinGLDaltonCBHuYMorrisCBHankinsJWeinlandSRet al.A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominant irritable bowel syndromeClin Gastroenterol Hepatol20097706810.1016/j.cgh.2009.02.023269347919281859Search in Google Scholar

Journal of Translational Internal Medicine

Effects of a low FODMAP diet and specific carbohydrate diet on symptoms and nutritional adequacy of patients with irritable bowel syndrome: Preliminary results of a single-blinded randomized trial

Massimo Vincenzi,
Massimo Vincenzi,
Irene Del Ciondolo,
Irene Del Ciondolo,
Elisa Pasquini,
Elisa Pasquini,
Katia Gennai and
Katia Gennai and
Barbara Paolini
Barbara Paolini

Published Online: 30 Jun 2017

Volume & Issue: Volume 5 (2017) - Issue 2 (June 2017)

Page range: 120 - 126

Journal & Issue Details

Journal of Translational Internal Medicine

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Abstract