低FODMAP食の安全性：英国とイタリアの研究報告

 

日本低フォドマップ食推進会

 

低FODMAP食は、過敏性腸症候群（IBS）の症状軽減に有用であることは世界的事実として認識されているが、

その長期管理には問題はないであろうか？

と、心配する人もいるであろう。

特に、日本では、「健康のために良い」と報道されている食品を、低FODMAP食では避けなければならないため、日本の栄養士やTVドクター、コメンテーターは、「栄養が偏る危険性があるのでは。。。」と言いそうな気がする。

 

それについて、英国とイタリアの栄養学の専門家から、そのような心配はないという報告があった。

 

まずは、イタリアの報告は以下である。

 

https://www.ncbi.nlm.nih.gov/pubmed/28721345

 

J Transl Int Med. 2017 Jun 30;5(2):120-126. doi: 10.1515/jtim-2017-0004. eCollection 2017 Jun.

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.

Vincenzi M1, Del Ciondolo I2, Pasquini E2, Gennai K2, Paolini B2.

Author information

1　Unit of Gastroenterology and Digestive Endoscopy, San Pier Damiano Hospital, Faenza, RA, Italy.

2　Dietetics and Clinical Nutrition Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy.

 

BACKGROUND AND OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

3か月の低FODMAP食においても、ビタミンDおよび葉酸欠乏を引き起こさない

 

次に、英国の報告は以下である。

 

https://www.ncbi.nlm.nih.gov/pubmed/28707437

 

Neurogastroenterol Motil. 2017 Jul 14. doi: 10.1111/nmo.13154. [Epub ahead of print]

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

O'Keeffe M1, Jansen C1, Martin L1, Williams M2, Seamark L2, Staudacher HM1, Irving PM1,3, Whelan K1,3, Lomer MC1,3.

 

1　Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.

2　Community Dietetics Service, Somerset Partnership NHS Foundation Trust, Bridgwater, Somerset, UK.

3　Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.

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 FODMAPreintroduction 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 g/d) compared with 19 (18%) of patients following a 'habitual' diet (29.4, SD 22.9 g/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 (P<.001) and affected social eating (P<.01) but there was no effect on food-related QOL. Healthcare utilization was similar between both groups.

CONCLUSION AND INFERENCES:

Low-FODMAP education is effective for long-term IBS management, enables a nutritionally adequate diet, and is broadly acceptable to patients.

 

6週間の導入期、およびその後のチャレンジ期を経て、自分が症状を来す食品を排除した食生活を6カ月以上行っている低FODMAP食の長期経過では、栄養学的に何らの問題もなく、また、食事の満足度も十分であった。

 

以上であり、

低FODMAP食について、

「そんな偏食は、健康に良くない」という批判があったとしても、

それについては、科学的にあり得ないと結論する。

 

なお、2番目の論文では、興味深い内容があったので追記する。

長期管理では、導入前よりも、自己制限していた食品は、パスタと小麦粉のパンであった。つまり、英国のBSでは、小麦粉がトリガーとなっている人が多いようである。