Brief Summary :
The goal of this clinical trial is to investigate the effects of differing FODMAP diets on gut microbiota, gut barrier function, symptom severity, quality of life, and psychological status in FGID patients. The main question it aims to answer is :
How does diets with differing FODMAP content affect the gut microbiota, gut barrier function, symptom severity, psychological status and quality of life in patients with FGID ? Researchers will compare low FODMAP diet, Gentle FODMAP diet and Traditional Dietary Advice (NICE guidelines) to see which diet is more suitable and effective for Malaysian FGID patients.
Participants will :
Be given either low FODMAP diet, Gentle FODMAP diet or Traditional Dietary Advice intervention and will be required to follow the intervention for two weeks.
Be required to provide stool and blood samples during baseline and intervention Record 4 day food diary and complete assessing questionnaires during baseline and intervention
Aged 18 and above
Able to provide informed consent
Those with pre-existing irritable bowel syndrome (IBS) or functional dyspepsia (FD) or both screened by gastroenterologists
Meet the ROME III- Asian criteria for FGID
Pregnant or lactating women
History declared by the participant of pre-existing gastrointestinal disorder, including but not limited to Inflammatory Bowel Disease, Coeliac Disease, Pancreatitis, Gallstone disease (biliary colic, cholecystitis), Diverticulitis
Cancer of any kind
Patients with reported history of previous resection of any part of the GI tract other than appendix or gall bladder, intestinal stoma
Parallel
Low FODMAP diet
BehavioralHigh FODMAP foods are swapped for low FODMAP alternatives, for two weeks (Elimination phase)
Gentle FODMAP diet
BehavioralKey High FODMAP foods will be identified from patients' food diaries and swapped with low FODMAP alternatives. (Elimination phase)
Traditional Dietary Advice
BehavioralSubjects are required to follow a set of healthy eating guidelines set by NICE guidelines for IBS for two weeks a. Have regular meals and take time to eat b. Avoid missing meals or leaving long gaps between eating c. Drink at least eight cups of fluid a day, especially water or other non-d. caffeinated drinks, such as herbal teas d. Restrict tea and coffee to three cups a day e. Reduce intake of alcohol and fizzy drinks . Limit intake of high-fibre food g. Reduce intake of resistant starch h. Limit fresh fruit to three portions a day
Effect of FODMAP restrictions on Gut Microbiota Abundance and Diversity
16s RNA gene seqeuncing will be conducted on the stool samples at both baseline and post-intervention timelines. This test would target the microbial diversity by assessing the abdundance of key bacterial taxa.
Effect of FODMAP restrictions on Gut Barrier Function
The stool samples collected would be subjected to zonulin test and short-chain fatty acid quantification (SCFA) in order to assess gut barrier function of subjects at baseline and post-intervention timelines. Zonulin is a protein that reversibly modulates the intestinal permeability, while SCFA such as butyrate are by-products of the carbohydrate fermentation facilitated by gut microbiome that enhances the integrity of tight junction of the intestinal barrier
Effect of 2 week FODMAP restrictions on Symptom Severity (IBS-SSS questionnaire)
Irritable Bowel Syndrome Symptom Severity Score (IBS-SSS) and Gastrointestinal Symptom Rating Scale (GSRS) will be filled out by subjects during baseline and post-intervention to assess symptom severity. For IBS-SSS, Four out of five items have visual analogue scales to describe the level of severity of abdominal pain, bloating or distension, disturbance of bowel habits and life impact of IBS symptoms. The level of severity will be categorised based on their total scores. A score of less than 25% is considered no pain, 25 to 50% is considered mild, 50 to 75% is considered moderate, and the score of 100% is very severe.
Effect of 2-week FODMAP restriction on Psychological Status
Hospital Anxiety and Depression Scale (HADS) will be filled out by subjects during baseline and post-intervention to assess symptom severity. This self-reported questionnaire contains 14 items that are scored on a 4-point Likert-type scale, ranging from 0 to 3, and are classified into two subscales measuring cognitive and emotional symptoms of depression (HADS-D) and anxiety (HADS-A). The total score on each subscale ranges from 0 to 21, and a higher score represents worse symptoms. A score equal to or greater than eight on either HADS-D or HADS-A is considered a 'possible case', and above 11 a 'probable case'.
Effect of 2-week FODMAP restriction on Quality of Life
European Quality of Life 5 Dimensions 5 Level Version Questionnaire (EQ-5D-5L) will be filled out by subjects during baseline and post-intervention to assess quality of life. This validated questionnaire consists of five items capturing different aspects of health, including mobility, self-care, ability to carry out usual activities, pain/discomfort and anxiety/depression. Each item has five levels of responses, where the minimum level being 'no problems' and maximum level being 'unable to do' things mentioned.
Effect of 2-week FODMAP restriction on Food Avoidance
A validated food avoidance and dietary trigger questionnaire will be filled out by subjects during baseline and post-intervention to assess food avoidance. This questionnaire is a 10-item tool in which question 1 is to identify dietary triggers of subjects. Question 2, 3, and 4 are follow up questions to assess bowel symptoms and dietary triggers. Question 5 that assess fear of eating, has a 6-point Likert scale, where the minimum point is 'Strongly Disagree' and the maximum point is 'Strongly Agree'.Question 6 assesses food avoidance behaviour using a 4-point Likert scale, where the minimum point is 'Never' and the maximum point is 'Always'. Questions 6,7,8,9 and 10 are used to assess patient's medical knowledge and medical history.
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