This story focuses on a dietary pattern that has been around for years but is experiencing increased awareness and clinical use: the low-FODMAP diet. “FODMAP” stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, types of short-chain carbohydrates that may be poorly absorbed by the small intestine, leading to bloating, constipation and abdominal pain.
Filled with caution and caveats, the story makes it clear that existing studies of the diet’s efficacy are small and, when taken in the aggregate, inconclusive–yet intriguing enough that some people (and dietitians) are giving it a try.
While we appreciate the cautionary signals sent by this story, we would have moved them much higher in the text. As written, initial story graphs maintain a fairly neutral tone and are followed by a testimonial that puts the low-FODMAP diet on the “success-ish” side of the ledger. It is not until the second half of the story that the cautions and caveats emerge.
Millions of people wrestle with abdominal pain, bloating, and changes in their bowel movement patterns and will be actively interested in lifestyle modifications to improve their symptoms. This story made it clear that the evidence is mixed.
The story notes that health insurance is unlikely to cover the costs of a clinic visit with a dietitian to discuss the proper implementation of the diet, but it fails to offer an estimate of what that out-of-pocket cost might be. The story could have offered an estimate on how other approaches to IBS treatment, such as medications or probiotics, might stack up. And since food manufacturers are apparently already offering low-FODMAP products, the story would have helped readers by indicating whether those products are more costly than their “regular” counterparts.
The story looks at the big picture here, and it does do a pretty good job quantifying the benefits, when relevant. For example, one recent study in the United States gets detailed attention in the story. In it, patients on the low-FODMAP diet perceived better relief from pain and bloating than did patients on a less restrictive diet. We’re told both the percentage of subjects who reported “adequate relief,” hovered around 40-50% for both diets. The story quickly follows that by explaining there was no statistically significant difference.
The story also highlights another study in which the low-FODMAP diet fared no better than another, less restrictive diet. “The data are not overwhelming,” notes one scientist. And the story, while mentioning that the 2014 American College of Gastroenterology guidelines stated that the diet showed promise, also quotes the organization as indicating that the quality of the evidence is “very low.”
The story explains that the diet is restrictive, in the sense that it asks patients to eliminate a wide array of foods eaten in a normal diet (before cautiously adding them back later in the process). It also hints that because of all the unknowns with this relatively new, not-fully-researched diet, “it’s not known if the diet leads to any nutritional deficiencies or keeps working in the long run — especially for patients who get little support from doctors or dietitians.”
Through sources and brief descriptions of extant research, the story makes it clear that there has been little systematic exploration of this diet and that existing studies are both small and at times contradictory.
The story did a good job explaining what irritable bowel syndrome is, and notes that it is “common.” While we wish more had been said about the prevalence, this is enough to rate satisfactory.
William Chey, a professor of gastroenterology, is listed as a consultant to Nestle on one of the studies. Nestle Health Science markets low-FODMAP products. Also, another source, dietitian Kate Scarlata, has a forthcoming book on FODMAP. We think both of these details should have been in the story.
We were glad to see that the story does note that the University of Michigan’s website for low-FODMAP diet resources, which is referenced in the article, receives funding from Nestle Health Science.
The story mentions a number of alternatives, including other existing diets that seem to compete favorably with the low-FODMAP diet, such as medication, probiotics, and fiber supplements. The story notes that these other strategies “still have roles in treating IBS”.
The text offers links to online explanations of the diet, as well as to lists of foods that would be eliminated initially as part of it. Anyone could give this a try, though the article recommends that IBS sufferers implement the diet under a dietitian’s supervision.
The story makes the case that the diet is a different approach than the alternatives (medications, probiotics, fiber), but it also makes it clear that this diet has been around for awhile. This is a trend story on this type of eating, rather than a look at a specific study.
The multi-source, multi-study nature of this story makes enterprise more likely and reliance on a news release less likely.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments (1)
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Paul Ernsberger
February 20, 2017 at 3:10 pmThe FODMAP foods are some of the healthiest you can eat. They are rich in soluble fiber that feeds beneficial gut bacteria. These bacteria sometimes produce gas. Cutting out dietary fiber to starve your gut bacteria and lessen the accumulation of gas may give you a more slender profile, but if anything it may impair health.
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