Low FODMAP diet can ease GI symptoms of those with endometriosis: Study

A low FODMAP diet developed by Monash University researchers for irritable bowel syndrome (IBS) has been shown to improve gastrointestinal symptoms in women with endometriosis.

Sixty percent of study participants responded to the Low FODMAP Diet (LFD), compared to 26 per cent who responded to a control diet based on Australian Dietary Guidelines.

The majority of those on the LFD experienced a clinically significant improvement in gastrointestinal symptoms, and overall symptom severity was 40 per cent lower on the LFD than on the control diet.

Published in Alimentary Pharmacology and Therapeutics, researchers found that the LFD also eased abdominal pain and bloating, and normalised stool consistency.

Dr Jane Varney, a Senior Research Dietitian in Monash University's School of Translational Medicine Department of Gastroenterology, and Alfred Health, said this research showed for the first time that the Low FODMAP Diet reduced gastrointestinal symptom severity in women with endometriosis.

Dr Varney said more than 75 per cent of women with endometriosis experienced gastrointestinal symptoms, which mimic those experienced by people with IBS. She said that while many women with endometriosis attempted to modify their diet to help manage their symptoms, until now there was limited evidence to suggest any particular dietary approach worked.

“Six out of 10 patients responded to the Low FODMAP Diet and reported clinically significant improvements in gastrointestinal symptoms,” Dr Varney said.

“Abdominal pain and bloating improved, stool form normalised and quality of life improved. Given the high prevalence of gastrointestinal symptoms among women with endometriosis, and the absence of targeted treatments, this study highlights a diet therapy that will bring symptom relief to many women.”

Developed in the mid-2000s, The Monash University Low FODMAP Diet revolutionised IBS treatment. Monash dietitians, scientists and gastroenterologists established the FODMAP diet’s effectiveness then released the FODMAP Diet App in 2012 and a cookbook in 2023.

This study involved 35 women aged over 18 with diagnosed endometriosis and gastrointestinal symptoms such as abdominal pain, bloating, altered bowel habits and pain during/after bowel movements.

After eating their usual diet for seven days, participants were randomised to one of two diets that were supplied by the researchers for 28 days. Both diets were based on Australian Healthy Eating Guidelines, but only one was low in FODMAPs. Participants then returned to their regular diet for 28 days, before crossing over to the alternate dietary intervention. The two study diets were matched for macronutrients, micronutrients and fibre, so they only differed in FODMAP content.

Senior author Associate Professor Rebecca Burgell, who is Head of the Functional Gut Service at Alfred Health, and an Adjunct Associate Professor at the Monash University School of Translational Medicine, said that despite the high prevalence of gastrointestinal symptoms in endometriosis, few treatments specifically targeted those symptoms, and some made them worse.

“Gastrointestinal symptoms associated with endometriosis are largely ignored in clinical guidelines,” Associate Professor Burgell said. “Most endometriosis guidelines fail to mention gastrointestinal symptoms and none offer advice about identification or management. Nor do IBS guidelines mention screening for endometriosis.”

Reference:

Jane E. Varney, Daniel So, Peter R. Gibson, Dakota Rhys-Jones, Yuet Sang Jimmy Lee, Jane Fisher, Judith S. Moore, Roni Ratner, Mark Morrison, Rebecca E. Burgell, Jane G. Muir, Clinical Trial: Effect of a 28-Day Low FODMAP Diet on Gastrointestinal Symptoms Associated With Endometriosis (EndoFOD)—A Randomised, Controlled Crossover Feeding Study, Alimentary Pharmacology & Therapeutics, https://doi.org/10.1111/apt.70161