What is the Best Diet for Irritable Bowel Syndrome

A randomized clinical trial shows that the relief of symptoms of irritable bowel syndrome (IBS) is similar in patients who follow standard dietary advice, a diet low in FODMAPs (Fermentable Oligo, Di, Monosaccharides And Polyols) or low in gluten for 1 month.
Standard dietary advice has proven to be less expensive, easier to integrate into daily life or outside the home.
Why is this important?

A randomized clinical trial shows that the relief of symptoms of irritable bowel syndrome (IBS) is similar in patients who follow standard dietary advice, a diet low in FODMAPs (Fermentable Oligo, Di, Monosaccharides And Polyols) or low in gluten for 1 month.
Standard dietary advice has proven to be less expensive, easier to integrate into daily life or outside the home.
Why is this important?

This randomized study contributes to overcoming the lack of robust data on the efficacy of diets that are very frequently offered as first-line treatment in IBS without constipation. More than 8 out of 10 people with IBS report food-related symptoms and more than 6 out of 10 people want to know what food(s) to avoid. In the context of IBS, the low-FODMAP diet is a second-line dietary treatment in the United Kingdom and first-line in the United States, yet it is restrictive. Hence the importance of having reliable data.

Methodology

This randomized trial compared the impact of traditional dietary advice to a low-FODMAP diet and a low-gluten diet. Individuals with non-constipated IBS (Rome IV criteria) were randomized to one of these three diet groups. Clinical response was assessed at 4 weeks. Standard dietary advice focuses on the adoption of a healthy and reasonable diet, based on taking regular meals, in quantities that are neither too small nor too large, maintaining good hydration and reducing the consumption of alcohol, caffeine, soft drinks, spicy or processed foods, fresh fruit (maximum 3 per day), fiber and other foods that promote gas production (beans, bread, sweeteners, etc.) and the eviction of any product for which the individual would be intolerant (dairy products for example).

Principle results

Overall, the analyzes focused on 99 subjects: 33 having followed the dietary advice, 33 a low-FODMAP diet and 33 a low-gluten diet. The mean age at inclusion was 37 years (71% female, 75% diarrhea-prone IBS (SII-D) and 25% mixed IBS (SII-M)).

The primary endpoint, i.e. reduction of ≥50 points in IBS symptom severity score (SII-SGS) at 4 weeks, was achieved by 54% of IBS-D individuals and 44 % of SSI-M individuals. The results showed that 42% of participants in the traditional dietary advice group, 55% of those on the low-FODMAP diet and 58% of those on the low-gluten diet met the primary endpoint. The improvement was similar for all elements of the analyzed score, regardless of the diet followed.

Participants who tested dietary advice reported significantly lower overall cost than other options. The dietary advice was also found to be less logistically time-consuming, easier to follow outdoors than the no-FODMAP or low-gluten diet, and easier to incorporate into daily life than the low-FODMAP diet.

The researchers were interested in the intake of macro- and micronutrients for each of these diets and no significant difference could be demonstrated over the 4-week follow-up period.

Depression was significantly improved on a low-FODMAP diet compared to traditional dietary advice. However, this did not have a significant impact on intestinal dysbiosis measured on stool samples. In the end, 70% of participants who followed the dietary advice, as well as 67% of those on a low-FODMAP diet and 61% of those who followed a low-gluten diet indicated that they would continue this diet.

Reviewer overview

What is the Best Diet for Irritable Bowel Syndrome - /10

Summary

A randomized clinical trial shows that the relief of symptoms of irritable bowel syndrome (IBS) is similar in patients who follow standard dietary advice, a diet low in FODMAPs (Fermentable Oligo, Di, Monosaccharides And Polyols) or low in gluten for 1 month. Standard dietary advice has proven to be less expensive, easier to integrate into daily life or outside the home.

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