Specialized diets in Irritable Bowel Syndrome: what works best for your patient?

Specialized diets in Irritable Bowel Syndrome: what works best for your patient??

Recently, many dietary approaches involving whole-foods have been tested for their applicability and effectiveness in treatment of chronic gut conditions.?

The recent paper published in 2022 by Rej et al. highlighted three, the most commonly used diets to manage symptoms of Irritable Bowel Syndrome (IBS), which were:?

• Traditional dietary advice (TDA),??
• Diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP),?
• Gluten-free diet (GFD).??

Firstly, let's asses the key characteristics of mentioned dietary approaches:

Traditional dietary advice (TDA)

TDA is the first-line dietary therapy, based on National Institute for Health and Care Excellence? and the British Dietetic Association guidance that proposes healthy eating style, regular meals, maintaining adequate hydration, and reducing the intake of alcohol, caffeine and fizzy drinks, as well as avoiding fatty, spicy processed foods. These guidelines also suggest to limit fresh fruit, beans, bread, sweeteners, to 3 potions per day as they are known to be a gas-producing foods. TDA also addresses any perceived food intolerances (e.g., dairy), which might lead to bloating or abdominal disturbances.?

Diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)

A low FODMAPs diet is recommended for managing symptoms of IBS, and it is based on the principle of initial elimination (first 4-6 weeks) all fermentable carbohydrates found in fruits, vegetables, dairy products, artificial sweeteners, and wheat (FODMAPS), which are known to increase colonic gas production, thereby exaggerating IBS symptoms. Following the elimination, these foods are gradually reintroduced, and symptoms monitored, what help in personalization.?

Gluten-free diet (GFD)

A gluten-free diet is often recommended to IBS patients even though they have not shown any symptoms of celiac disease or wheat allergy (Cozma-Petru? et al., 2017). Interestingly, following a wheat free diet, similarly like gluten free diet could be considered in IBS management.??

So, how those diets perform in the clinical setting?

Results presented by Rej et al. (2022) based on evidence provided from randomized trials comparing TDA against the low FODMAP diet and GFD have shown similar improvements in IBS symptom severity scores, regardless of their allocated diet. Although overall reductions in macronutrient and micronutrient intake did not significantly differ across the diets, patients prescribed a low FODMAP had the greatest reduction in total FODMAP content (27.7 g/day before intervention to 7.6 g/day at week 4) compared with the GFD (27.4 g/day to 22.4 g/day) and TDA (24.9 g/day to 15.2 g/day).?

Work of Rej et al. (2022) also highlighted some additional benefits of TDA from the patient- perspective:?

• Patients suffering from IBS found TDA cheaper, less time-consuming to shop and easier to follow, in particularly when eating out compared to GFD and low FODMAP.??
• TDA was also easier to incorporate into daily life than the low FODMAP.

Although TDA, low FODMAP, and GFD are effective examples of effective dietary approaches used in IBS management, TDA seems to be the most patient-friendly in terms of cost and convenience (Rej et al., 2022).?

More details about the diets can be found below:

Rej A, Sanders DS, Shaw CC, Buckle R, Trott N, Agrawal A, Aziz I. Efficacy and Acceptability of Dietary Therapies in Non-Constipated Irritable Bowel Syndrome: A Randomized Trial of Traditional Dietary Advice, the Low FODMAP Diet, and the Gluten-Free Diet. Clin Gastroenterol Hepatol. 2022 Dec;20(12):2876-2887.e15. doi: 10.1016/j.cgh.2022.02.045. Epub 2022 Feb 28. PMID: 35240330.?