A Rej et al. Clin Gastroenterol Hepatol 2022; 20: 2876-2887. Open Access! 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
Methods: In patients (n=99) with Rome IV–defined non-constipated IBS, outcomes after randomization to one of three diets were compared. The “traditional dietary advice” group: “Its principles include adopting healthy, sensible eating patterns such as having regular meals, never eating too little/too much, maintaining adequate hydration, and reducing the intake of (1) alcohol/caffeine/fizzy drinks, (2) fatty/spicy/processed foods, (3) fresh fruit to a maximum of 3 per day, (4) fiber and other commonly consumed gas-producing foods (eg, beans, bread, sweeteners, etc), and (5) addressing any perceived food intolerances (eg, dairy).” (Link: National Institute for Health and Care Excellence advice on IBS mgt). The Gluten-Free diet allowed for cross-contamination. All patients had specialist dietary counseling.
- All three diets resulted in improvement. The primary end point of ≥50-point reduction in IBS-SSS was met by 42% (n = 14/33) undertaking TDA, 55% (n = 18/33) for LFD, and 58% (n = 19/33) for GFD (P = .43)
- Alterations in stool dysbiosis index were similar across the diets, with 22%–29% showing reduced dysbiosis
- “The pragmatic study design, whereby the responsibility was left on patients to undertake the diets following appropriate education, means our findings can be generalized”
My take: All three diet approaches would be appropriate to reduce IBS symptoms, thought the TDA is the easiest for patients.
Related blog posts:
- ACG IBS Clinical Guidelines (2021)
- Gluten-Free Diet –Role in IBS?
- Which Diet is Best for Irritable Bowel Syndrome?
- Can We Predict Which Patients with IBS Will Respond to Dietary Therapy Based on Their Microbiome?
- Another Study: Low FODMAPs Diet for Irritable Bowel Syndrome
- FODMAP diet -Real World Experience
- An Unexpected Twist for “Gluten Sensitivity” | gutsandgrowth
- Low FODMAPs Diet in Pediatric Irritable Bowel | gutsandgrowth
- What Happens When Patients With ‘Gluten Sensitivity’ Are Challenged with Gluten? | gutsandgrowth
- FODMAPS Advice From Harvard
- Gluten-Free Diet Can Be Unhealthy
- Gluten-Free –No Evidence It is Helpful for Healthy Individuals
- AGA Guidelines for Pharmacologic Therapy of IBS-D and IBS-C