Traditional Dietary Advice Preferred in Non-Constipated IBS

An UK randomized trial revealed that traditional dietary advice (TDA), low FODMAP diet (LFD) and gluten-free diet (GFD) are all effective approaches in non-constipated irritable bowel syndrome (IBS), but TDA is the most patient-friendly in terms of cost and convenience. A total of 99 patients with non-constipated IBS completed the study. They were randomized to TDA, LFD, or GFD (the latter allowing for minute gluten cross-contamination). After 4 weeks of dietary intervention the primary endpoint of ≥50-point reduction in symptom severity score (IBS-SSS) was met by 42%, 55%, and 58% of patients undertaking TDA, LFD, and GFD respectively. Responders had similar improvements in IBS-SSS items regardless of their allocated diet. Patients reported TDA cheaper, less time-consuming to shop, and easier to follow when eating out than the GFD and LFD. TDA was also easier to incorporate into daily life than the LFD. Overall reductions in micro- and macro- nutrient intake did not significantly differ across the diets. However, the LFD group had the greatest reduction in total FODMAP content (27.7g/day pre-intervention to 7.6g/day at week 4) compared with the GFD (27.4g/day to 22.4g/day) and TDA (24.9g/day to 15.2g/day). Alterations in stool dysbiosis index were similar across the diets, with 22-29% showing reduced dysbiosis, 35-39% no change, and 35-40% increased dysbiosis. Baseline clinical characteristics and stool dysbiosis index did not predict response to dietary therapy. The findings are in line with some previous studies and suggest that TDA as the first-choice dietary therapy in non-constipated IBS, with LFD and GFD reserved according to specific patient preferences and specialist dietetic input. The TDA includes adopting healthy, sensible eating patterns, such as having regular meals with proper portion sizes, maintaining adequate hydration, and reducing the intake of alcohol/caffeine/fizzy drinks, fatty/spicy/processed foods, gas-producing foods (e.g. beans, bread, sweeteners, etc.), as well as addressing any perceived food intolerances (e.g. dairy). The LFD initially eliminates all FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols commonly found in fruits, vegetables, dairy products, artificial sweeteners, and wheat) for 4-6 weeks, followed by their gradual re-introduction and personalization. The mechanism of GFD are extensively debated and may not to be via the removal of gluten per se, but rather through reducing fructan content (as a FODMAP) due to wheat exclusion. Source: https://www.sciencedirect.com/