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Gluten-Free, Low FODMAP Diets Beneficial for IBS Symptoms

Symptom flare-ups in patients on a gluten-free diet were significantly lower than in patients on a high-gluten diet.

A clear hierarchy of diets that reduce the symptoms of irritable bowel syndrome (IBS) is beginning to emerge.

A team, led by Seung Jung Yu, Department of Internal Medicine, Inje University Busan Paik Hospital, reviewed the efficacy of food restriction diets on patients with IBS.

Diet and IBS

While diet is a factor in aggravating IBS, the types of diets with an exacerbating factor is not currently known.

In the systematic review and network meta-analysis of randomized controlled trials, the investigators reviewed databases for studies from inception to July 21, 2021 that assess the efficacy of restriction diets in adult patients with IBS. The analysis included trials that evaluated a restriction diet compared to a control diet and assessed the improvement in global IBS symptoms.

There was a total of 1949 citation identified, with 14 randomized, controlled trials eligible for the systematic review and network meta-analysis. The results ultimately showed a starch and sucrose-reduced diet and a diet with low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) were significantly better than a usual diet in reducing IBS symptoms.

Flare-Ups

The team also found symptom flare-ups in patients on a gluten-free diet were significantly lower than in patients on a high-gluten diet.

“These findings showed that the starch- and sucrose-reduced, low FODMAP, and gluten-free diets had superior effects in reducing IBS symptoms,” the authors wrote. “Further studies, including head-to-head trials will be needed to establish the effectiveness of dietary restrictions on IBS symptoms.”

The FODMAP Diet

Earlier this year, investigators found the FODMAP diet can be a promising supplemental therapeutic approach to better managing patients with inflammatory bowel disease (IBD).

A team, led by Catarina D. Simões, Faculty of Health Sciences, University Fernando Pessoa, reviewed the effect of individual FODMAP diets on the human gut microbiota in patients with IBD and developed an updated overview of low-FODMAP diets for IBD, particularly the implementation, advantages, limitations, and the impact of the gut microbiota.

This diet values whole grains, fruits, vegetables, and lean proteins like chicken and fish, while eliminating the processed sugars and sweeteners that are prevalent in many diets today.

The low-FODMAP diet has been in the past hypothesized as a potential therapeutic approach for patients with IBD in disease management. However, when implementing this diet there is the potential risk of nutrition deficiencies due to the specific broad food restrictions. There is also the possibility of aggravating gut microbiota dysbiosis for patients with IBD.

The investigators found the low-FODMAP diet could effectively improve clinical outcomes in managing IBD, as well as ensure a better quality of life for patients with IBD. However, there are some areas of concern, namely the adequacy of the diet and the impact it has on the gut microbiota.

The study, “Efficacy of a Restrictive Diet in Irritable Bowel Syndrome: A Systematic Review and Network Meta-analysis,” was published online in The Korean Journal of Gastroenterology.