Patients Find Traditional Dietary Advice Most Accessible for IBS

While traditional dietary advice, a low FODMAP diet, and a gluten-free diet are each effective dietary therapies for nonconstipated irritable bowel syndrome (IBS), traditional dietary advice is the most patient-friendly when it comes to cost and convenience. Researchers published their findings online ahead of print in the journal Clinical Gastroenterology and Hepatology.

“We recommend traditional dietary advice as the first-choice dietary therapy in nonconstipated IBS,” researchers wrote, “with a low FODMAP diet and gluten-free diet reserved according to specific patient preferences and specialist dietetic input.”

The recommendation stems from a clinical trial that compared the 3 dietary interventions in 99 patients randomly assigned to a single approach for 4 weeks.

According to the study, 42% of patients assigned traditional dietary advice, 55% assigned a low FODMAP diet, and 58% assigned a gluten-free diet achieved a 50-point or greater reduction in in IBS symptom severity score (IBS-SSS), which signified clinical response and was the primary endpoint of the study. Within responders, improvements in individual IBS-SSS items were similar across the dietary approaches.

Traditional dietary advice was reported to be the least expensive, least time-consuming to shop for, and easiest to follow when eating out among all 3 approaches. It was also easier than the low FODMAP diet to incorporate into daily life, the study found. Meanwhile, the greatest reduction in total FODMAP content was with the low FODMAP diet: from an average 27.7 g/day preintervention to 7.6 g/day at week 4, compared with 27.4 g/day to 22.4 g/day with the gluten-free diet, and 24.9 g/day to 15.2 g/day with traditional dietary advice.

“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,” researchers reported. “Baseline clinical characteristics and stool dysbiosis index did not predict response to dietary therapy.”

—Jolynn Tumolo

Reference:
Rej A, Sanders DS, Shaw CC, et al. 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. Published online ahead of print, February 28, 2022.