Which diets reduce symptoms of irritable bowel syndrome (IBS)?

Updated: Dec 11, 2019
  • Author: Jenifer K Lehrer, MD; Chief Editor: BS Anand, MD  more...
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Answer

Many patients are interested in dietary manipulation to decrease their symptoms. Several different diets have been proposed. [36] Diets low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) hold particular interest in reducing symptoms of irritable bowel syndrome. [37] Investigators found 10 of 54 bacterial markers differed significantly between 32 patients who responded to FODMAPs and 29 who did not; using their findings, they developed a response index that assesses gut microbial composition and has the potential to identify patients who are more likely to respond to a dietary FODMAP restriction. [38] In a preclinical, murine study, a low-FODMAP diet did not appear to exacerbate nor mitigate inflammation on a postinflammatory model of IBS. [39] However, a retrospective study (2013-2016) comprising data from 164 Irish patients with IBS found that a low-FODMAP diet provided significant all-symptomatic improvement at 3-, 6-, and 12-month follow-up. [40]

Probiotics are very interesting for treating symptoms, but it is unclear for which patients probiotics are helpful, and in what form, dose, combination, or strain. [41, 42, 43] A meta-analysis concluded that Bifidobacterium infantis may help alleviate some symptoms of irritable bowel syndrome. [44]

A systematic review and meta-analysis of 13 articles that assessed the differential expression of intestinal microbiota in 360 patients with this condition compared to 268 healthy controls found downregulation of bacterial colonization of Lactobacillus, Bifidobacterium, and Faecalibacterium prausnitzii in patients with irritable bowel syndrome. [45] Those with the diarrhea-predominant subtype had significantly different expression of Lactobacillus and Bifidobacterium. A different systematic review and meta-analysis evaluated 43 articles on probiotics and showed that probiotics helped relieve pain, bloating, and gas [46] ; however, again, it remains unknown which probiotic is the best.

A European multicenter pilot study that evaluated the effectiveness of palmitoylethanolamide/polydatin in 54 patients with irritable bowel syndrome compared to 12 healthy controls did not show any significant changes in modifying the biologic profile of the condition (eg, mast cell count); however, this combination significantly improved the severity of abdominal pain when compared to placebo. [47]

In a study of 998 adolescent Iranian girls, investigators noted a 16.9% prevalence of irritable bowel syndrome and identified several factors that appeared to be associated with an increased risk of this condition, including intrameal fluid consumption, consumption of spicy and fried food, insufficient chewing, and greater loss of teeth (≥5 teeth). [48]


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