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Medscape

What is the Best Diet for IBS?

A starch- and sucrose-reduced diet ranks the highest for decreasing global irritable bowel syndrome (IBS) symptoms, whereas a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet offers benefits in reducing global IBS symptoms, abdominal pain, and abdominal bloating. METHODOLOGY: Patients with IBS often report food-related symptoms and seek dietary interventions to help manage their condition. Researchers conducted a systematic review and network meta-analysis of randomized controlled trials to evaluate the efficacy of dietary interventions for IBS symptoms. Eligible trials compared an active dietary intervention involving multiple food changes with either a control intervention (such as a habitual diet, sham diet, high FODMAP diet, or other dietary advice) or another active intervention also requiring multiple food changes Outcomes included the proportion of patients with no improvement in global IBS symptoms, abdominal pain severity, bloating/distension severity, or bowel habits. TAKEAWAY: Researchers identified 28 eligible randomized controlled trials (comprising 2338 patients) of 11 dietary interventions, with several — including low FODMAP, the British Dietetic Association/National Institute for Health and Care Excellence (BDA/NICE), lactose-reduced, starch- and sucrose-reduced, personalized, and Mediterranean diets — studied in multiple trials. Among dietary interventions superior to habitual diet, a starch- and sucrose-reduced diet ranked first in reducing global IBS symptoms in two trials (relative risk for no improvement [RR], 0.41; P -score = .84), and a low FODMAP diet ranked fourth across 24 trials (RR, 0.51; P -score = .71). -score = .84), and a low FODMAP diet ranked fourth across 24 trials (RR, 0.51; -score = .71). For abdominal pain, a starch- and sucrose-reduced diet ranked second in two trials (RR, 0.54; P -score = .73) and a low FODMAP diet ranked fifth in 23 trials (RR, 0.61; P -score = .64) compared with a habitual diet. -score = .73) and a low FODMAP diet ranked fifth in 23 trials (RR, 0.61; -score = .64) compared with a habitual diet. The low FODMAP diet was superior to habitual diet for reducing abdominal bloating/distension across 23 trials (RR, 0.55; P -score = .64). -score = .64). No diets outperformed habitual diet for improving bowel habits; however, the low FODMAP diet was more effective than the BDA/NICE diet. IN PRACTICE: 'These findings highlight a potential role for alternative diets such as the starch-reduced and sucrose-reduced diet and FODMAP-simple diet, indicating an opportunity for expanding dietary choices in IBS. Given the variability in IBS pathophysiology that can exist across patients, different diets could provide different benefits, and offering multiple evidence-based options might prove valuable,' an expert wrote in an accompanying comment. SOURCE: The study was led by Melanie S. Cuffe, MBChB, Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, England. It was published online in The Lancet Gastroenterology and Hepatology. LIMITATIONS: Most trials had relatively short durations, limiting their ability to measure efficacy for a chronic condition like IBS. Only two trials examined all three stages of the FODMAP diet (ie, restriction, reintroduction, and personalization). Although IBS is primarily managed in primary care, only four trials were conducted partially in this setting. DISCLOSURES: The analysis received no funding support. The authors declared having no conflicts of interest.