According to a new study, dietary interventions work better than medication when it comes to managing IBS symptoms.
- Irritable bowel syndrome (IBS) is a prevalent
gastrointestinal condition, estimated to affect about one in 10 people
globally.
- A new study suggests that dietary interventions
may be more effective in reducing IBS symptoms than medical treatments.
- All options showed meaningful symptom
improvements, but experts agree that sustained dietary changes are key to
managing IBS.
A new study suggests that dietary interventions may be
more effective than medication for managing symptoms of irritable
bowel syndrome (IBS).
IBS is a chronic gastrointestinal condition affecting
an
In a first-of-its-kind study, researchers at
Sahlgrenska University Hospital in Gothenburg, Sweden, compared the
effectiveness of two diet-based treatments and one pharmaceutical treatment in
adults with moderate to severe IBS symptoms.
After 4
weeks, both diets and medical intervention significantly reduced symptom
severity, with diets outperforming the medical option, and a low FODMAP
diet combined with traditional IBS dietary advice being
most effective.
A low FODMAP diet contains foods that are low in
fermentable oligosaccharides, disaccharides, monosaccharides, and polyols,
hence its name. This type of diet is often associated with better
gastrointestinal health.
In the current study, 6 months after the diet groups
had partially resumed normal eating patterns, the majority still reported
clinically meaningful symptom improvement.
These findings appeared in
Dietary
interventions vs. medical treatment for IBS
This single-center,
single-blind, randomized controlled trial was conducted in a specialized
outpatient clinic for disorders of gut-brain interactions.
The study’s 294 participants were predominantly women
(82%) with an average age of 38 and moderate-to-severe IBS.
Included participants scored 175 or higher using the
IBS Severity Scoring System (IBS-SSS)—measuring abdominal pain frequency and
intensity, bloating, satisfaction with bowel habits, and quality of life
related to IBS—and had no other serious diseases or food allergies.
They were randomly assigned into three groups:
- a
low FODMAP diet coupled with traditional IBS dietary advice from the
United Kingdom’s National Institute for Health
and Care Excellence (NICE)
- a
high-fiber, low-carbohydrate diet with an average carbohydrate intake of
50 grams (g) per day
- pharmaceutical
treatment tailored to their specific IBS symptoms.
Participants were unaware of their diet types, but
those in the medication group knew their treatment.
A study dietitian informed the diet groups about their
diets without revealing diet names or labeling foods as low in FODMAPs or
carbohydrates.
After the initial 4-week intervention, the diet groups
were advised on how to proceed for six months, including reintroducing FODMAPs
for some, while medication group members were offered nutritional guidance
alongside their ongoing treatment.
A reduction in IBS-SSS scores was the primary measure
of the interventions’ success.
Low FODMAP
diet may be best for IBS management
Within the study, high
completion rates were observed, with 90% or more of participants finishing the
4-week interventions across all groups.
Following the 4-week intervention, each group recorded
a significant decrease in IBS symptoms, as indicated by a drop of 50 points or
more in IBS-SSS scores.
The most
notable improvement was in the group following a low FODMAP diet and
traditional dietary advice (76%), followed by the low-carbohydrate group (71%)
and the medication group, which showed the least but still significant
improvement (58%).
All groups experienced substantial improvements in
quality of life, with fewer physical, anxiety, and depressive symptoms
reported.
Despite partially returning to their normal diets
during the 6-month follow-up, 68% in the low FODMAP and traditional advice
group and 60% in the low-carbohydrate group continued experiencing significant
symptom relief, indicating potential long-term benefits.
How low
FODMAP and low-carb diets may improve IBS symptoms
The traditional dietary
recommendations that were given in the study included consuming regular meals
and snacks, sitting during meals, chewing foods thoroughly, and limiting common
IBS symptom triggers like coffee, carbonated drinks, alcohol, fatty foods, and
spicy foods.
These recommendations were integrated with low-FODMAP
food consumption, including foods like rice, potatoes, quinoa, gluten-free
bread, vegetables, and fruits, along with low-fat, lactose-free dairy products,
fish and seafood, and plant-based proteins.
This combined diet intervention resulted in superior
IBS outcomes in the present study.
Alyssa Simpson RDN, CGN, CLT,
a registered dietitian and certified gastrointestinal nutritionist, who was not
involved in the study, explained why the low FODMAP diet, in particular, is so
helpful for those with IBS:
“The low FODMAP diet
reduces fermentable carbohydrates that cause gas, bloating, and discomfort in
IBS, while also decreasing foods that draw water into the intestines, improving
stool consistency. Reducing fermentable carbohydrates in [the] diet may shift
the balance of bacteria towards those that thrive on non-fermentable
substrates, potentially improving symptoms of IBS.”
She also described how the second best option in the
study, a fiber-rich, low-carb diet, could benefit IBS.
Unlike diets high in refined carbs and added sugars, a
high-fiber, low-carb diet “may help promote a healthier balance of gut
bacteria, which could positively impact IBS symptoms,” she said.
Similar
to a low FODMAP diet, “a low-carbohydrate diet may alter the gut microbiota by
reducing the availability of carbohydrates for fermentation, favoring the
growth of bacteria that metabolize proteins and fats.”
Simpson noted that medications for IBS can indirectly
affect the gut microbiome by positively impacting gastrointestinal function and
symptoms.
However, certain medications, like antibiotics, can
disrupt the balance of gut bacteria, leading to potentially harmful effects,
she cautioned.
Dietary
changes remain key for IBS treatment
The present study is the
first to test a combined low FODMAP and traditional IBS diet, assess a low-carb
diet’s effectiveness for IBS, and compare these dietary approaches to standard
medical treatments.
Kiran
Campbell, a registered dietitian not involved in the study,
highlighted that “all three interventions in the study showed improvements in
quality of life, anxiety and depression symptoms, and non-gastrointestinal
somatic symptoms — like weakness, fatigue, dizziness, etc.”
While all participants in this study experienced
benefits, this study had a limited duration, and they were under observation
while receiving treatments, so it is possible participants reported
improvements in part due to their awareness of being studied.
Still, recent
Campbell suggested that in addition to the better
outcomes, there are potential long-term benefits of using dietary interventions
over medications as a first-line treatment for IBS.
She said these include “improving a patient’s
understanding of nutrition and helping them remove barriers to lifelong healthy
eating,” as well as potentially helping patients pinpoint specific foods that
are causing GI distress.
“In some patients,
resolving [gastrointestinal] issues may be as simple as avoiding certain types
of sugars (FODMAPS). If pharmacological approaches are used as a first-line of
defense these patients would otherwise never know where the issue is
originating from. Dietary approaches to managing IBS are a great way to rule
out food causes [of] abdominal issues.”— Kiran Campbell, RDN
Individualized
IBS care is crucial
To optimize the
management of IBS symptoms through dietary interventions, Simpson and Campbell
agreed the ultimate goal is to minimize unnecessary restrictions and focus only
on eliminating specific trigger foods.
Simpson
and Campbell noted that by identifying and avoiding only the foods that
aggravate symptoms, patients can achieve a balanced diet, reduce the risk of
nutritional deficiencies, and maintain a healthier gut microbiome, contributing
to overall quality of life.
They highly recommend working with a registered
dietitian for a tailored approach to ensure a diet that is nutritionally
adequate, varied, and as unrestricted as possible, facilitating long-term
maintenance and well-being.
Ultimately, the experts both emphasized the need for
more research into the effects of interventions on nutritional status and the
gut microbiome to improve IBS management strategies.
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