Diet and irritable bowel syndrome: an update from a UK consensus meeting

Abstract

There has been a renewed interest in the role of dietary therapies to manage irritable bowel syndrome (IBS), with diet high on the agenda for patients. Currently, interest has focussed on the use of traditional dietary advice (TDA), a gluten-free diet (GFD) and the low FODMAP diet (LFD). A consensus meeting was held to assess the role of these dietary therapies in IBS, in Sheffield, United Kingdom.Evidence for TDA is from case control studies and clinical experience. Randomised controlled trials (RCT) have demonstrated the benefit of soluble fibre in IBS. No studies have assessed TDA in comparison to a habitual or sham diet. There have been a number of RCTs demonstrating the efficacy of a GFD at short-term follow-up, with a lack of long-term outcomes. Whilst gluten may lead to symptom generation in IBS, other components of wheat may also play an important role, with recent interest in the role of fructans, wheat germ agglutinins, as well as alpha amylase trypsin inhibitors. There is good evidence for the use of a LFD at short-term follow-up, with emerging evidence demonstrating its efficacy at long-term follow-up. There is overlap between the LFD and GFD with IBS patients self-initiating gluten or wheat reduction as part of their LFD. Currently, there is a lack of evidence to suggest superiority of one diet over another, although TDA is more acceptable to patients.In view of this evidence, our consensus group recommends that dietary therapies for IBS should be offered by dietitians who first assess dietary triggers and then tailor the intervention according to patient choice. Given the lack of dietetic services, novel approaches such as employing group clinics and online webinars may maximise capacity and accessibility for patients. Further research is also required to assess the comparative efficacy of dietary therapies to other management strategies available to manage IBS.

Efficacy of Different Dietary Patterns in the Treatment of Functional Gastrointestinal Disorders in Children and Adolescents: A Systematic Review of Intervention Studies

“…In adults, differing FODMAP content has been tested depending on the diet used; allowed amounts have been 7.6 g/day, 15.2 g/day, and 22.4 g/day for a low-FODMAP diet, traditional dietary advice, and GFD, respectively. A suggested threshold for symptom improvements in adults is 12 g FODMAPs/day [ 29 ]. However, this has yet to be confirmed in pediatrics.…”

“…However, in recent years, there has been renewed interest in the role of specific dietary patterns in the treatment of FGIDs. Currently, interest is focused on the low-FODMAP diet [ 27 ], fructose- or lactose-restricted diet (FRD or LRD) [ 28 ], gluten-free diet (GFD) [ 29 ], and Mediterranean diet (MD) [ 30 ].…”

Current evidence for dietary therapies in irritable bowel syndrome

“…Adapted from Rej et al [93]. GFD, gluten-free diet; mNICE, National Institute for Health and Care Excellence; LFD, low-FODMAP diet; TDA, traditional dietary advice.…”

Nonceliac gluten sensitivity

“…Due to the high content of fructans (0.7–2.9 g% in wheat flour), wheat is one of the major sources of dietary FODMAPs, a group of poorly absorbed carbohydrates that increase small bowel water content by osmosis and release gases, predominantly carbon dioxide and hydrogen, from bacterial fermentation. Over the last decade, there has been considerable interest in the role of the low FODMAP diet (LFD) to manage patients with IBS, a functional intestinal disorder largely overlapping with NCWS [ 8 ]. A recent systematic review on the effectiveness of the LFD in improving NCWS concluded that the GFD represent first-line therapy but also that a complete FODMAP restriction (not only wheat fructans) can further decrease gastrointestinal symptoms in individuals with NCWS [ 9 ].…”

“…As previously noted, there is overlap between the LFD and the GFD, in that the GFD eliminates wheat derivatives that are also the major source of FODMAPs (fructans), and IBS patients often self-initiated gluten/wheat reduction as part of their LFD. To avoid this confusing situation and optimize dietary treatment, a recent UK Consensus document recommends that (a) dietary therapies for IBS should be offered by dietitians (instead than physicians/gastroenterologists) who first assess dietary triggers and then tailor the intervention according to patient choice; (b) novel approaches such as employing group clinics and online webinars may maximize capacity and accessibility for patients [ 8 ]. Further research is required to assess the comparative efficacy of dietary therapies to other management strategies available to manage IBS.…”