Traditional Dietary Advice Optimal as an Irritable Bowel Syndrome Therapy

A traditional diet might be the best option for patients with non-constipated irritable bowel syndrome (IBS).

A team, Anupam Rej, Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, compared traditional dietary advice against the low FODMAP diet and gluten-free diet.

Diets

Different diets have been utilized as therapeutic options for non-constipated IBS. However, there remains a lack of sufficient and quality evidence on the efficacy on a lot of these diets.

In the study, the investigators examined patients with Rome IV-defined non-constipated IBS to be treated with either traditional dietary advice, the low FODMAP diet, or the gluten-free diet.

The investigators sought primary endpoints of the clinical response following 4 weeks of dietary intervention, defined by at least a 50 point reduction in the IBS symptom severity score (IBS-SSS).

Some secondary endpoints included changes in individual IBS-SSS items within clinical responders, acceptability and food-related quality of life with dietary therapy, changes in nutritional intake, alterations in stool dysbiosis index, and baseline factors associated with clinical response.

Results

The results show 42% (n = 14) of the traditional dietary advice group met the primary endpoint, compared to 55% (n = 18) of the low FODMAP group and 58% (n = 19) of the gluten-free diet group (P = 0.43).

There was a similar improvement in IBS-SSS items regardless of the allocated diets.

However, there are some financial and other incentives for the different diets.

Overall, traditional dietary advice was cheaper (P <0.01), less time-consuming to shop (P <0.01), and easier to follow when eating out (P = 0.03) than the other 2 diets.

Traditional dietary advice was also easier to incorporate into daily life than the low FODMAP diet (P = 0.02).

There was a greater reduction in total FODMAP content in the low FODMAOP group (27.7g /day pre-intervention to 7.6 g/day at week 4) compared with the gluten-free diet (27.4/g/day to 22.4g/day) and traditional dietary advice (24.9 g/day to 15.2 g/day) groups (p <0.01).

In addition, reductions in micro- and macro-nutrient intake did not significantly differ between the 3 diets.

Also, alterations in stool dysbiosis index were similar between the diets, with 22-29% showing reduced dysbiosis, 35-39% no change, and 35-40% increased dysbiosis (P = 0.99). Baseline clinical characteristics and stool dysbiosis index did not predict a clinical response to dietary therapy.

“TDA, LFD and GFD are effective approaches in non-constipated IBS, but TDA is the most patient-friendly in terms of cost and convenience,” the authors wrote. “We recommend TDA as the first-choice dietary therapy in non-constipated IBS, with an LFD and GFD reserved according to specific patient preferences and specialist dietetic input.”

The study, “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,” was published online in Clinical Gastroenterology and Hepatology.