Eating 'healthy' is part of the first-line approach in the management of IBS, as indicated by British Dietetic Association's (BDA) guidelines. BDA recommends the limitation of potential dietary triggers such as alcohol, caffeine, spicy and fatty foods. General dietary advice on healthy eating includes having a regular meal pattern, not eating late at night, avoiding large meals, eating slowly and chewing thoroughly. Although the diet based on BDA's recommendations has not been compared to a sham diet, several trials compared it to the low FODMAP diet (LFD). One recent nonrandomized trial showed that although IBS symptoms improved with both the first-line IBS diet and LFD, the LFD led to a higher rate of relief of abdominal pain and diarrhea. Similarly, a single-blind randomized controlled trial (RCT) in IBS-D patients reported that compared to baseline, both first-line IBS diet and LFD significantly reduced overall scores of symptom severity, abdominal pain, distension, consistency, and frequency, the reduction being greater with LFD. Another study showed similar benefits on symptoms and QoL using a balanced Mediterranean diet, LFD or GFD. The balanced diet focuses on distributing meals, calories and FODMAPs over 24 h, hence preventing excessive FODMAP intake. Taken together, although few studies have shown that the first-line dietary approach in IBS may improve symptoms, future research is required to demonstrate that healthy eating patterns alone are an effective treatment option for IBS. Nonetheless, a balanced diet should be encouraged to support overall health.
Curr Opin Gastroenterol. 2021;37(2):152-157. © 2021 Lippincott Williams & Wilkins