Advertisement

Dietary Interventions and Irritable Bowel Syndrome: A Review of the Evidence

  • Shawn L. Shah
  • Brian E. Lacy
Large Intestine (BD Cash, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Large Intestine

Abstract

Irritable bowel syndrome (IBS) is the best studied of the functional gastrointestinal disorders. It is a highly prevalent disorder characterized by symptoms of abdominal pain, bloating, and disordered bowel habits, which may include constipation, diarrhea, or both. IBS has a significant negative impact on patients, both financially and with regard to their quality-of-life. At present, there is no cure for IBS, and while there are a number of pharmacological therapies available to treat IBS symptoms, they are not uniformly effective. For this reason, many patients and providers are turning to dietary interventions in an attempt to ameliorate IBS symptoms. At first glance, this approach appears reasonable as dietary interventions are generally safe and side effects, including potential adverse reactions with medications, are rare. However, although dietary interventions for IBS are frequently recommended, there is a paucity of data to support their use. The goals of this article are to answer key questions about diets currently recommended for the treatment of IBS, using the best available data from the literature.

Keywords

Irritable bowel syndrome Dietary interventions Exclusion diets Fiber FODMAP Fermentable oligosaccharides Disaccharides Monosaccharides Polyols 

Abbreviations

FODMAP

Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols

IBS

Irritable bowel syndrome

Notes

Compliance with Ethical Standards

Conflicts of Interest

SLS and BEL declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Bohn L, Storsrud S, Tornblom H, Bengtsson U, Simren M. Self-reported food-related gastrointestinal symptoms of IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol. 2013;108:634–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Locke GR, Zinsmeister AR, Talley NJ, Fett SL, Melton SJ. Risk factors for irritable bowel syndrome: role of analgesics and food sensitivities. Am J Gastroenterol. 2000;95:157–65.CrossRefPubMedGoogle Scholar
  3. 3.
    Monsbakken KW, Vandvik PO, Farup PG. Perceived food intolerance in subjects with irritable bowel syndrome—etiology, prevalence and consequences. Eur J Clin Nutr. 2006;60:667–72.CrossRefPubMedGoogle Scholar
  4. 4.
    Simren M, Mansson A, Langkilde AM, et al. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion. 2001;63:108–15.CrossRefPubMedGoogle Scholar
  5. 5.
    National Ambulatory Medical Care Survey. National Center for Health Statistics: NAMCS Description. Available at: http://www.cdc.gov/nchs/about/major/ahcd/namcsdes.htm.
  6. 6.
    Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143:1179–87.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Longstreth GF, Wilson A, Knight K, Wong J, Chiou CF, Barghout V, et al. Irritable bowel syndrome, health care use, and costs: a U.S. managed care perspective. Am J Gastroenterol. 2003;98:600–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Maxion-Bergemann S, Thielecke F, Abel F, Bergemann R. Costs of irritable bowel syndrome in the UK and US. Pharmacoeconomics. 2006;24:21–37.CrossRefPubMedGoogle Scholar
  9. 9.
    Chang L, Lembo A, Sultan S. American Gastroenterological Association Institute technical review pharmacological management of irritable bowel syndrome. Gastroenterology. 2014;147:1149–72.CrossRefPubMedGoogle Scholar
  10. 10.
    Ford AC, Moayeddi P, Lacy BE, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109 Suppl 1:S2–26.CrossRefPubMedGoogle Scholar
  11. 11.
    Chey WD, Olden K, Carter E, et al. Utility of the Rome I and Rome II criteria for irritable bowel syndrome in U.S. women. Am J Gastroenterol. 2002;97:2803–11.CrossRefPubMedGoogle Scholar
  12. 12.
    Stephen AM, Cummings JH. Mechanism of action of dietary fibre in the human colon. Nature. 1980;284:283–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Eswaran S, Muir J, Chey WD. Fiber and functional gastrointestinal disorders. Am J Gastroenterol. 2013;108:718–27.CrossRefPubMedGoogle Scholar
  14. 14.•
    Moayyedi P, Quigley EMM, Lacy BE, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109:1367–74. Systematic review and meta-analysis showing efficacy of dietary soluble fiber supplementation over placebo at improving global IBS symptoms.Google Scholar
  15. 15.
    Jones VA, Mclaughlan P, Shorthouse M, Workman E, Hunter JO. Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome. Lancet. 1982;2:1115–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Moayyedi P, Quigley EM, Lacy BE, et al. The effect of dietary intervention on irritable bowel syndrome: a systematic review. Clin Transl Gastroenterol. 2015;6:e107.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Barrett JS, Gearry RB, Muir JG, et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther. 2010;31:874–82.PubMedGoogle Scholar
  18. 18.
    Austin GL, Dalton CB, Hu Y, et al. A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol. 2009;7:706–8.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Marriott BP, Cole N, Lee E. National estimates of dietary fructose intake increased from 1977 to 2004 in the United States. J Nutr. 2009;139:1228S–35.CrossRefPubMedGoogle Scholar
  20. 20.
    Madsen JL, Linnet J, Rumessen JJ. Effect of nonabsorbed amounts of a fructose-sorbitol mixture on small intestinal transit in healthy volunteers. Dig Dis Sci. 2006;51:147–53.CrossRefPubMedGoogle Scholar
  21. 21.
    Shepherd SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc. 2006;106:1631–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Choi YK, Kraft N, Zimmerman B, Jackson M, Rao SSC. Fructose intolerance in IBS and utility of fructose-restricted diet. J Clin Gastroenterol. 2008;42:233–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Biesiekierski JR, Newnham ED, Shepherd SJ, Muir JG, Gibson PR. Characterization of adults with a self-diagnosis of nonceliac gluten sensitivity. Nutr Clin Pract. 2014;29:504–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011;106:508–14.CrossRefPubMedGoogle Scholar
  25. 25.
    Vazquez-Roque MI, Camilleri M, Smyrk T, et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology. 2013;144:903–11.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.•
    Aziz I, Trott N, Briggs R, North JR, Hadjivassiliou M, Sanders DS. Efficacy of a gluten-free diet in subjects with irritable bowel syndrome-diarrhea unaware of their HLA-DQ2/8 genotype. Clin Gastroenterol Hepatol. 2015;14(5):696–703.e1. Prospective study evaluating 41 IBS-D patients on a 6-week gluten-free diet with modest symptom improvement in vast majority of patients.Google Scholar
  27. 27.
    Ong DK, Mitchell SB, Barrett JS, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010;25:1366–73.CrossRefPubMedGoogle Scholar
  28. 28.
    Gearry RB, Irving PM, Barrett JS, Shepherd SJ, Gibson PR. Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease—a pilot study. J Crohns Colitis. 2009;3:8–14.CrossRefPubMedGoogle Scholar
  29. 29.
    Staudacher HM, Whelan K, Irving PM, Lomer MCE. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet. 2011;24:487–95.CrossRefPubMedGoogle Scholar
  30. 30.
    Staudacher HM, Lomer MCE, Anderson JL, et al. Fermentable carbohydrate restriction reduces luminal Bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr. 2012;142:1510–8.CrossRefPubMedGoogle Scholar
  31. 31.••
    De Roest RH, Dobbs BR, Chapman BA, et al. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Int J Clin Pract. 2013;67:895–903. Prospective study evaluating 90 IBS patients on a low-FODMAP diet with significant improvements in global IBS symptoms.Google Scholar
  32. 32.
    Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;46:67–75.CrossRefGoogle Scholar
  33. 33.••
    Böhn L, Störsrud S, Liljebo T, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015;149:1399–407. Multi-center, parallel, single-blind study evaluating 75 IBS patients randomized to either a low-FODMAP or “frequently recommended” IBS diet finding significant reductions in global IBS symptoms in both cohorts.Google Scholar
  34. 34.•
    Pedersen N, Andersen NN, Vegh Z, et al. Ehealth: low FODMAP diet vs. Lactobacillus rhamnosus GG in irritable bowel syndrome. World J Gastroenterol. 2014;20:16215–26. Randomized, unblinded controlled trial evaluating 123 IBS patients with significant IBS symptom improvement in both the low-FODMAP diet and probiotic cohorts as compared to a normal Danish diet cohort.Google Scholar
  35. 35.
    Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013;145:320–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyDartmouth-Hitchcock Medical CenterLebanonUSA

Personalised recommendations