The Role of Diet in the Treatment of Irritable Bowel Syndrome

Diet may be more effective than medications for easing IBS symptoms 

Irritable Bowel Syndrome (IBS) has long challenged patients and healthcare providers with its complex symptoms and elusive management strategies. However, a groundbreaking study from the University of Gothenburg suggests that dietary interventions could be more effective than traditional medication in managing these symptoms. This finding could revolutionize the approach to treating one of the most common gastrointestinal disorders worldwide.

IBS is a functional gastrointestinal disorder characterized by a combination of symptoms such as recurrent abdominal pain, bloating, and changes in bowel habits (diarrhea, constipation, or both). Unlike inflammatory bowel diseases (IBD) like Crohn's disease or ulcerative colitis, IBS does not cause changes in bowel tissue or increase the risk of colorectal cancer. The exact cause of IBS remains unknown, but factors such as gut-brain axis disturbances, small intestinal bacterial overgrowth, and food sensitivity are believed to play roles. It is traditionally treated through antidiarrheals, gut antispasmodics, and dietary advice (for example, avoiding excessive intake of food triggers such as alcohol, caffeine, and fizzy drinks). 

The study compared the effectiveness of dietary and pharmacological treatments in managing IBS.The participants were 100 adult patients at Sahlgrenska University Hospital with moderate to severe IBS. 

The first group was given a low FODMAP diet combined with traditional dietary advice. FODMAPs are fermentable carbohydrates, including products that contain lactose, legumes, onions, and grains that ferment in the colon and may cause pain in IBS. 

The second group was given a low-carbohydrate and high-protein/fat diet. The third group received symptom-targeted medication treatment. After four weeks, using an established IBS symptom scoring scale, it was determined that both dietary treatments showed better outcomes than medication. 76% of those that received traditional IBS dietary advice and low FODMAPs had significantly reduced symptoms. In the group receiving low carbohydrates and high protein/fat, there was a 71% improvement in symptoms. On the other hand, 58% saw improvement in symptoms in the medication group. All groups also reported significantly better quality of life and less symptoms of anxiety & depression.

The results were compelling. Both dietary approaches significantly outperformed the pharmacological treatment in reducing IBS symptoms. These findings suggest that dietary changes could be considered as a first-line treatment for IBS, emphasizing the need for personalized treatment strategies.

Though more investigation is needed about how to best personalize treatment of IBS in the future, this study highlights the potential of not only dietary management as a primary treatment for IBS, but also that there are several alternative treatments that are effective. This personalized approach could lead to higher patient empowerment, fewer side effects, and overall cost reductions in healthcare. 

Written by Nikhita Joshi.

Edited by Iana Malasevskaia, MD.

References:

1. Nybacka, S., et al. A low FODMAP diet plus traditional dietary advice versus a low-carbohydrate diet versus pharmacological treatment in irritable bowel syndrome (CARBIS): a single-centre, single-blind, randomised controlled trial. The Lancet Gastroenterology & Hepatology, 2024; DOI: 10.1016/S2468-1253(24)00045-1