Abstract
Irritable Bowel Syndrome (IBS) is a very common functional gastrointestinal disease. Its pathogenesis is multifactorial and not yet clearly defined, and hence, its therapy mainly relies on symptomatic treatments. Changes in lifestyle and dietary behavior are usually the first step, but unfortunately, there is little high-quality scientific evidence regarding a dietary approach. This is due to the difficulty in setting up randomized double-blind controlled trials which objectively evaluate efficacy without the risk of a placebo effect. However, a Low Fermentable Oligo-, Di- and Mono-saccharides And Polyols (FODMAP) Diet (LFD) and Gluten Free Diet (GFD) are among the most frequently suggested diets. This paper aims to evaluate their possible role in IBS management. A GFD is less restrictive and easier to implement in everyday life and can be suggested for patients who clearly recognize gluten as a trigger of their symptoms. An LFD, being more restrictive and less easy to learn and to follow, needs the close supervision of a skilled nutritionist and should be reserved for patients who recognize that the trigger of their symptoms is not, or not only, gluten. Even if the evidence is of very low-quality for both diets, the LFD is the most effective among the dietary interventions suggested for treating IBS, and it is included in the most updated guidelines.
Highlights
Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal disorders
Bellini et al, in a study involving 73 IBS patients, showed that the Low FODMAP Diet (LFD) was effective in controlling digestive symptoms both in the short and long term, and in improving quality of life, anxiety and depression, even if some problems regarding acceptability were reported and adherence decreased in the long term [38]
The overlap of symptoms between NCWS and IBS, the lack of reliable markers for the diagnosis of both of them and the possibility that they could both benefit from similar types of diets generate difficulties in clearly distinguishing and characterizing this relatively new disease which deserves further studies to clarify the controversial aspects still existing
Summary
Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal disorders. Patients with IBS do not have identifiable structural or biochemical abnormalities and the diagnosis is based on the Rome IV criteria, which stress the importance of abdominal pain related to defecation and change in bowel frequency and stool consistency/form [1,2]. Polyols (FODMAPs) have been highlighted as possible mechanisms by which food could cause symptoms in predisposed patients These act by increasing the fluid content of the intestinal lumen due to the recall of water induced by osmotic activity, forcing water into the gastrointestinal tract and increasing the production of gas by the gut microbiota as a consequence of food fermentation [11,12]. Many different do-it-yourself diets are very frequently followed by patients, with non-scientifically motivated restrictions of one or more categories of food These are often suggested by friends and relatives, the media and/or star system celebrities and imply a high risk of nutritional inadequacy [15]. The main limitations of clinical trials regarding the dietary therapy for IBS are: The difficulty in establishing an effective blinding This is because over the years IBS patients continue or come to know many diets commonly suggested for IBS therapy. The aim of this paper is to discuss the evidence regarding two of the most advised diets for IBS, the LFD and the GFD, in order to evaluate which of the two could be more suitable for IBS patients
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