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Efficacy of Mediterranean Diet vs. Low-FODMAP Diet in Patients With Nonconstipated Irritable Bowel Syndrome: A Pilot
Prashant Singh1, Gregory Dean1, Sofia Iram1
1Divsion of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, USA.
Introduction:
Mediterranean diet (MD) has been proposed as a dietary therapy for irritable bowel syndrome (IBS) but its efficacy remains unclear. We compared the efficacy of MD to a diet low in fermentable oligo-, di-, monosaccharides, and polyols (LFD).
Methods:
In this pilot-feasibility, randomized controlled trial (RCT), adult patients with diarrhea-predominant IBS (IBS-D) or mixed bowel pattern (IBS-M) were randomized to MD versus LFD for 4 weeks. Meals were provided for both groups (ModifyHealth, GA). Daily variables included abdominal pain intensity (API) and bloating, while IBS symptom severity score (IBS-SSS) and IBS adequate relief (IBS-AR) were scored weekly. The primary endpoint was the proportion of patients with ≥ 30% decrease in API for ≥ 2/4 weeks.
Results:
Of 26 randomized patients, 20 finished the study (10 per group). Seventy-three percent of the MD group met the primary endpoint compared to 81.8% of the LFD group (p = 1.0). Although not statistically significant, a numerically higher proportion of the LFD group reported adequate relief and met the responder endpoint for IBS-SSS (50-point reduction) compared to the MD group (54.6% vs. 27.3% for IBS-AR and 81.8% vs. 45.5% for IBS-SSS, p = 0.39 and 0.18, respectively). The LFD group also had a significantly greater reduction in IBS-SSS score over the 4-week treatment period compared to the MD group (-105.5 vs. -60, p = 0.02).
Conclusion:
MD provides symptom relief in IBS-D and IBS-M; however, the magnitude of relief was higher with the LFD. Larger diet comparison studies in real-world settings are needed before MD can be routinely recommended to IBS patients.
Trial Registration:
Clinicaltrials.gov: NCT05807919.
Insights
The Mediterranean diet (MD) offers symptom relief for irritable bowel syndrome (IBS) patients, but a low fermentable oligo-, di-, monosaccharides, and polyols diet (LFD) showed greater symptom improvement in this pilot study.
Area of Science:
- Gastroenterology
- Dietary Science
- Clinical Nutrition
Background:
- The Mediterranean diet (MD) is proposed for irritable bowel syndrome (IBS) management, but its comparative efficacy is not well-established.
- A low fermentable oligo-, di-, monosaccharides, and polyols diet (LFD) is a common dietary intervention for IBS.
- This study aimed to compare the efficacy of MD versus LFD in IBS patients.
Purpose of the Study:
- To compare the efficacy of the Mediterranean diet (MD) against a low fermentable oligo-, di-, monosaccharides, and polyols diet (LFD) for symptom management in patients with IBS-D or IBS-M.
- To evaluate symptom relief, including abdominal pain and bloating, in IBS patients following either dietary intervention.
Main Methods:
- A pilot-feasibility randomized controlled trial (RCT) involving adult patients diagnosed with diarrhea-predominant IBS (IBS-D) or mixed bowel pattern IBS (IBS-M).
- Participants were randomized to receive either a Mediterranean diet (MD) or a low fermentable oligo-, di-, monosaccharides, and polyols diet (LFD) for four weeks, with meals provided.
- Primary endpoint: proportion of patients achieving a ≥30% decrease in abdominal pain intensity for ≥2 out of 4 weeks. Secondary endpoints included IBS symptom severity score (IBS-SSS) and adequate relief (IBS-AR).
Main Results:
- Of 26 randomized patients, 20 completed the study (10 per group).
- Seventy-three percent of the MD group met the primary endpoint versus 81.8% in the LFD group (p=1.0).
- The LFD group demonstrated a significantly greater reduction in IBS-SSS over the 4-week period compared to the MD group (p=0.02), and numerically higher rates of adequate relief and IBS-SSS responder status.
Conclusions:
- The Mediterranean diet (MD) provides symptom relief for patients with IBS-D and IBS-M.
- The low fermentable oligo-, di-, monosaccharides, and polyols diet (LFD) demonstrated a higher magnitude of symptom relief compared to the MD in this pilot study.
- Larger, real-world diet comparison studies are necessary to establish routine recommendations for the MD in IBS management.
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