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The Mediterranean Diet for Irritable Bowel Syndrome : A Randomized Clinical Trial
Joy O Bamidele1, Grace M Brownlow1, Rosie M Flack1
1Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom (J.O.B., G.M.B., R.M.F., M.G.S.).
Background:
Patients with irritable bowel syndrome (IBS) frequently seek dietary advice, but few evidence-based options exist. Major societal guidelines recommend traditional dietary advice (TDA) as first-line therapy, with the cumbersome and resource-intensive low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet reserved as second-line therapy. Recent pilot data suggest that the Mediterranean diet (MD), renowned for its general health benefits, improves IBS symptoms, but whether it can be considered another first-line dietary option is unknown.
Objective:
To determine if the MD is noninferior to TDA in managing IBS symptoms.
Design:
Randomized noninferiority clinical trial. (ClinicalTrials.gov: NCT05985018).
Setting:
Online virtual platform.
Participants:
139 persons with IBS from across the United Kingdom.
Intervention:
6 weeks of the MD (n = 68) or TDA (n = 71).
Measurements:
Primary end point was the proportion achieving clinical response, defined as 50-point or greater reduction in IBS Symptom Severity Scale (IBS-SSS). Secondary outcomes included changes in IBS-SSS scores, psychological health, somatic symptom reporting, quality of life, diet satisfaction, and Mediterranean Diet Adherence Screener (MEDAS).
Results:
Baseline characteristics (mean age, 40.4 years [range, 19 to 65 years]; 80% women) and IBS-SSS (mean, 309 [SD, 90]) were similar between groups. On modified intention-to-treat analysis, the primary end point was met by 62% (95% CI, 50% to 73%) following a MD versus 42% (CI, 31% to 55%) following TDA. The difference in clinical response favored the MD (difference, 20 percentage points [CI, 4 to 36 percentage points]; P = 0.017), demonstrating noninferiority and superiority. There was a greater reduction in the mean IBS-SSS after a MD than TDA (-101.2 vs. -64.5; Δ-36.7 [CI,-70.5 to -2.8]; P = 0.034). No statistically significant differences were seen between the groups with regard to changes in mood, somatic symptoms, quality of life, or diet satisfaction. The MEDAS significantly increased after a MD compared with TDA (P < 0.001).
Limitation:
No long-term data.
Conclusion:
The MD showed noninferiority and superiority to TDA in managing IBS symptoms. It represents a viable first-line dietary intervention for IBS.
Primary Funding Source:
None.
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