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According to a new study, evidence was found that these dietary interventions were more efficacious at 4 weeks, suggesting their potential as first-line treatments.
“IBS is a disorder that may have different underlying causes, and it can manifest in different ways among patients. It is also likely that the most effective treatment option can differ in patients,” said lead author Sanna Nybacka, RD, PhD, a postdoctoral researcher in molecular and clinical medicine at the University of Gothenburg’s Sahlgrenska Academy, Gothenburg, Sweden.
“Up to 80% of patients with IBS report that their symptoms are exacerbated by dietary factors, and dietary modifications are considered a promising avenue for alleviating IBS symptoms,” she said. “However, as not all patients respond to dietary modifications, we need studies comparing the effectiveness of dietary vs pharmacological treatments in IBS to better understand which patients are more likely to benefit from which treatment.”
The study was published online in The Lancet Gastroenterology and Hepatology.
Treatment Comparison
Dr. Nybacka and colleagues conducted a single-blind randomized controlled trial at a specialized outpatient clinic at Sahlgrenska University Hospital in Gothenburg, Sweden, between January 2017 and September 2021. They included adults with moderate to severe IBS, which was defined as ≥ 175 points on the IBS Severity Scoring System (IBS-SSS), and who had no other serious diseases or food allergies.
The participants were assigned 1:1:1 to receive a low-FODMAP diet plus traditional dietary advice (50% carbohydrates, 33% fat, 17% protein), a fiber-optimized diet with low carbohydrates and high protein and fat (10% carbohydrates, 67% fat, 23% protein), or optimized medical treatment based on predominant IBS symptoms. Participants were masked to the names of the diets, but the pharmacological treatment was open-label.
After 4 weeks, participants were unmasked and encouraged to continue their diets.
During 6 months of follow-up, those in the low-FODMAP group were instructed on how to reintroduce FODMAPs, and those in the pharmacological treatment group were offered personalized diet counseling and to continue their medication.
Among 1104 participants assessed for eligibility, 304 were randomly assigned. However, 10 participants did not receive their intervention after randomization, so only 294 participants were included in the modified intention-to-treat population: 96 in the low-FODMAP group, 97 in the low-carbohydrate group, and 101 in the optimized medical treatment group. Overall, 82% were women, and the mean age was 38 years.
Following the 4-week intervention, 73 of 96 participants (76%) in the low-FODMAP group, 69 of 97 participants (71%) in the low-carbohydrate group, and 59 of 101 participants (58%) in the optimized medical treatment group had a reduction of ≥ 50 points in the IBS-SSS compared with baseline.
A stricter score reduction of ≥ 100 points was observed in 61% of the low-FODMAP group, 58% of the low-carbohydrate group, and 39% of the optimized medical treatment group.
In both the low-FODMAP group and the low-carbohydrate group, 95% of participants completed the 4-week intervention compared with 90% among the pharmacological group. Two people in each group said adverse events prompted their discontinuation, and five in the medical treatment group stopped prematurely due to side effects. No serious adverse events or treatment-related deaths occurred.
“We were surprised by the effectiveness of the fiber-optimized low-carbohydrate diet, which demonstrated comparable efficacy to the combined low-FODMAP and traditional IBS diet,” Dr. Nybacka said. “While previous knowledge suggested that high-fat intake could worsen symptoms in some individuals, the synergy with low-carbohydrate intake appeared to render the diet more tolerable for these patients.”
The authors noted that since all three treatment options showed significant and clinically meaningful efficacy, patient preference, ease of implementation, compliance, cost-effectiveness, and long-term effects, including those on nutritional status and gut microbiota, should be considered in personalized plans.
Future Practice Considerations
Dr. Nybacka and colleagues recommended additional trials before implementing the low-carbohydrate diet in clinical practice. “Worse blood lipid levels among some participants in the low-carbohydrate group point to an area for caution,” she said.
The research team also plans to evaluate changes in microbiota composition and metabolomic profiles among participants to further understand factors associated with positive treatment outcomes.
“Approximately two thirds of patients with IBS report that certain foods trigger symptoms of IBS, which is why many patients are interested in exploring dietary interventions for their symptoms,” said Brian Lacy, MD, professor of medicine and program director of the GI fellowship program at the Mayo Clinic in Jacksonville, Florida. “One of the most commonly employed diets for the treatment of IBS is the low-FODMAP diet.”
Dr. Lacy, who wasn’t involved with this study, co-authored the 2021 American College of Gastroenterology clinical guideline for the management of IBS.
He and his colleagues recommended a limited trial of a low-FODMAP diet to improve symptoms, as well as targeted use of medications for IBS subtypes with constipation or diarrhea and gut-directed psychotherapy for overall IBS symptoms.
“However, there are problems with the low-FODMAP diet, as it can be difficult to institute, it can be fairly restrictive, and long-term use has the potential to lead to micronutrient deficiencies,” he said. “Importantly, large studies comparing dietary interventions directly to medical therapies are absent, which led to the study by Nybacka and colleagues.”
Dr. Lacy noted several limitations, including the single-center focus, short-term intervention, and variety of therapies used among the medical arm of the study. In addition, some therapies available in the United States aren’t available in Europe, so the varying approaches to medical management in the former may lead to different results. At the same time, he said, the study is important and will be widely discussed among patients and clinicians.
“I think it will likely stand the test of time,” Dr. Lacy said. “An easy-to-use diet with common sense advice that improves symptoms will likely eventually translate into first-line therapy for IBS patients.”
The study was funded by grants from the Healthcare Board Region Västra Götaland, Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and AFA Insurance; the ALF agreement between the Swedish government and county councils; Wilhelm and Martina Lundgren Science Foundation; Skandia; Dietary Science Foundation; and Nanna Swartz Foundation. Several authors declared grants, consulting fees, and advisory board roles with various pharmaceutical companies. Dr. Lacy reported no relevant disclosures.
A version of this article appeared on Medscape.com.
According to a new study, evidence was found that these dietary interventions were more efficacious at 4 weeks, suggesting their potential as first-line treatments.
“IBS is a disorder that may have different underlying causes, and it can manifest in different ways among patients. It is also likely that the most effective treatment option can differ in patients,” said lead author Sanna Nybacka, RD, PhD, a postdoctoral researcher in molecular and clinical medicine at the University of Gothenburg’s Sahlgrenska Academy, Gothenburg, Sweden.
“Up to 80% of patients with IBS report that their symptoms are exacerbated by dietary factors, and dietary modifications are considered a promising avenue for alleviating IBS symptoms,” she said. “However, as not all patients respond to dietary modifications, we need studies comparing the effectiveness of dietary vs pharmacological treatments in IBS to better understand which patients are more likely to benefit from which treatment.”
The study was published online in The Lancet Gastroenterology and Hepatology.
Treatment Comparison
Dr. Nybacka and colleagues conducted a single-blind randomized controlled trial at a specialized outpatient clinic at Sahlgrenska University Hospital in Gothenburg, Sweden, between January 2017 and September 2021. They included adults with moderate to severe IBS, which was defined as ≥ 175 points on the IBS Severity Scoring System (IBS-SSS), and who had no other serious diseases or food allergies.
The participants were assigned 1:1:1 to receive a low-FODMAP diet plus traditional dietary advice (50% carbohydrates, 33% fat, 17% protein), a fiber-optimized diet with low carbohydrates and high protein and fat (10% carbohydrates, 67% fat, 23% protein), or optimized medical treatment based on predominant IBS symptoms. Participants were masked to the names of the diets, but the pharmacological treatment was open-label.
After 4 weeks, participants were unmasked and encouraged to continue their diets.
During 6 months of follow-up, those in the low-FODMAP group were instructed on how to reintroduce FODMAPs, and those in the pharmacological treatment group were offered personalized diet counseling and to continue their medication.
Among 1104 participants assessed for eligibility, 304 were randomly assigned. However, 10 participants did not receive their intervention after randomization, so only 294 participants were included in the modified intention-to-treat population: 96 in the low-FODMAP group, 97 in the low-carbohydrate group, and 101 in the optimized medical treatment group. Overall, 82% were women, and the mean age was 38 years.
Following the 4-week intervention, 73 of 96 participants (76%) in the low-FODMAP group, 69 of 97 participants (71%) in the low-carbohydrate group, and 59 of 101 participants (58%) in the optimized medical treatment group had a reduction of ≥ 50 points in the IBS-SSS compared with baseline.
A stricter score reduction of ≥ 100 points was observed in 61% of the low-FODMAP group, 58% of the low-carbohydrate group, and 39% of the optimized medical treatment group.
In both the low-FODMAP group and the low-carbohydrate group, 95% of participants completed the 4-week intervention compared with 90% among the pharmacological group. Two people in each group said adverse events prompted their discontinuation, and five in the medical treatment group stopped prematurely due to side effects. No serious adverse events or treatment-related deaths occurred.
“We were surprised by the effectiveness of the fiber-optimized low-carbohydrate diet, which demonstrated comparable efficacy to the combined low-FODMAP and traditional IBS diet,” Dr. Nybacka said. “While previous knowledge suggested that high-fat intake could worsen symptoms in some individuals, the synergy with low-carbohydrate intake appeared to render the diet more tolerable for these patients.”
The authors noted that since all three treatment options showed significant and clinically meaningful efficacy, patient preference, ease of implementation, compliance, cost-effectiveness, and long-term effects, including those on nutritional status and gut microbiota, should be considered in personalized plans.
Future Practice Considerations
Dr. Nybacka and colleagues recommended additional trials before implementing the low-carbohydrate diet in clinical practice. “Worse blood lipid levels among some participants in the low-carbohydrate group point to an area for caution,” she said.
The research team also plans to evaluate changes in microbiota composition and metabolomic profiles among participants to further understand factors associated with positive treatment outcomes.
“Approximately two thirds of patients with IBS report that certain foods trigger symptoms of IBS, which is why many patients are interested in exploring dietary interventions for their symptoms,” said Brian Lacy, MD, professor of medicine and program director of the GI fellowship program at the Mayo Clinic in Jacksonville, Florida. “One of the most commonly employed diets for the treatment of IBS is the low-FODMAP diet.”
Dr. Lacy, who wasn’t involved with this study, co-authored the 2021 American College of Gastroenterology clinical guideline for the management of IBS.
He and his colleagues recommended a limited trial of a low-FODMAP diet to improve symptoms, as well as targeted use of medications for IBS subtypes with constipation or diarrhea and gut-directed psychotherapy for overall IBS symptoms.
“However, there are problems with the low-FODMAP diet, as it can be difficult to institute, it can be fairly restrictive, and long-term use has the potential to lead to micronutrient deficiencies,” he said. “Importantly, large studies comparing dietary interventions directly to medical therapies are absent, which led to the study by Nybacka and colleagues.”
Dr. Lacy noted several limitations, including the single-center focus, short-term intervention, and variety of therapies used among the medical arm of the study. In addition, some therapies available in the United States aren’t available in Europe, so the varying approaches to medical management in the former may lead to different results. At the same time, he said, the study is important and will be widely discussed among patients and clinicians.
“I think it will likely stand the test of time,” Dr. Lacy said. “An easy-to-use diet with common sense advice that improves symptoms will likely eventually translate into first-line therapy for IBS patients.”
The study was funded by grants from the Healthcare Board Region Västra Götaland, Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and AFA Insurance; the ALF agreement between the Swedish government and county councils; Wilhelm and Martina Lundgren Science Foundation; Skandia; Dietary Science Foundation; and Nanna Swartz Foundation. Several authors declared grants, consulting fees, and advisory board roles with various pharmaceutical companies. Dr. Lacy reported no relevant disclosures.
A version of this article appeared on Medscape.com.
According to a new study, evidence was found that these dietary interventions were more efficacious at 4 weeks, suggesting their potential as first-line treatments.
“IBS is a disorder that may have different underlying causes, and it can manifest in different ways among patients. It is also likely that the most effective treatment option can differ in patients,” said lead author Sanna Nybacka, RD, PhD, a postdoctoral researcher in molecular and clinical medicine at the University of Gothenburg’s Sahlgrenska Academy, Gothenburg, Sweden.
“Up to 80% of patients with IBS report that their symptoms are exacerbated by dietary factors, and dietary modifications are considered a promising avenue for alleviating IBS symptoms,” she said. “However, as not all patients respond to dietary modifications, we need studies comparing the effectiveness of dietary vs pharmacological treatments in IBS to better understand which patients are more likely to benefit from which treatment.”
The study was published online in The Lancet Gastroenterology and Hepatology.
Treatment Comparison
Dr. Nybacka and colleagues conducted a single-blind randomized controlled trial at a specialized outpatient clinic at Sahlgrenska University Hospital in Gothenburg, Sweden, between January 2017 and September 2021. They included adults with moderate to severe IBS, which was defined as ≥ 175 points on the IBS Severity Scoring System (IBS-SSS), and who had no other serious diseases or food allergies.
The participants were assigned 1:1:1 to receive a low-FODMAP diet plus traditional dietary advice (50% carbohydrates, 33% fat, 17% protein), a fiber-optimized diet with low carbohydrates and high protein and fat (10% carbohydrates, 67% fat, 23% protein), or optimized medical treatment based on predominant IBS symptoms. Participants were masked to the names of the diets, but the pharmacological treatment was open-label.
After 4 weeks, participants were unmasked and encouraged to continue their diets.
During 6 months of follow-up, those in the low-FODMAP group were instructed on how to reintroduce FODMAPs, and those in the pharmacological treatment group were offered personalized diet counseling and to continue their medication.
Among 1104 participants assessed for eligibility, 304 were randomly assigned. However, 10 participants did not receive their intervention after randomization, so only 294 participants were included in the modified intention-to-treat population: 96 in the low-FODMAP group, 97 in the low-carbohydrate group, and 101 in the optimized medical treatment group. Overall, 82% were women, and the mean age was 38 years.
Following the 4-week intervention, 73 of 96 participants (76%) in the low-FODMAP group, 69 of 97 participants (71%) in the low-carbohydrate group, and 59 of 101 participants (58%) in the optimized medical treatment group had a reduction of ≥ 50 points in the IBS-SSS compared with baseline.
A stricter score reduction of ≥ 100 points was observed in 61% of the low-FODMAP group, 58% of the low-carbohydrate group, and 39% of the optimized medical treatment group.
In both the low-FODMAP group and the low-carbohydrate group, 95% of participants completed the 4-week intervention compared with 90% among the pharmacological group. Two people in each group said adverse events prompted their discontinuation, and five in the medical treatment group stopped prematurely due to side effects. No serious adverse events or treatment-related deaths occurred.
“We were surprised by the effectiveness of the fiber-optimized low-carbohydrate diet, which demonstrated comparable efficacy to the combined low-FODMAP and traditional IBS diet,” Dr. Nybacka said. “While previous knowledge suggested that high-fat intake could worsen symptoms in some individuals, the synergy with low-carbohydrate intake appeared to render the diet more tolerable for these patients.”
The authors noted that since all three treatment options showed significant and clinically meaningful efficacy, patient preference, ease of implementation, compliance, cost-effectiveness, and long-term effects, including those on nutritional status and gut microbiota, should be considered in personalized plans.
Future Practice Considerations
Dr. Nybacka and colleagues recommended additional trials before implementing the low-carbohydrate diet in clinical practice. “Worse blood lipid levels among some participants in the low-carbohydrate group point to an area for caution,” she said.
The research team also plans to evaluate changes in microbiota composition and metabolomic profiles among participants to further understand factors associated with positive treatment outcomes.
“Approximately two thirds of patients with IBS report that certain foods trigger symptoms of IBS, which is why many patients are interested in exploring dietary interventions for their symptoms,” said Brian Lacy, MD, professor of medicine and program director of the GI fellowship program at the Mayo Clinic in Jacksonville, Florida. “One of the most commonly employed diets for the treatment of IBS is the low-FODMAP diet.”
Dr. Lacy, who wasn’t involved with this study, co-authored the 2021 American College of Gastroenterology clinical guideline for the management of IBS.
He and his colleagues recommended a limited trial of a low-FODMAP diet to improve symptoms, as well as targeted use of medications for IBS subtypes with constipation or diarrhea and gut-directed psychotherapy for overall IBS symptoms.
“However, there are problems with the low-FODMAP diet, as it can be difficult to institute, it can be fairly restrictive, and long-term use has the potential to lead to micronutrient deficiencies,” he said. “Importantly, large studies comparing dietary interventions directly to medical therapies are absent, which led to the study by Nybacka and colleagues.”
Dr. Lacy noted several limitations, including the single-center focus, short-term intervention, and variety of therapies used among the medical arm of the study. In addition, some therapies available in the United States aren’t available in Europe, so the varying approaches to medical management in the former may lead to different results. At the same time, he said, the study is important and will be widely discussed among patients and clinicians.
“I think it will likely stand the test of time,” Dr. Lacy said. “An easy-to-use diet with common sense advice that improves symptoms will likely eventually translate into first-line therapy for IBS patients.”
The study was funded by grants from the Healthcare Board Region Västra Götaland, Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and AFA Insurance; the ALF agreement between the Swedish government and county councils; Wilhelm and Martina Lundgren Science Foundation; Skandia; Dietary Science Foundation; and Nanna Swartz Foundation. Several authors declared grants, consulting fees, and advisory board roles with various pharmaceutical companies. Dr. Lacy reported no relevant disclosures.
A version of this article appeared on Medscape.com.
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<root generator="drupal.xsl" gversion="1.7"> <header> <fileName>168146</fileName> <TBEID>0C050353.SIG</TBEID> <TBUniqueIdentifier>MD_0C050353</TBUniqueIdentifier> <newsOrJournal>News</newsOrJournal> <publisherName>Frontline Medical Communications</publisherName> <storyname/> <articleType>2</articleType> <TBLocation>QC Done-All Pubs</TBLocation> <QCDate>20240522T132931</QCDate> <firstPublished>20240522T133130</firstPublished> <LastPublished>20240522T133130</LastPublished> <pubStatus qcode="stat:"/> <embargoDate/> <killDate/> <CMSDate>20240522T133130</CMSDate> <articleSource>FROM THE LANCET GASTROENTEROLOGY AND HEPATOLOGY</articleSource> <facebookInfo/> <meetingNumber/> <byline>Carolyn Crist</byline> <bylineText>CAROLYN CRIST</bylineText> <bylineFull>CAROLYN CRIST</bylineFull> <bylineTitleText/> <USOrGlobal/> <wireDocType/> <newsDocType>News</newsDocType> <journalDocType/> <linkLabel/> <pageRange/> <citation/> <quizID/> <indexIssueDate/> <itemClass qcode="ninat:text"/> <provider qcode="provider:imng"> <name>IMNG Medical Media</name> <rightsInfo> <copyrightHolder> <name>Frontline Medical News</name> </copyrightHolder> <copyrightNotice>Copyright (c) 2015 Frontline Medical News, a Frontline Medical Communications Inc. company. All rights reserved. This material may not be published, broadcast, copied, or otherwise reproduced or distributed without the prior written permission of Frontline Medical Communications Inc.</copyrightNotice> </rightsInfo> </provider> <abstract/> <metaDescription>Among patients with irritable bowel syndrome (IBS), a low-carbohydrate diet or a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and p</metaDescription> <articlePDF/> <teaserImage/> <teaser>“Up to 80% of patients with IBS report that their symptoms are exacerbated by dietary factors,” said Dr. Sanna Nybacka.</teaser> <title>Low-FODMAP, Low-Carb Diets May Beat Medical Treatment for IBS</title> <deck/> <disclaimer/> <AuthorList/> <articleURL/> <doi/> <pubMedID/> <publishXMLStatus/> <publishXMLVersion>1</publishXMLVersion> <useEISSN>0</useEISSN> <urgency/> <pubPubdateYear/> <pubPubdateMonth/> <pubPubdateDay/> <pubVolume/> <pubNumber/> <wireChannels/> <primaryCMSID/> <CMSIDs/> <keywords/> <seeAlsos/> <publications_g> <publicationData> <publicationCode>im</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>fp</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>GIHOLD</publicationCode> <pubIssueName>January 2014</pubIssueName> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> <journalTitle/> <journalFullTitle/> <copyrightStatement/> </publicationData> </publications_g> <publications> <term canonical="true">21</term> <term>15</term> </publications> <sections> <term canonical="true">27970</term> <term>39313</term> </sections> <topics> <term canonical="true">213</term> <term>49620</term> </topics> <links/> </header> <itemSet> <newsItem> <itemMeta> <itemRole>Main</itemRole> <itemClass>text</itemClass> <title>Low-FODMAP, Low-Carb Diets May Beat Medical Treatment for IBS</title> <deck/> </itemMeta> <itemContent> <p><span class="tag metaDescription">Among patients with <span class="Hyperlink">irritable bowel syndrome</span> (IBS), a low-carbohydrate diet or a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) plus traditional IBS dietary advice outperformed pharmacological treatment.</span><br/><br/>According to a new study, evidence was found that these dietary interventions were more efficacious at 4 weeks, suggesting their potential as first-line treatments.<br/><br/>“IBS is a disorder that may have different underlying causes, and it can manifest in different ways among patients. It is also likely that the most effective treatment option can differ in patients,” said lead author Sanna Nybacka, RD, PhD, a postdoctoral researcher in molecular and clinical medicine at the University of Gothenburg’s Sahlgrenska Academy, Gothenburg, Sweden.<br/><br/>“Up to 80% of patients with IBS report that their symptoms are exacerbated by dietary factors, and dietary modifications are considered a promising avenue for alleviating IBS symptoms,” she said. “However, as not all patients respond to dietary modifications, we need studies comparing the effectiveness of dietary vs pharmacological treatments in IBS to better understand which patients are more likely to benefit from which treatment.”<br/><br/>The study was <span class="Hyperlink"><a href="https://www.thelancet.com/journals/langas/article/PIIS2468-1253(24)00045-1/abstract">published online</a></span> in <em>The Lancet Gastroenterology and Hepatology</em>.<br/><br/></p> <h2>Treatment Comparison</h2> <p>Dr. Nybacka and colleagues conducted a single-blind randomized controlled trial at a specialized outpatient clinic at Sahlgrenska University Hospital in Gothenburg, Sweden, between January 2017 and September 2021. They included adults with moderate to severe IBS, which was defined as ≥ 175 points on the IBS Severity Scoring System (IBS-SSS), and who had no other serious diseases or <span class="Hyperlink">food allergies</span>.</p> <p>The participants were assigned 1:1:1 to receive a low-FODMAP diet plus traditional dietary advice (50% carbohydrates, 33% fat, 17% protein), a fiber-optimized diet with low carbohydrates and high protein and fat (10% carbohydrates, 67% fat, 23% protein), or optimized medical treatment based on predominant IBS symptoms. Participants were masked to the names of the diets, but the pharmacological treatment was open-label.<br/><br/>After 4 weeks, participants were unmasked and encouraged to continue their diets.<br/><br/>During 6 months of follow-up, those in the low-FODMAP group were instructed on how to reintroduce FODMAPs, and those in the pharmacological treatment group were offered personalized diet counseling and to continue their medication.<br/><br/>Among 1104 participants assessed for eligibility, 304 were randomly assigned. However, 10 participants did not receive their intervention after randomization, so only 294 participants were included in the modified intention-to-treat population: 96 in the low-FODMAP group, 97 in the low-carbohydrate group, and 101 in the optimized medical treatment group. Overall, 82% were women, and the mean age was 38 years.<br/><br/>Following the 4-week intervention, 73 of 96 participants (76%) in the low-FODMAP group, 69 of 97 participants (71%) in the low-carbohydrate group, and 59 of 101 participants (58%) in the optimized medical treatment group had a reduction of ≥ 50 points in the IBS-SSS compared with baseline.<br/><br/>A stricter score reduction of ≥ 100 points was observed in 61% of the low-FODMAP group, 58% of the low-carbohydrate group, and 39% of the optimized medical treatment group.<br/><br/>In both the low-FODMAP group and the low-carbohydrate group, 95% of participants completed the 4-week intervention compared with 90% among the pharmacological group. Two people in each group said adverse events prompted their discontinuation, and five in the medical treatment group stopped prematurely due to side effects. No serious adverse events or treatment-related deaths occurred.<br/><br/>“We were surprised by the effectiveness of the fiber-optimized low-carbohydrate diet, which demonstrated comparable efficacy to the combined low-FODMAP and traditional IBS diet,” Dr. Nybacka said. “While previous knowledge suggested that high-fat intake could worsen symptoms in some individuals, the synergy with low-carbohydrate intake appeared to render the diet more tolerable for these patients.”<br/><br/>The authors noted that since all three treatment options showed significant and clinically meaningful efficacy, patient preference, ease of implementation, compliance, cost-effectiveness, and long-term effects, including those on nutritional status and gut microbiota, should be considered in personalized plans.<br/><br/></p> <h2>Future Practice Considerations</h2> <p>Dr. Nybacka and colleagues recommended additional trials before implementing the low-carbohydrate diet in clinical practice. “Worse blood lipid levels among some participants in the low-carbohydrate group point to an area for caution,” she said.</p> <p>The research team also plans to evaluate changes in microbiota composition and metabolomic profiles among participants to further understand factors associated with positive treatment outcomes.<br/><br/>“Approximately two thirds of patients with IBS report that certain foods trigger symptoms of IBS, which is why many patients are interested in exploring dietary interventions for their symptoms,” said Brian Lacy, MD, professor of medicine and program director of the GI fellowship program at the Mayo Clinic in Jacksonville, Florida. “One of the most commonly employed diets for the treatment of IBS is the low-FODMAP diet.”<br/><br/>Dr. Lacy, who wasn’t involved with this study, co-authored the 2021 American College of Gastroenterology <span class="Hyperlink"><a href="https://doi.org/10.14309/ajg.0000000000001036">clinical guideline</a></span> for the management of IBS.<br/><br/>He and his colleagues recommended a limited trial of a low-FODMAP diet to improve symptoms, as well as targeted use of medications for IBS subtypes with <span class="Hyperlink">constipation</span> or <span class="Hyperlink">diarrhea</span> and gut-directed psychotherapy for overall IBS symptoms.<br/><br/>“However, there are problems with the low-FODMAP diet, as it can be difficult to institute, it can be fairly restrictive, and long-term use has the potential to lead to micronutrient deficiencies,” he said. “Importantly, large studies comparing dietary interventions directly to medical therapies are absent, which led to the study by Nybacka and colleagues.”<br/><br/>Dr. Lacy noted several limitations, including the single-center focus, short-term intervention, and variety of therapies used among the medical arm of the study. In addition, some therapies available in the United States aren’t available in Europe, so the varying approaches to medical management in the former may lead to different results. At the same time, he said, the study is important and will be widely discussed among patients and clinicians.<br/><br/>“I think it will likely stand the test of time,” Dr. Lacy said. “An easy-to-use diet with common sense advice that improves symptoms will likely eventually translate into first-line therapy for IBS patients.”<br/><br/>The study was funded by grants from the Healthcare Board Region Västra Götaland, Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and AFA Insurance; the ALF agreement between the Swedish government and county councils; Wilhelm and Martina Lundgren Science Foundation; Skandia; Dietary Science Foundation; and Nanna Swartz Foundation. Several authors declared grants, consulting fees, and advisory board roles with various pharmaceutical companies. Dr. Lacy reported no relevant disclosures.<span class="end"/></p> <p> <em>A version of this article appeared on <span class="Hyperlink"><a href="https://www.medscape.com/viewarticle/low-fodmap-low-carb-diets-may-beat-medical-treatment-ibs-2024a10009kb">Medscape.com</a></span>.</em> </p> </itemContent> </newsItem> <newsItem> <itemMeta> <itemRole>teaser</itemRole> <itemClass>text</itemClass> <title/> <deck/> </itemMeta> <itemContent> </itemContent> </newsItem> </itemSet></root>
FROM THE LANCET GASTROENTEROLOGY AND HEPATOLOGY