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World J Gastroenterol. Jun 7, 2017; 23(21): 3771-3783
Published online Jun 7, 2017. doi: 10.3748/wjg.v23.i21.3771
Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!
Anamaria Cozma-Petruţ, Felicia Loghin, Doina Miere, Dan Lucian Dumitraşcu
Anamaria Cozma-Petruţ, Doina Miere, Department of Bromatology, Hygiene, Nutrition, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
Felicia Loghin, Department of Toxicology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
Dan Lucian Dumitraşcu, 2nd Medical Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
Author contributions: Cozma-Petruţ A and Dumitraşcu DL contributed to the literature search and manuscript writing; Loghin F and Miere D contributed to the scientific content and revision of the manuscript; Dumitraşcu DL gave the study idea, the final revision of the article.
Conflict-of-interest statement: All authors declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dan Lucian Dumitraşcu, MD, Professor, 2nd Medical Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, 4 Clinicilor Street, 400006 Cluj-Napoca, Romania. ddumitrascu@umfcluj.ro
Telephone: +40-722-756475 Fax: +40-264-593355
Received: February 13, 2017
Peer-review started: February 14, 2017
First decision: March 16, 2017
Revised: April 8, 2017
Accepted: May 4, 2017
Article in press: May 4, 2017
Published online: June 7, 2017
Processing time: 114 Days and 16.3 Hours
Abstract

A substantial proportion of patients with irritable bowel syndrome (IBS) associate their symptoms with the ingestion of specific foods. Therefore, in recent years, scientific research has increasingly focused on the role of diet in IBS and dietary management is now considered an important tool in IBS treatment. This article reviews the main dietary approaches in IBS emphasizing evidence from experimental and observational studies and summarizing the main diet and lifestyle recommendations provided by dietary guidelines and scientific literature. Despite the limited evidence for a beneficial role, general advice on healthy eating and lifestyle is recommended as the first-line approach in the dietary management of IBS. Standard recommendations include adhering to a regular meal pattern, reducing intake of insoluble fibers, alcohol, caffeine, spicy foods, and fat, as well as performing regular physical activity and ensuring a good hydration. Second-line dietary approach should be considered where IBS symptoms persist and recommendations include following a low FODMAP diet, to be delivered only by a healthcare professional with expertise in dietary management. The efficacy of this diet is supported by a growing body of evidence. In contrast, the role of lactose or gluten dietary restriction in the treatment of IBS remains subject to ongoing research with a lack of high-quality evidence. Likewise, further clinical trials are needed to conclude the efficacy of probiotics on IBS symptoms.

Keywords: Irritable bowel syndrome; Alcohol; Caffeine; Spicy foods; Fat; Dietary fiber; Milk; FODMAP; Gluten; Probiotics

Core tip: In recent years, dietary management has shown promise as a key tool in the treatment of irritable bowel syndrome (IBS). This article gives a high topical review of dietary approaches in IBS treatment and evaluates the current evidence to support their efficacy in the improvement of IBS symptoms. On the basis of diet and lifestyle recommendations in IBS, identified in dietary guidelines and scientific literature, the article provides the “IBS Food Pyramid”, namely a novel, visual, user-friendly tool for the dietary counseling of IBS patients by healthcare professionals.