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The role of diet in irritable bowel syndrome: implications for dietary advice

Journal article
Authors A. Rej
L. Aziz
Hans Törnblom
D. S. Sanders
Magnus Simrén
Published in Journal of Internal Medicine
Volume 286
Issue 5
Pages 490-502
ISSN 0954-6820
Publication year 2019
Published at Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Pages 490-502
Language en
Keywords diet, fibre, FODMAP, gluten, Irritable bowel syndrome, low-fodmap diet, gluten-free diet, randomized clinical-trial, gastrointestinal symptoms, celiac-disease, reduces symptoms, wheat, sensitivity, food, efficacy, General & Internal Medicine
Subject categories Internal medicine


Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects approximately 10% of the population. Diet triggers symptoms in the vast majority of individuals with IBS. In view of this, there has been a focus on the role of diet in IBS. The diets currently being headlined for IBS include (i) traditional dietary advice, (ii) the low fermentable oligo-, di-, mono- saccharides and polyols (FODMAPs) diet and (iii) the gluten-free diet (GFD). Although traditional dietary advice is considered as the first-line dietary therapy, its evidence base is variable, with a few randomized controlled trials (RCTs) exploring the efficacy of this approach, other than for fibre. There are now a growing number of RCTs demonstrating the efficacy of the low FODMAP diet in the short-term, with some emerging data on the long-term 'adapted' low FODMAP diet. There are also several RCTs showing the benefits of a GFD in IBS; however, this concept is hampered with uncertainty as to the mechanism of action. Nevertheless, all of these dietary therapies are viable options for individuals with IBS, with the dietitian and patient engagement at the forefront of achieving success. However, future pragmatic studies are needed to clarify the comparative efficacy and convenience of implementing these various diets into routine life. Moreover, it is imperative to better delineate the concern that restrictive diets - such as the low FODMAP and GFD - may promote nutritional inadequacies, disordered eating behaviours, and lead to detrimental alterations to the gut microbiota.

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