A new study discovered that nutrition, especially a low carb diet, may be more beneficial than medicine in treating irritable bowel syndrome (IBS). (1)
Swedish researchers conducted the study published in The Lancet Gastroenterology and Hepatology in April. They evaluated the effects of a low-FODMAP diet, a low-carb diet, and typical medical therapies for IBS.
Previous research has not measured the differences between these treatments, says study author and dietitian Sanna Nybacka, PhD, a postdoctoral researcher at Chalmers University of Technology in Gothenburg, Sweden. “This is the first study that has tested the efficacy of medical treatment (according to clinical routine) compared to dietary treatment,” she said.
The addition of a low carb diet was a novel feature in the study, as conventional IBS treatment generally relies on drugs or a low-FODMAP diet. (2) “This was also the first study to test the efficacy of a diet low in total carbohydrates, and the results were surprisingly good,” Nybacka told the newspaper.
Given that IBS affects 10-15% of American adults, these findings may have far-reaching ramifications. (3) Here’s what this research may imply if you have IBS.
A Closer Look at Diets, Medicine, and IBS
Nybacka and her colleagues conducted their investigation on 294 Swedish people with IBS of any kind and moderate-to-severe symptom intensity. Approximately one-third were allocated to follow a low-FODMAP diet, one-third to a low-carb diet, and one-third to medical therapy.
A low-FODMAP diet consisted of around 3.4 grams of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols daily. These carbohydrates (found in dairy products, specific fruits and vegetables, lentils, and some grains) are known to increase the quantity of fluid in the intestines, produce gas, and alter the rate of digestion. (4)
As a result, a low-FODMAP diet is frequently employed as a first line of defense for persons with IBS who have food-related symptoms, according to William Chey, MD, a gastrointestinal professor at the University of Michigan Medical School.
The study’s low-FODMAP diet was also tailored to include around 30 grams of fiber daily and suggestions to minimize coffee, alcohol, and fizzy drinks.
In contrast, a low carb diet was defined as consuming no more than 50 grams of carbs daily. “To maintain weight stability on this restrictive diet, participants were given more protein and fat,” Nybacka told me. We also optimized the fiber intake in this diet to provide approximately 25 grams of dietary fiber per day.”
The third group of participants received three medications for constipation (sterculia, macrogol, and linaclotide) and three for diarrhea (loperamide, cholestyramine, and ondansetron).
After four weeks, most individuals in each group reported improved symptoms, although those in the low-FODMAP and low-carb groups reported the most significant benefits. Seventy-six percent of those on a low-FODMAP diet and 71% on a low carb diet had a decline of at least 50 points on the IBS-SSS, a test used to assess IBS symptom severity.
“Overall, between the two diets, we found very similar improvements; both diets managed well in reducing symptom severity of IBS, and the two diets did particularly well in reducing abdominal pain and bloating,” Nybacka told the newspaper. “Both diets also improved quality of life in a similar way.” In comparison, only 58% of those taking medication saw the same improvement in IBS-SSS levels.
It’s worth mentioning that the study had certain limitations. Aside from being limited to Swedish people, the study lasted just four weeks, which Nybacka believes may be insufficient to make clear conclusions concerning dietary vs medicinal therapy for IBS. Future research may expand this comparison to test the study’s findings across time.
Why a Low Carb Diet Could Outperform Meds
The low-FODMAP diet has been well-established in medical literature as a strategy for relieving IBS symptoms. Thus, the current study’s findings are not surprising in that regard. (5)
The most profound questions: Why would a low-carb diet have identical benefits as a low-FODMAP diet, and why may both be superior to medication?
“It’s possible that [a low carb diet] worked well for people because it restricted other carbs that people with IBS may struggle to digest,” Amanda Sauceda, MS, RDN, gut health nutritionist and lecturer at California State University, Long Beach, told Health. (After all, a low-FODMAP diet restricts carbs.) “It could also work well because it changed how quickly food moves through the gut, improving harder stool.”
Sauceda hypothesized that having enough fiber in a low-carb diet likely helped people’s symptoms improve.
“When you optimize your fiber within a certain amount of carbs, you have to be very selective (in a good way) with your food,” she told me. “You have to focus on eating carb foods that are higher in fiber, and those tend to be less processed and more nutrient dense.”
Regarding why a low carb diet may outperform pharmaceuticals for people with IBS, Chey stated that current medical therapy for this illness is frequently patchy since it is challenging to match drugs to the underlying causes of various people’s symptoms.
“That’s why, in almost every study on medication for IBS, only about 50% of subjects improve,” he told me. Until biomarker-based drugs are developed for targeted IBS therapy, “we have no way to identify which of the medical options we have is the right medication for an individual patient,” he stated. As a result, diet might be a more successful strategy.
What This Means for People With IBS
They stated that not everyone with IBS will benefit from dietary modification. Some people may respond better to stress release, talk therapy, or other therapies. Nonetheless, nutritional adjustments are crucial in symptom treatment for many patients.
“Diet is a big factor for IBS because food can trigger digestive symptoms, which can cut into someone’s quality of life,” Sauceda shares. Furthermore, because there is no cure for IBS and drugs might be inefficient or cause adverse effects, modifying your diet is a low-risk option.
Of course, the study’s findings do not imply that a low-carb diet is a cure-all for IBS. “There is no one standard approach to managing IBS with diet,” Sauceda explains.
However, if you want to try a low-carb or low-FODMAP diet to relieve IBS symptoms, a qualified dietitian can assist you. Chey and Sauceda recommended keeping track of your food consumption, stresses, and symptoms to better understand your unique triggers.
“Keeping a food journal where you track what you’re eating, how you’re feeling, and your stress levels can be very helpful for info to start figuring out the food piece,” Sauceda told me. “This info can also be very helpful when you work with your dietitian.”
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