Is the high five diet beneficial for individuals with Irritable Bowel Syndrome (IBS)?

The Low FODMAP Diet is the Most Evidence-Based Dietary Approach for IBS

The low FODMAP diet is currently the most evidence-based dietary treatment for irritable bowel syndrome (IBS) and has been found to reduce overall symptoms, abdominal pain, and bloating in randomized controlled trials. 1

First-Line Dietary Recommendations

Before trying specialized diets, patients should follow these general dietary principles:

• Maintain regular meal patterns and take time to eat 1, 2
• Drink at least 8 cups of fluid daily, primarily water or non-caffeinated beverages 1, 2
• Limit tea and coffee to 3 cups per day 1, 2
• Reduce intake of alcohol and carbonated drinks 1, 2
• Limit fresh fruit to 3 portions per day (approximately 80g per portion) 1, 2
• Increase soluble fiber intake (found in psyllium, oats, and fruit flesh) 1, 2, 3
• Avoid insoluble fiber (found in wheat bran and fruit/vegetable skins) as it may worsen bloating and pain 1, 3
• Consider probiotics for at least 4 weeks to assess effectiveness 1, 2

The Low FODMAP Diet Approach

If symptoms persist after implementing first-line dietary recommendations, the low FODMAP diet should be considered as a second-line approach:

Implementation Process

• The diet consists of three distinct phases 1, 4:
  1. Restriction phase (4-6 weeks maximum)
  2. Reintroduction phase (6-10 weeks)
  3. Personalization phase based on reintroduction results

Patient Selection

• Good candidates include patients with insight into meal-related symptoms and motivation to make dietary changes 4
• Poor candidates include those at risk for malnutrition, with food insecurity, eating disorders, or moderate-to-severe anxiety/depression 1, 4

Professional Support

• The diet should be implemented with guidance from a registered dietitian nutritionist with gastrointestinal expertise 1, 4
• Self-implementation is not recommended due to the diet's complexity 4

Efficacy

• Approximately 70% of patients respond to the diet with significant improvement in symptom severity and quality of life 4
• The diet shows greater improvement in bloating compared to other dietary approaches 1, 4

Alternative Dietary Approaches

• Soluble fiber supplementation (psyllium/ispaghula) is effective for IBS symptoms, particularly in constipation-predominant IBS 1, 2, 3
• The Mediterranean diet may benefit those with mild gastrointestinal symptoms and comorbid mental health conditions 4
• Gluten-free diets have shown benefits in some IBS patients, though the mechanism remains unclear 5, 6

Important Considerations and Pitfalls

• Long-term strict FODMAP restriction may negatively impact the intestinal microbiome and should not be continued indefinitely 4
• For patients with comorbid mental health conditions, consider a gentler approach focusing on selected high-FODMAP foods rather than complete restriction 1, 4
• Patients with diarrhea should avoid sorbitol, an artificial sweetener found in sugar-free products 1
• Those experiencing bloating may benefit from consuming oats and linseeds (up to 1 tablespoon daily) 1, 2

Lifestyle Recommendations

• Regular physical activity is recommended for all IBS patients 2
• Create time for relaxation and stress management 1, 2
• Assess physical activity levels and encourage increasing them if low 1, 2

By following this structured approach to dietary management, starting with general recommendations and progressing to more specialized interventions like the low FODMAP diet when necessary, patients with IBS can experience significant symptom improvement and enhanced quality of life.