Lancet Gastroenterol Hepatol. 2024 Dec;9(12):1147-1161.doi: 10.1016/S2468-1253(24)00238-3.

Kevin Whelan ¹, Alexander C Ford ², Helen Burton-Murray ³, Heidi M Staudacher ⁴

Author information

¹Department of Nutritional Sciences, King's College London, London, UK. Electronic address: kevin.whelan@kcl.ac.uk.

²Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK.

³Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.

⁴Food and Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia.

Abstract

Diet is a cornerstone in the management of irritable bowel syndrome (IBS). There is evidence of efficacy across the spectrum of dietary management strategies, including some supplements (eg, specific fibres), foods, and whole diets (eg, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols [known as the low-FODMAP diet]). Whole-diet interventions, particularly those that restrict intake, can be challenging to deliver effectively and safely. Factors to consider include patient demographics, food cost and availability, and the acceptability of dietary management and its impact on food-related quality of life. There is concern regarding a potential role of restrictive whole-diet interventions in eating disorder risk. Optimal approaches to delivering dietary management in the health-care setting are unclear. The aim of this Review is to summarize the clinical evidence for the dietary management of IBS; to discuss the challenges, burdens, and risks of dietary management; and to propose how these challenges, burdens, and risks should be mitigated and minimised in clinical practice.