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Irritable bowel syndrome: can nutrient manipulation help?

Cabré, Eduard

Current Opinion in Clinical Nutrition and Metabolic Care: September 2010 - Volume 13 - Issue 5 - p 581–587
doi: 10.1097/MCO.0b013e32833b6471
Nutrition and the gastrointestinal tract: Edited by M. Isabel T.D. Correia and Miquel A. Gassull

Purpose of review To describe the evidences for the usefulness of dietary manipulations (including the use of probiotics and prebiotics) in the management of irritable bowel syndrome (IBS).

Recent findings Exclusion diets do not have a role in the management of these patients except in the case of malabsorbed sugars (lactose, fructose). However, recent work suggests that excluding these sugars is more effective in non-IBS than in IBS patients. Also, the first small open series on the use of very low (20 g/day) carbohydrate diet (VLCD) in IBS has been published with promising results. However, safety concerns do not allow us to recommend them. In the period of review, further evidence has been provided on the role of psyllium in IBS. Also, the available evidence on the use of probiotics in IBS has been meta-analyzed.

Summary IBS patients should eat a balanced diet without restrictions, and (except for malabsorbed sugars) exclusion diets are not useful in most of them. The role of VLCD remains to be established. The concept that increasing fiber intake is useful for IBS may not be true for all patients, and hydrophilic colloids (e.g. psyllium) are preferred. There is growing evidence for the effectiveness of probiotics in IBS.

Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain

Correspondence to Eduard Cabré, MD, PhD, Department of Gastroenterology (5th floor), Hospital Universtari Germans Trias i Pujol, Carretera del Canyet s/n., 08916 Badalona, Spain Tel: +34 93 497 8909; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.