A Comparison of the Low-FODMAPs Diet and a Tritordeum-Based Diet on the Gastrointestinal Symptom Profile of Patients Suffering from Irritable Bowel Syndrome-Diarrhea Variant (IBS-D): A Randomized Controlled Trial

Francesco Russo, Giuseppe Riezzo, Antonella Orlando, Michele Linsalata, Benedetta D'Attoma, Laura Prospero, Antonia Ignazzi, Gianluigi Giannelli, Francesco Russo, Giuseppe Riezzo, Antonella Orlando, Michele Linsalata, Benedetta D'Attoma, Laura Prospero, Antonia Ignazzi, Gianluigi Giannelli

Abstract

The dietary approach low in oligosaccharides, disaccharides, monosaccharides, and fermentable polyols (FODMAPs-LFD) is a good strategy for treating irritable bowel syndrome (IBS). Beyond the LFD, other dietary approaches with beneficial effects may be hypothesized. Among them, consumption of Tritordeum-based foods (TBD, bread, bakery products, and pasta) in substitution of other cereals seem to achieve promising results. In a randomized controlled trial, we compared the effects of 12 weeks of LFD to TBD in improving the symptom profile of IBS-diarrhea (IBS-D) patients. The two diets equally improved gastrointestinal symptoms and QoL, measured by the IBS Severity Scoring System (IBS-SSS) questionnaire, reducing the total score after four weeks and maintaining this range until the end of treatment (IBS-SSS total score change: −132.1; 95% CI: −74.9 to −189.4 and −130.5; 95% CI: −73.2 to −187.7; p < 0.0001 after LFD and TBD, respectively). The two diets did not modify the micronutrients content when extended for 12 weeks. LFD could be regarded as a first-line dietary approach for IBS-D patients. However, TBD may represent a valid alternative, with high palatability, especially among Italian patients, for whom pasta is considered one of the main assets of dietetic culture, and would be easier to manage in their daily habits.

Keywords: irritable bowel syndrome; low-FODMAPs diet; symptom profile; tritordeum.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The study design timeline. GE = gastroenterological, BIA = bioelectrical impedance analysis, IBS-SSS = Irritable Bowel Syndrome Severity Scoring System, IDARS = IBS diet adherence reporting scale.
Figure 2
Figure 2
The CONSORT flowchart of the study.
Figure 3
Figure 3
The effects of diets during administration on the IBS Severity Scoring System (IBS-SSS) total scores in IBS-D patients. Mixed-design ANOVA analysis and Bonferroni’s multiple comparisons test. V2 (day 0): attribution visit; V3 (4 weeks) and V4 (8 weeks): intermediate visits; V5 (12 weeks): final visit. LFD: Low-FODMAPs diet. TFD: Tritordeum-based food diet. Dotted blue lines indicate scores categorizing IBS symptoms as “mild” (75 to 175), “moderate” (175 to 300), and “severe” (>300). Data are expressed as M±SEM. Multiple comparisons IBS-SSS total score change: −132.1 (95% CI: −74.9 to −189.4) and −130.5 (95% CI: −73.2 to −187.7) after LFD and TBD, respectively (p < 0.0001).

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