Effects of Gluten-Free and Low-FODMAP Dietary Interventions on IBS and Cardiometabolic Health: Evidence from Clinical Trials and Meta-Analysis
DOI:
https://doi.org/10.66021/pakmcr1488Keywords:
Irritable Bowel Syndrome, Gluten-Free Diet, Low-FODMAP Diet, Cardiometabolic Health, Dietary Intervention, Meta-AnalysisAbstract
Background: Irritable bowel syndrome (IBS) affects a substantial proportion of the global population, prompting investigation into dietary interventions as therapeutic strategies. Gluten-free diets (GFD) and low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diets (LFD) have emerged as potential treatments, yet their efficacy and broader health implications remain subjects of ongoing research.
Objective: This comprehensive review synthesizes evidence from clinical trials and meta-analyses to evaluate the effects of GFD and LFD on IBS symptom management and cardiometabolic health outcomes.
Methods: A systematic literature search identified 75 studies on GFD and IBS, 83 studies on LFD and IBS, and 71 studies on cardiometabolic outcomes. Studies included randomized controlled trials (RCTs), systematic reviews, and meta-analyses published through 2026. Primary outcomes included IBS symptom severity scores, quality of life measures, and cardiometabolic parameters including lipid profiles, blood pressure, glucose metabolism, and body composition.
Results: LFD demonstrated robust efficacy in reducing IBS symptoms, with meta-analyses showing significant improvements in IBS Symptom Severity Scale (IBS-SSS) scores (standardized mean difference [SMD] −0.66, 95% CI −0.88 to −0.44) and quality of life. GFD showed more variable results, with some trials reporting significant symptom improvement while meta-analyses indicated insufficient evidence for routine recommendation. Combined LFD-GFD approaches showed enhanced efficacy for bloating and pain reduction. Regarding cardiometabolic outcomes, GFD demonstrated mixed effects, with some studies showing improvements in HDL cholesterol and triglycerides, while others reported increased total cholesterol and potential nutritional concerns. LFD research has primarily focused on gastrointestinal outcomes with limited cardiometabolic data.
Conclusions: LFD represents an evidence-based dietary intervention for IBS symptom management, while GFD efficacy remains controversial and may be limited to specific patient subgroups. The cardiometabolic safety profile of both diets requires further investigation, particularly for long-term adherence. Clinicians should consider individualized dietary approaches with appropriate nutritional monitoring.
