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. 2024 Jan;22(1):164-172.e6.
doi: 10.1016/j.cgh.2023.07.012. Epub 2023 Jul 29.

The Association Between a Mediterranean Diet and Symptoms of Irritable Bowel Syndrome

Ellie Y Chen  1 , Swapna Mahurkar-Joshi  2 , Cathy Liu  2 , Nancee Jaffe  1 , Jennifer S Labus  2 , Tien S Dong  3 , Arpana Gupta  2 , Shravya Patel  4 , Emeran A Mayer  2 , Lin Chang  5
Affiliations

The Association Between a Mediterranean Diet and Symptoms of Irritable Bowel Syndrome

Ellie Y Chen et al. Clin Gastroenterol Hepatol. 2024 Jan.

Abstract

Background & aims: Low adherence to Mediterranean diet (MD) has been shown to be associated with a higher prevalence of irritable bowel syndrome (IBS), but its association with IBS symptoms is not established. We aim to assess the association between MD and IBS symptoms, identify components of MD associated with IBS symptoms, and determine if a symptom-modified MD is associated with changes in the gut microbiome.

Methods: One hundred and six Rome +IBS and 108 health control participants completed diet history and gastrointestinal symptom questionnaires. Adherence to MD was measured using Alternate Mediterranean Diet and Mediterranean Diet Adherence Screener. Sparse partial least squares analysis identified MD food items associated with IBS symptoms. Stool samples were collected for 16S ribosomal RNA gene sequencing and microbial composition analysis in IBS subjects.

Results: Alternate Mediterranean Diet and Mediterranean Diet Adherence Screener scores were similar between IBS and health control subjects and did not correlate with Irritable Bowel Syndrome Severity Scoring System, abdominal pain, or bloating. Among IBS participants, a higher consumption of fruits, vegetables, sugar, and butter was associated with a greater severity of IBS symptoms. Multivariate analysis identified several MD foods to be associated with increased IBS symptoms. A higher adherence to symptom-modified MD was associated with a lower abundance of potentially harmful Faecalitalea, Streptococcus, and Intestinibacter, and higher abundance of potentially beneficial Holdemanella from the Firmicutes phylum.

Conclusions: A standard MD was not associated with IBS symptom severity, although certain MD foods were associated with increased IBS symptoms. Our study suggests that standard MD may not be suitable for all patients with IBS and likely needs to be personalized in those with increased symptoms.

Keywords: Irritable Bowel Syndrome; Mediterranean Diet; Microbiome; Symptoms.

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Conflict of interest statement

Conflicts of interest

These authors disclose the following: Emeran Mayer is a scientific advisory board member of Danone, Axial Biotherapeutics, Amare, Mahana Therapeutics, Pendulum, Bloom Biosciences, Seed, and APC Microbiome Ireland. Lin Chang is consultant for Food Marble; and has stock options in Food Marble and ModifyHealth. The remaining authors disclose no conflicts.

Figures

Figure 1.
Figure 1.
Sparse partial least squares analysis of the correlations between MD food items and IBS symptoms. Anti-MD foods are foods typically avoided or consumed occasionally in a Mediterranean style diet. Pro-MD foods are foods preferentially consumed in a Mediterranean-style diet. The heatmap shows Pearson correlation coefficients between the derived dietary variables and derived symptom variables. Deeper red color represents higher positive correlation and deeper blue represents higher negative correlation. Dendrogram row/column clusters based on the hierarchical clustering method. aAnti-MD foods. bPro-MD foods.
Figure 2.
Figure 2.
(A) Principal coordinate analysis comparison in beta-diversity between IBS subjects with low, medium, and high symptom aMED-m. (B) Relative abundance of fecal microbiota in IBS subjects with high aMED-m versus low aMED-m score.
See this image and copyright information in PMC

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