Low-FODMAP Diet plus a Probiotic for IBS

Diets low in indigestible sugars (FODMAPs) improve symptoms of irritable bowel syndrome (IBS), particularly diarrhea, bloating, and excessive flatus. Low-FODMAP diets induce changes in fecal microbiota, including reductions of bifidobacteria. Low concentrations of bifidobacteria have been associated with higher pain levels in IBS, and may represent an unwanted and adverse outcome of low-FODMAP diets.

In a randomized, controlled trial, 104 patients with IBS (excluding constipation-predominant type, or IBS-C) were randomized to a low-FODMAP or sham diet for 4 weeks and to a placebo or probiotic supplement (VSL #3). In the per-protocol analysis, adequate symptom relief was significantly greater with the low-FODMAP versus sham diet (61% vs. 39%)…