Irritable bowel syndrome (IBS) is a gut–brain axis chronic disorder, characterized by recurrent abdominal pain and altered bowel habits in the absence of organic pathology. Nutrition plays a central role in symptom management, yet no single dietary strategy has demonstrated universal effectiveness. This narrative review critically evaluates current nutritional approaches to IBS. The low-Fermentable Oligo-, Di-, Mono-saccharides and Polyols (FODMAP) diet is the most extensively studied and provides short-term symptom relief, but its long-term effects on microbiota diversity remain concerning. The Mediterranean diet, due to its anti-inflammatory and prebiotic properties, offers a sustainable, microbiota-friendly option; however, it has specific limitations in the context of IBS, particularly due to the adverse effects of certain FODMAP-rich foods. A gluten-free diet may benefit individuals with suspected non-celiac gluten sensitivity, although improvements are often attributed to fructan restriction and placebo and nocebo effects. Lactose-free diets are effective in patients with documented lactose intolerance, while a high-soluble-fiber diet is beneficial for constipation-predominant IBS. IgG-based elimination diets are emerging but remain controversial and require further validation. In this review, we present the 10 dietary commandments for IBS, pragmatic and easily retained recommendations. It advocates a personalized, flexible, and multidisciplinary management approach, avoiding rigidity and standardized protocols, with the aim of optimizing adherence, symptom mitigation, and health-related quality of life. Future research should aim to evaluate, in real-world clinical settings, the impact and applicability of the 10 dietary commandments for IBS in terms of symptom improvement and quality of life The low-Fermentable Oligo-, Di-, Mono-saccharides and Polyols (FODMAP) diet is the most extensively studied and provides short-term symptom relief, but its long-term effects on microbiota diversity remain concerning. The Mediterranean diet, due to its anti-inflammatory and prebiotic properties, offers a sustainable, microbiota-friendly option; however, it has specific limitations in the context of IBS, particularly due to the adverse effects of certain FODMAP-rich foods. A gluten-free diet may benefit individuals with suspected non-celiac gluten sensitivity, although improvements are often attributed to fructan restriction and placebo and nocebo effects. In recent years, the consumption of gluten-free products has increased significantly, even among individuals without a diagnosed health condition. This trend is often driven by the desire for a healthier lifestyle, although such benefits are more likely associated Low-FODMAP Diet Mediterranean Diet Gluten-Free Diet Lactose-Free Diet High-Fiber Diet IgG-Guided Diet Goal Reduce fermentation and FODMAP-related symptoms Balanced, anti-inflammatory nutrition Reduce symptoms similar to celiac disease Reduce symptoms related to lactose intolerance Increase stool bulk, regulate motility Eliminate foods with IgG-mediated immune response Physiopathological Rationale Eliminates fermentable carbohydrates Rich in protective nutrients and natural prebiotics Some IBS patients show sensitivity to gluten Lactose intolerance is common in IBS Fibers improve intestinal function Based on food-specific IgG immune response Effects on IBS Significant symptom improvement Benefits on microbiota and inflammation Reduced symptoms in some patients (mainly IBS-D) Reduced bloating and diarrhea in intolerant individuals Particularly useful in IBS-C Some studies show benefits, but evidence is inconclusive Limitations /Criticisms Restrictive and difficult to maintain Naturally contains FODMAP (e.g., legumes, fruits) Effective only in subgroups; possible placebo effect Only effective in patients with actual intolerance May worsen symptoms in IBS-D Limited data; risk of excessive dietary restrictions Composition Temporary exclusion, followed by FODMAP reintroduction Whole grains, vegetables, fruits, legumes, EVO oil Excludes all gluten-containing products Eliminates milk and lactose-containing dairy products Rich in soluble and insoluble fibers Personalized exclusion based on IgG tests Tolerability Good in the short term; challenging long-term Generally good, variable in IBS Good in those reporting gluten sensitivity Good in lactose-intolerant individuals Good in IBS-C; poor in IBS-D Variable; depends on individual response Scientific Support Solid and supported by international guidelines Strong in general nutrition; emerging in IBS Limited; useful in selected non-celiac patients Limited but recommended when positive for intolerance Recommended for IBS-C Controversial; studies have methodological limitations Effects on Microbiota Risk of reduced diversity if not balanced Positive (prebiotic effect) Potential reduction in diversity if not well managed Less impact, but imbalance possible if poorly compensated Promotes beneficial bacteria if tolerated Unclear or poorly studied Note: The indicators of tolerability and scientific support are derived from a narrative synthesis of the current literature reviewed in this article, including randomized controlled trials, meta-analyses, and international guidelines. The gluten-free diet, originally designed for patients with celiac disease, has also been applied to individuals with IBS, especially in cases of suspected non-celiac gluten sensitivity. However, a significant portion of the benefit observed may actually result from the reduction in fructans found in gluten-containing cereals, rather than from the elimination of gluten itself. Some controlled studies suggest a placebo or nocebo effect associated with gluten reintroduction. This diet may indeed be helpful for specific subgroups of patients, but it is essential to clearly distinguish between celiac disease, non-celiac sensitivity, and IBS to avoid unnecessary restrictions.

nd retail outlets, and reports in the medical literature and mainstream press of the clinical benefits of gluten avoidance. Individuals may restrict gluten from their diets for a variety of reasons, such as improvement of gastrointestinal and nongastrointestinal symptoms, as well as a perception that gluten is potentially harmful and, thus, restriction represents a healthy lifestyle. Emerging evidence shows that gluten avoidance may be beneficial for some patients with gastrointestinal symptoms, such as those commonly encountered with irritable bowel syndrome. However, high-quality evidence supporting gluten avoidance for physical symptoms or diseases other than those specifically known to be caused by immune-mediated responses to gluten is neither robust nor convincing. In fact, gluten avoidance may be associated with adverse effects in patients without proven gluten-related diseases. This article provides insight regarding gluten avoidance patterns and effects on patients without gluten-related diseases, and highlights concerns surrounding gluten avoidance in the absence of a gluten-mediated immunologic disease. Keywords: Celiac disease, gluten, gluten-free diet, nonceliac gluten sensitivity Epidemiology and Economics of a Gluten-Free Diet The consumption of gluten-free foods has significantly increased over the last 30 years. More than $15.5 billion were spent on retail sales of gluten-free foods in 2016, which is more than double the amount spent in 2011. 1 The rapid rise in the popularity of a gluten-free diet (GFD) and gluten-free foods has been driven by multiple factors, including social and traditional media coverage, aggressive consumer-directed marketing by manufacturers and retail outlets, and reports in the medical literature and mainstream press of the clinical benefits related to gluten avoidance. A lifelong GFD is well recognized as the standard of care for patients with gluten-related diseases such as celiac disease and gluten ataxia, in which immun Health Benefits and Adverse Effects of a Gluten-Free Diet in Non–Celiac Disease Patients - PMC Skip to main content Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Gastroenterol Hepatol (N Y) . 2018 Feb;14(2):82–91. Health Benefits and Adverse Effects of a Gluten-Free Diet in Non–Celiac Disease Patients Benjamin Niland Benjamin Niland , MD 1 Dr Niland is a clinical instructor in the Department of Medicine in the Division of Gastroenterology at the University of South Alabama School of Medicine in Mobile, Alabama. 2 Dr Cash is a professor of medicine and chief of the Division of Gastroenterology at the University of South Alabama School of Medicine. A lifelong GFD is well recognized as the standard of care for patients with gluten-related diseases such as celiac disease and gluten ataxia, in which immunemediated inflammatory responses to gluten proteins are directed primarily against the small intestinal mucosa and cerebellar Purkinje fibers, respectively. 2 Immunoglobulin (Ig) E–mediated wheat allergy is another relatively rare gluten-related disease that Potential Benefits and Harms of a GFD in Non–Celiac Disease Patients Conditions With Potential Benefits From a GFD Potential Harms of a GFD Gluten-sensitive irritable bowel syndrome Deficiencies of micronutrients and fiber Nonceliac gluten sensitivity Increases in fat content of foods Schizophrenia or other mental health conditions Hyperlipidemia Atopy Hyperglycemia Fibromyalgia Coronary artery disease Endometriosis Increased financial costs Obesity Social impairment or restrictions Athletic performance Open in a new tab GFD, gluten-free diet. One impetus for the practice of gluten avoidance in this population may be the perception that a GFD is a nutritionally healthier option than a traditional Western diet. Another potential perceived benefit of a GFD is that it is associated with weight loss. Kim and colleagues evaluated a GFD and its effect on obesity, metabolic syndrome, and cardiovascular risk in non–celiac disease participants in the NHANES from 2009 to 2014, and found that a GFD was associated with a decrease in weight over 1 year, lower waist circumference, and higher high density lipoprotein levels compared to the general population. A study by Lebwohl and colleagues examined a large group of non–celiac disease men (n=45,303) and women (n=64,714) from the Health Professionals Follow-Up Study and the Nurses’ Health Study, respectively, and assessed patients with low-, medium-, and high-gluten consumption based on food diaries. 70 The aim was to identify whether gluten consumption was associated with coronary heart disease. The authors found an inverse relationship between the outcomes of coronary artery disease and fatal and non-fatal myocardial infarctions with gluten intake. The percentage has decreased in recent years, and was 0.3% in 2013 to 2014 based on data from the NHANES. 5 It is important to make the diagnosis of celiac disease in these patients due to the long-term prognostic implications. Therefore, it is worthy to note that many patients on a GFD due to perceived health benefits should have celiac disease ruled out by diagnostic evaluation. Summary The GFD continues to trend in popular culture and the media, and more people are restricting gluten from their diet. The medical community must seek to provide an evidence-based approach delineating both the benefits and potential harms of a GFD.

water at meal time, and avoiding dairy foods. Fruitarianism Gluten free diet, while essential for people with celiac disease or gluten sensitivity, has also An individual's diet is the sum of food and drink that one habitually consumes. Dieting is the practice of attempting to achieve or maintain a certain weight through diet. People's dietary choices are often affected by a variety of factors, including ethical and religious beliefs, clinical need, or a desire to control weight. Not all diets are considered healthy. Some people follow unhealthy diets DASH…