Mediterranean Diet for Irritable Bowel Syndrome

#!115 2025 The Rowen Report

Dear Subscriber,

Irritable bowel disease is a major problem in our society. Some 6-7% of the US population so suffers and this is less than the 10-15% worldwide incidence. Symptoms include abdominal pain, bloating, alterations in bowel motions. It is a real nuisance for millions. Fortunately, it does not equate to the more serious bowl inflammatory disease conditions like ulcerative colitis and or Crohn’s disease.

There are many suspected causes. Most important consideration is a disruption to the gut-brain axis. Your gut is in constant communication with your brain via the vagus nerve and in BOTH directions. But is it your brain that sets it off, your gut, or both?

Frankly, I think the cause is a myriad of issues which cannot be addressed by the synthetic petrochemical pharmaceutical industry. Our intestinal tracts were not designed by Nature/God with drugs in mind. We were designed with whole foods made by Nature in mind. I agree that compounds in certain foods can be irritating. We’ve discussed lectins here. Gluten is one such lectin and a nasty one at that. Many foods have lectins but I happen to believe that rotating foods and spreading out the issue in variety reduces the problem considerably, but obviously that will vary from person to person. My diet (vegetarian) is LOADED with lectins, and I eat mostly Living Foods, but have little gut issues. Yet others could be quite sensitive.

Abnormal gut microbiome is very high on my list. Causes? Drugs, environmental toxins, diet not fit for humans. This can be hard to treat. We use Dr. Biome probiotic.(coupon code oxygen), ozone or oxidative therapy tailored to patient, very targeted nutritional supplements, and cleaning up diet to support the gut microbiome, which cleaned up diet includes Mediterranean. Occult parasites are also a big issue. These can be very difficult to detect.

IBS patients traditionally follow a rather strict diet described often as cumbersome. Particularly, the FODMAP diet (low fermentable oligosaccharides, disaccharides, monosaccharides, polyols). This is not an easy diet. So a study was conducted on intervention with the famous Mediterranean Diet. You will see the abstract below. The diet performed better than traditional dietary advice in 138 UK patients and should now be considered a first line diet approach.

Here is a summary of the Med Diet: a heart-healthy eating pattern inspired by traditional foods from countries bordering the Mediterranean Sea, emphasizing whole, plant-based foods like fruits, vegetables, whole grains, beans, nuts, and olive oil, while limiting red meat, processed foods, and added sugars, focusing on fish/seafood a few times a week, and incorporating healthy fats for better heart health, longevity, and overall well-being.

I happen to find this interesting because this diet does have lectins (grains, beans, etc.) but is now found to help IBS. I am a fan of the Med Diet. In a clean world, I’d have no issues with people eating fish and modest amounts of meat. Fish are getting more contaminated, and meat has become a real issue for hormones, antibiotics and toxins. The Med Diet is quite moderate and proven health benefits across the board. If you have IBS or vascular disease, this is a diet well worth your consideration in face of many health challenges.

To Your Excellent Health!

Robert Jay Rowen, MD

Abstract:

Background: Patients with irritable bowel syndrome (IBS) frequently seek dietary advice, but few evidence-based options exist. Major societal guidelines recommend traditional dietary advice (TDA) as first-line therapy, with the cumbersome and resource-intensive low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet reserved as second-line therapy. Recent pilot data suggest that the Mediterranean diet (MD), renowned for its general health benefits, improves IBS symptoms, but whether it can be considered another first-line dietary option is unknown.

Objective: To determine if the MD is noninferior to TDA in managing IBS symptoms.

Design: Randomized noninferiority clinical trial. (ClinicalTrials.gov: NCT05985018).

Setting: Online virtual platform.

Participants: 139 persons with IBS from across the United Kingdom.

Intervention: 6 weeks of the MD (n = 68) or TDA (n = 71).

Measurements: Primary end point was the proportion achieving clinical response, defined as 50-point or greater reduction in IBS Symptom Severity Scale (IBS-SSS). Secondary outcomes included changes in IBS-SSS scores, psychological health, somatic symptom reporting, quality of life, diet satisfaction, and Mediterranean Diet Adherence Screener (MEDAS).

Results: Baseline characteristics (mean age, 40.4 years [range, 19 to 65 years]; 80% women) and IBS-SSS (mean, 309 [SD, 90]) were similar between groups. On modified intention-to-treat analysis, the primary end point was met by 62% (95% CI, 50% to 73%) following a MD versus 42% (CI, 31% to 55%) following TDA. The difference in clinical response favored the MD (difference, 20 percentage points [CI, 4 to 36 percentage points]; P = 0.017), demonstrating noninferiority and superiority. There was a greater reduction in the mean IBS-SSS after a MD than TDA (-101.2 vs. -64.5; Δ-36.7 [CI,-70.5 to -2.8]; P = 0.034). No statistically significant differences were seen between the groups with regard to changes in mood, somatic symptoms, quality of life, or diet satisfaction. The MEDAS significantly increased after a MD compared with TDA (P < 0.001).

Limitation: No long-term data.

Conclusion: The MD showed noninferiority and superiority to TDA in managing IBS symptoms. It represents a viable first-line dietary intervention for IBS.