Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!

Figure 1 Irritable bowel syndrome food pyramid. The pyramid was built upon the current dietary guidelines[12,13,21] and the existing literature[17,24,79,80] on diet and lifestyle recommendations in IBS. The pyramid consists of nine levels. At the base of the pyramid, it is emphasized the importance of regular physical activity, good hydration and healthy eating habits. Then, foods are arranged on the basis of recommended intake frequency in ascending order, from the most to the least frequent. Each food level also contains examples of what the patient can consume within a low FODMAP diet. A pictogram on the left side of the pyramid highlights the importance of seeking specialized dietary advice in case considering the low FODMAP dietary approach. The other pictograms on the left side are accompanied by recommendations on the intake of dietary fiber and administration of probiotics in IBS. Recommendations have associated superscript letters symbolizing the level of scientific evidence that supports them. IBS: Irritable bowel syndrome.