Dieta y Tratamiento para el Síndrome de Intestino Irritable

Recomendaciones Dietéticas

La dieta baja en FODMAPs, supervisada por un dietista, es el enfoque dietético más eficaz para reducir los síntomas globales y el dolor abdominal en pacientes con síndrome de intestino irritable, pero debe implementarse como terapia de segunda línea después de los consejos dietéticos generales 1, 2, 3
Mantener comidas regulares y tomarse tiempo para comer 4
Evitar saltarse comidas o dejar largos intervalos entre comidas 4
Beber al menos 8 vasos de líquido al día, especialmente agua o bebidas sin cafeína 4
Limitar el té y café a 3 tazas al día 4
Reducir el consumo de alcohol y bebidas gaseosas 4
Limitar la fruta fresca a 3 porciones por día (aproximadamente 80g por porción) 4
Aumentar el consumo de fibra soluble como ispaghula (psyllium), comenzando con dosis bajas (3-4 g/día) y aumentando gradualmente para evitar la distensión 1, 5
Evitar la fibra insoluble (como el salvado de trigo) ya que puede exacerbar los síntomas 1, 5, 6
Los pacientes con gases y distensión pueden beneficiarse de consumir avena y semillas de lino (hasta 1 cucharada por día) 4
Los probióticos pueden ser efectivos para los síntomas globales y el dolor abdominal 1, 6
Se recomienda probar los probióticos durante 12 semanas y discontinuarlos si no hay mejoría 1, 7

Todos los pacientes con SII deben realizar ejercicio físico regular 1, 5
Crear tiempo para la relajación y manejar el estrés 4
Evaluar los niveles de actividad física y aconsejar aumentarlos si son bajos 4
Loperamida puede ser efectiva para la diarrea en SII, pero debe titularse cuidadosamente para evitar efectos secundarios 1, 6
Ciertos antiespasmódicos pueden ser efectivos para los síntomas globales y el dolor abdominal 1, 7
Los antidepresivos tricíclicos son efectivos como segunda línea para síntomas globales y dolor abdominal, comenzando con dosis bajas (10 mg de amitriptilina) y aumentando gradualmente hasta 30-50 mg 2, 3

Rice is considered a safe starch for IBS patients because it lacks the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) that trigger gastrointestinal symptoms, according to the British Dietetic Association 8, 9, 10
The European Food Safety Authority recommends rice as a well-tolerated carbohydrate source that doesn't produce the short-chain fatty acids that lower colonic pH and exacerbate symptoms in IBS patients 8

The National Institute for Health and Care Excellence suggests starting with traditional dietary advice that includes rice as a safe carbohydrate option, with a first-line approach including regular meals with rice as a base carbohydrate, adequate hydration, and avoiding large meals that may trigger symptoms 9, 11
The American Gastroenterological Association recommends implementing a low-FODMAP diet under dietitian supervision if symptoms persist, with rice remaining a cornerstone food during all three phases of the diet 8, 9, 10

A meta-analysis of 11 trials (658 participants) demonstrated reduced risk of remaining symptomatic (RR 0.71; 95% CI 0.61 to 0.83) compared to control interventions, according to the American College of Gastroenterology 8, 9, 10

The British Society of Gastroenterology recommends that patients with stricturing disease consume well-cooked and soft rice to minimize mechanical irritation, with careful chewing and proper cooking to a soft consistency helping patients incorporate rice safely 12
The European Society for Clinical Nutrition and Metabolism suggests that while soluble fiber like ispaghula benefits IBS (RR 0.83; 95% CI 0.73 to 0.94), insoluble fiber like wheat bran may exacerbate symptoms, and white rice is particularly well-tolerated due to its low insoluble fiber content 9, 10, 13

The low-FODMAP diet is the most evidence-based dietary approach for IBS, and juice selection should follow FODMAP principles, with the critical factor being the fructose-to-glucose ratio in the juice, as recommended by the Gastroenterology society 14

Citrus juices (orange, lemon, lime) are specifically allowed in limited quantities during the Crohn's Disease Exclusion Diet, which is used for patients with IBD and concomitant IBS-like symptoms, according to the Gastroenterology society 15, 16
White grape juice contains fructose and glucose in more balanced concentrations, facilitating better absorption through the disaccharidase-related transport system, as reported by the Pediatrics society 17

Apple juice should be avoided as it contains excess fructose relative to glucose, leading to malabsorption and osmotic diarrhea, as stated by the Pediatrics society 17
Pear juice similarly has unfavorable fructose-to-glucose ratios and contains sorbitol, which is absorbed slowly via passive diffusion, according to the Pediatrics society 17

Glucose is absorbed rapidly via active carrier-mediated transport, while fructose requires facilitated transport and absorbs more efficiently when glucose is present in equal concentrations, as explained by the Pediatrics society 17
Sorbitol (in apple, pear, cherry juices) absorbs poorly via passive diffusion, creating osmotic load, as reported by the Pediatrics society 17

Juice consumption should occur as part of the low-FODMAP diet's three-phase approach: restriction (4-6 weeks), reintroduction (6-10 weeks), and personalization, as recommended by the Gastroenterology society 14
Individual tolerance should be assessed during the reintroduction phase by challenging with single juice types over 3 days while monitoring symptoms, according to the Gastroenterology society 14

Work with a registered dietitian with GI expertise when implementing juice restrictions as part of a low-FODMAP diet, as the approach can be complex, as suggested by the Gastroenterology society 14