Diet for irritable bowel syndrome patients in Jordan

Dietary care in irritable bowel syndrome is a staged plan managed by a dietitian together with the doctor to reduce bloating, pain and disturbed bowel habit. It is not a permanent list of banned foods. IBS is a functional disorder: the bowel works and no visible damage is found at endoscopy, but its sensitivity and motility are disturbed. The diagnosis is clinical, based on the pattern and duration of symptoms once conditions that mimic it have been excluded, such as coeliac disease, inflammatory bowel disease, thyroid disorders and lactose intolerance. For that reason the service starts with a clear diagnosis rather than with a self-chosen diet. The plan is built around the dominant symptom pattern in this particular patient: diarrhoea, constipation or alternation between them, the severity and timing of bloating, the eating history, medicines, anxiety and sleep, weight and its trend, and whatever tests the doctor requested. In practice work begins with the basics, which are often enough on their own: regular meal times, eating slowly and calmly, moderating caffeine, fizzy drinks, fried fat and sweeteners, and adjusting the type of fibre according to the dominant pattern, because not all fibre helps everyone and some kinds increase bloating. If the basics are not enough, a structured trial of reduced fermentable carbohydrates, widely known as a low-FODMAP approach, is run in phases, and this is where the common danger lies. **The restriction phase is temporary and limited, and structured reintroduction is a compulsory part of the treatment.** Staying on broad restriction for months without supervision impoverishes the diet, harms muscle mass and the beneficial gut flora, and makes social life harder than the symptoms were. That is why no food lists or portions are published here: the approach is managed by a dietitian who knows how to bring a patient out of it, not only how to start it. The limits must be stated: **diet does not cure irritable bowel syndrome**. It reduces symptoms in many people, does not help everyone to the same degree, does not replace the doctor's treatment, and does not address the accompanying anxiety or stress, which needs its own approach. Be wary too of severe elimination diets adopted without supervision, of commercial food-sensitivity blood tests sold to identify forbidden foods, which are not an accepted way to diagnose food intolerance, of colon-cleansing mixtures and herbal products of unknown origin, of fat-burner supplements, and of slimming injections promoted without diagnosis, some of which worsen bowel symptoms in the first place. Ketogenic eating or prolonged fasting without supervision can deepen constipation and narrow the diet further, and in diabetes or kidney disease it is a medical decision. Whether any phase of the plan is appropriate and how long it should last are decided by clinical assessment and laboratory results, not by reading a page. Dietitian and gastroenterologist work together, and the plan is reviewed whenever symptoms change or a warning sign appears that calls for fresh investigation.