Irritable bowel syndrome

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Diet

There are a number of dietary changes a person with IBS can make to prevent the overreaction of the gastrocolic reflex and lessen pain, discomfort, and bowel dysfunction. Having soluble fiber foods and supplements, substituting soy or rice products for dairy, being careful with fresh fruits and vegetables that are high in insoluble fiber, and eating regular small amounts, can all help to lessen the symptoms of IBS. Foods and beverages to be avoided or minimized include red meat, oily or fatty and fried products, dairy (even when there is no lactose intolerance), solid chocolate, coffee (regular and decaffeinated), alcohol, carbonated beverages (especially those also containing sorbitol), and artificial sweeteners. However, care should be taken to avoid adding foods to the diet to which the patient is allergic or intolerant.[1]

Definitive determination of dietary issues can be accomplished by testing for the physiological effects of specific foods. The ELISA food allergy panel can identify specific foods to which a patient has a reaction. Other testing can determine if there are nutritional deficiencies secondary to diet that may also play a role. Removal of foods causing IgG immune response as measured using the ELISA food panel has been shown to substantially decrease symptoms of IBS in several studies.[2]

There is no evidence that digestion of food or absorption of nutrients is problematic for those with IBS at rates different from those without IBS. However, the very act of eating or drinking can provoke an overreaction of the gastrocolic response in some patients with IBS due to their heightened visceral sensitivity, and this can lead to abdominal pain, diarrhea, and/or constipation.[3]

Several of the most common dietary triggers are well-established by clinical studies at this point; research has shown that IBS patients are hypersensitive to fats and fructose. [4] [5]

It also appears that some foods are more difficult for the gut as evidenced by elevated food-specific IgG4 antibodies being present,[6] [7] while others increase colonic contractions, which may be painful, due to increased visceral sensitivity in IBS sufferers. [8]

Fiber

In patients who do not have diarrhea predominant irritable bowel, soluble fiber at does of 20 grams per day can reduce overall symptoms but will not reduce pain. The research supporting dietary fiber contains conflicting, small studies that are complicated by the the heterogeneity of types of fiber and doses used [9]. The one meta-analysis that controlled for solubility found that only soluble fiber improved global symptoms of irritable bowel and neither type of fiber reduced pain [9]. Positive studies have used 20-30 grams per day of psyllium seed (also called ispaghula husk)[10] [11]. One study specifically examined the effect of dose and found that 20 grams of ispaghula husk was better than 10 grams and equivalent to 30 grams per day [12]An uncontrolled study noted increased symptoms with insoluble fibers. [13] It is unclear if these symptoms are truly increased compared to a control group. If the symptoms are increased, it is unclear if these patients were diarrhea predominant (which can be exacerbated by fiber [14][15]), or if the increase is temporary before benefit occurs.

  1. ↑ Van Vorous, Heather. Eating for IBS. 2000. ISBN 1569246009. Excerpted with author's permission at Help for Irritable Bowel Syndrome (see IBS Diet Section)
  2. ↑ Atkinson W, Sheldon TA, Shaath N, Whorwell PJ (2004). "Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial". Gut 53 (10): 1459–64. PMID 15361495 Full text.
  3. ↑ Sjölund K, Ekman R, Lindgren S, Rehfeld J (1996). "Disturbed motilin and cholecystokinin release in the irritable bowel syndrome.". Scand J Gastroenterol 31 (11): 1110-4. PMID 8938905.
  4. ↑ Caldarella MP, Milano A, Laterza F, Sacco F, Balatsinou C, Lapenna D, Pierdomenico SD, Cuccurullo F, Neri M (2005). "Visceral sensitivity and symptoms in patients with constipation- or diarrhea-predominant irritable bowel syndrome (IBS): effect of a low-fat intraduodenal infusion". Am J Gastroenterol 100 (2): 383–9. PMID 15667496.
  5. ↑ Choi, Y. Fats, Fructose May Contribute to IBS Symptoms. ACG 68th Annual Scientific Meeting: Abstract 21, presented October 13, 2003; Abstract 547, presented October 14, 2003.
  6. ↑ Zar S, Benson MJ, Kumar D (2005). "Food-specific serum IgG4 and IgE titers to common food antigens in irritable bowel syndrome". Am J Gastroenterol 100 (7): 1550–7. PMID 15984980.
  7. ↑ Zar S, Mincher L, Benson MJ, Kumar D (2005). "Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome". Scand J Gastroenterol 40 (7): 800–7. PMID 16109655.
  8. ↑ Mayer EA, Berman S, Suyenobu B, Labus J, Mandelkern MA, Naliboff BD, Chang L (2005). "Differences in brain responses to visceral pain between patients with irritable bowel syndrome and ulcerative colitis". Pain 115 (3): 398–409. PMID 15911167.
  9. ↑ 9.0 9.1 Bijkerk C, Muris J, Knottnerus J, Hoes A, de Wit N (2004). "Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome.". Aliment Pharmacol Ther 19 (3): 245-51. PMID 14984370. Cite error: Invalid <ref> tag; name "pmid14984370" defined multiple times with different content
  10. ↑ Prior A, Whorwell P (1987). "Double blind study of ispaghula in irritable bowel syndrome.". Gut 28 (11): 1510-3. PMID 3322956.
  11. ↑ Jalihal A, Kurian G. "Ispaghula therapy in irritable bowel syndrome: improvement in overall well-being is related to reduction in bowel dissatisfaction.". J Gastroenterol Hepatol 5 (5): 507-13. PMID 2129822.
  12. ↑ Kumar A, Kumar N, Vij J, Sarin S, Anand B (1987). "Optimum dosage of ispaghula husk in patients with irritable bowel syndrome: correlation of symptom relief with whole gut transit time and stool weight.". Gut 28 (2): 150-5. PMID 3030900.
  13. ↑ Francis CY, Whorwell PJ (1994). "Bran and irritable bowel syndrome: time for reappraisal". Lancet 344 (8914): 39–40. PMID 7912305.
  14. ↑ Cann P, Read N, Holdsworth C, Barends D (1984). "Role of loperamide and placebo in management of irritable bowel syndrome (IBS).". Dig Dis Sci 29 (3): 239-47. PMID 6365490.
  15. ↑ Cann P, Read N, Holdsworth C (1984). "What is the benefit of coarse wheat bran in patients with irritable bowel syndrome?". Gut 25 (2): 168-73. PMID 6319244.
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