-IBIS-1.7.6-
tx
digestive system
irritable bowel syndrome
Nutrition
dietary guidelines
eating principles:
elimination/rotation diet, rotation diet, rotation diet expanded
(Parker TJ, et al. J Human Nutr Diet. 1995;8:159-166.)
correct nutrient deficiencies
provide adequate calories
be careful with food combinations: especially avoid starch, sugar, protein combinations (for example, cheesecake). Avoid eating too many types of foods at one time. Stick to one type of starch per meal. Eat more steamed vegetables than raw ones. See General Guidelines for Eating
short (3-5 day) fasts are recommended as are an alkaline juice fast (see Fasting in materia medica)
high complex carbohydrate, high fiber diet
all foods must be eaten slowly, chewed and salivated well; eat in a calm atmosphere, do not read or watch television while eating
sample diet
» acute phase (1-3 weeks)
breakfast: whole brown rice cereal (cook 3-4 tbsp. rice flour with 2 cups water, stirring constantly over heat), 2 tsp. olive or corn oil
morning snack: raw grated apple or applesauce or baked apples (sour or semi-sour only)
lunch: vegetable soup from celery, parsley, zucchini, squash, pumpkin, carrot, potatoes (blended and strained), steamed carrots and squash, rice or millet or barley or potato, 2 tsp. olive or corn oil
afternoon snack: same as morning
dinner: same as lunch
» as improvement occurs:
breakfast: oatmeal 3 times per week; add soft boiled egg during one meal 3 times per week
snacks: add almonds (raw and blanched) with apples
lunch and dinner: if no intolerance to dairy, add yogurt (preferably goat), green beans, waxed beans, lettuce, cucumber, green onion, parsley, celery, garlic, lentils, peaches, apricots, watermelon, grapefruit, grapes, ripe bananas, goat whey
supplements: liquid chlorophyll, alfalfa tabs, chlorella, calming herb teas: lemon balm, chamomile, fennel, peppermint
» after stabilization:
Vegetarian Sample Diet
cruciferous vegetables to be eaten only with carminatives (fennel, caraway, cumin, anise, dill)
therapeutic foods:
foods that calm the Shen (Spirit), harmonize the Stomach and Spleen
potato broth, cooked carrots, okra, steamed and mashed parsnips, squash, pumpkin, figs and flax seed tea, steamed zucchini and squash, papaya, grated raw apple, applesauce, ripe peaches without skin, banana (not in Cold conditions), rice porridge (Shefi)
miso soup, slippery elm gruel, psyllium seed powder, flax seed powder (Marz)
foods high in the omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, cold water fish, evening primrose oil, black currant oil, flaxseed oil (Marz)
foods high in water-soluble fiber: Fiber may help some individuals with irritable bowel symptoms; psyllium seed husks, barley, rye, flax seed, pectin, guar gum, oat bran, legumes, brown rice, and vegetables are fiber sources that are most likely to provide benefit and less likely to provide sensitivity reactions. Wheat bran is usually not effective in reducing irritation and inflammation and in many cases may exacerbate the situation.
(Manning AP, et al. Lancet 1977;ii:417-418; Cann PA, et al Gut 1984;25:168-173; Arffmann S, et al. Scand J Gastroenterol 1985;20:295-298; Soloft J, et al. Lancet 1976;i:270-273; Lucey MR, et al. Gut 1987;28:221-225; Francis CY, et al. Lancet 1994;344:39-40; Hotz J, Plein K. Med Klin 1994;89:645-651; Gaby AR. Nutrition and Healing 1996;Feb:1,10-11.)
fresh juices:
carrot (Walker, 132.)
carrot and apple
carrot and spinach (Walker, 132.)
carrot, beet, and cucumber (Walker, 132.)
papaya (Jensen, 61; Airola, 63.)
raw cabbage (Airola, 63.)
celery juice and apple (Shefi)
specific remedies:
pour boiling water over 15 g dried powdered apple and serve twice daily.. (Yin-fang and Cheng-jun, 45.)
foods contraindicated:
artichoke, grapeskins and seeds, food sensitivities
avoid:
food intolerances: while true food allergies may be less common than sometimes claimed, the presence of food sensitivities or intolerances among individuals with irritable bowel symptoms appears to be significant when demonstarted by symptom reduction upon removal of the food in question from the diet; some researchers believe that aggravations due to food reactions are more likely ot occur when at least 3.5 ounces of the offending food is eaten on a daily basis.
(Alun Jones V, et al. Lancet 1982;ii:1115-1117; Alun Jones V, et al. Lancet 1983; ii:633-634; Birtwistle S. Lancet 1983; II:634; Smith MA, et al. Lancet 1985;ii:1064; Parker TJ, et al. J Human Nutr Diet 1995;8:159-166; King TS, et al. Lancet 1998;352:1187-1189.)
wheat, corn and dairy, carrageenan-containing foods are among the most common symptom-provoking foods
(Moyana T, Lalonde JM. Ann Clin Lab Sci. 1991 Jul-Aug;21(4):258-263; Bohmer CJ, Tuynman HA. Eur J Gastroenterol Hepatol 1996 Oct;8(10):1013-1016; Francis CY, Whorwell PJ. Lancet 1994;344:39-40; Niec AM, et al. Am J Gastroenterol 1998;93:2184-2190.)
peanuts, meat, sugar and sweet food, refined and processed foods, corn, soybeans, most legumes, coffee, caffeine, oranges alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods
supplements
Vitamin A 50,000 IU per day.
Vitamin E 400 IU per day.
Vitamin C buffered 3 g per day.
Folic acid 40-60 mg per day. (with diarrhea) (Carruthers, 1946, 394ff)
Zinc 60 mg per day.
Alfalfa tabs
Chlorella
Evening Primrose oil: anti-inflammatory action
(Cotterell CJ, et al 1990, 421-426.)
Flaxseed oil 2 Tbsp per day.
Peppermint oil 3-6 caps (0.2 ml/cap) per day. (Dew MJ, et al. Br J Clin Pract 1984 Nov-Dec;38(11-12):394, 398.; Rees WD, et al. Br Med J 1979;2(6194):835-836; Leicester RJ, Hunt RH. Lancet 1982;ii:989; Rogers J, et al. Lancet 1988;ii:98-99; Liu JH, et al. J Gastroenterol. 1997 Dec;32(6):765-768; May B, et al. Arzneimittelforschung. 1996 Dec;46(12):1149-1153.)
liquid chlorophyll
footnotes
Alun Jones V, McLaughlan P, Shorthouse M, Workman E, Hunter JO. Food intolerance: A major factor in the pathogenesis of irritable bowel syndrome. Lancet 1982 Nov 20;2(8308):1115-1117.
Abstract: Specific foods were found to provoke symptoms of irritable bowel syndrome (IBS) in 14 of 21 patients. In 6 patients who were challenged double blind the food intolerance was confirmed. No difference was detected in changes in plasma glucose, histamine, immune complexes, haematocrit, eosinophil count, or breath hydrogen excretion produced after challenge or control foods. Rectal prostaglandin E2 (PGE2), however, increased significantly, and in a further 5 patients rectal PGE2 correlated with wet faecal weight. Food intolerance associated with prostaglandin production is an important factor in the pathogenesis of IBS.
Alun Jones V, Shorthouse M, Workman E, Hunter JO. Food intolerance and the irritable bowel. Lancet 1983; ii:633-34. (Letter)
Arffmann S, Andersen JR, Hegnhoj J, et al. The effect of coarse wheat bran in the irritable bowel syndrome. A double-blind cross-over study. Scand J Gastroenterol 1985;20:295-298.
Ayres RC, Robertson DA, Naylor K, Smith CL. Stress and oesophageal motility in normal subjects and patients with irritable bowel syndrome. Gut. 1989 Nov;30(11):1540-1543.
Abstract: Patterns of oesophageal motility were recorded in 17 healthy volunteers and 12 patients with the irritable bowel syndrome. Recordings were taken at rest and under stress by hyperventilation, a dichotic hearing challenge and a cold pressor test. In healthy volunteers the dichotic hearing challenge was associated with a significant increase in the mean amplitude of oesophageal peristalsis from 69.9 mmHg to 82.4 mmHg (p less than 0.01) and in the percentage of simultaneous waves from 9.7% to 24.5% (p less than 0.01). The cold pressor test increased the peristaltic amplitude from 69.9 mmHg to 87.1 mmHg (p less than 0.001) and the percentage of simultaneous waves from 9.7% to 34.4% (p less than 0.01). Both manoeuvres were associated with increases in pulse and blood pressure. In patients with irritable bowel syndrome, the resting mean oesophageal peristaltic amplitude was higher than that seen in normal volunteers (95.9 mmHg v 69.9 mmHg p less than 0.05). Changes in oesophageal motility during stress were similar in these patients to those seen in normal subjects although the changes were not significant. This study refutes the hypothesis that symptoms of irritable bowel syndrome and their association with stress are attributable to increased sensitivity of oesophageal motility to disruption by stressful stimuli.
Bentley SJ, Pearson DJ, Rix KJ. Food hypersensitivity in irritable bowel syndrome. Lancet 1983 Aug 6;2(8345):295-297.
Abstract: Food hypersensitivity as a cause of abdominal symptoms was investigated by means of exclusion diets and double-blind food provocation in patients with irritable bowel syndrome. Twenty-seven patients entered the study; nineteen complied with dietary manipulation. Food hypersensitivity as a cause of their presenting symptoms was confirmed by double-blind food provocation in only three patients, who also had evidence of associated atopic disease and positive skin tests to common inhalant allergens. Evidence of minor psychiatric disorder was found in twelve of fourteen patients examined by an independent psychiatrist.
Bohmer CJ, Tuynman HA. The clinical relevance of lactose malabsorption in irritable bowel syndrome. Eur J Gastroenterol Hepatol 1996 Oct;8(10):1013-1016.
Abstract: OBJECTIVE: The prevalence of lactose malabsorption (LM) in the Caucasian population of northern Europe is estimated to be low. Irritable bowel syndrome (IBS) is a very common diagnosis, and its symptoms are nearly identical to those of LM. Therefore we investigated the prevalence of LM among IBS patients in comparison with healthy volunteers. DESIGN: A double-blind clinical trial compared with healthy controls. SETTING: One out-patient gastroenterology clinic in the Netherlands. PATIENTS: 70 Caucasian IBS patients and 35 healthy volunteers (staff members). METHODS: All 105 underwent hydrogen (H2) breath and blood glucose tests, after an oral intake of 50 grams of lactose. The IBS patients were treated with a lactose-restricted diet for 6 weeks. They completed a lactose intake score before, and a symptom score scored by six separate criteria, before, during and after treatment. RESULTS: In 17 out of 70 (24.3%) IBS patients LM was detected, in comparison with 2 out of 35 (5.7%) controls (P < 0.009). There was no difference in the pre-entry mean lactose intake and symptom score between the LM positive and negative IBS patients. The mean symptom score of the LM positive group showed a marked decrease after 6 weeks of dietary therapy (P < 0.001). CONCLUSION: A substantial number of IBS patients showed a clinically unrecognized lactose malabsorption, which could not be discriminated by symptoms and dietary history, and which can be treated with a lactose-restricted diet. Therefore LM has to be excluded before the diagnosis IBS is made.
Cotterell CJ, Lee AJ, Hunter JO. Double-blind cross-over trial of evening primrose oil in women with menstrually-related irritable bowel syndrome. In: Omega-6 Essential Fatty Acids: Pathophysiology and roles in clinical medicine, Alan R Liss, New York, 1990, 421-426.
Dew MJ, Evans BK, Rhodes J. Peppermint oil for the irritable bowel syndrome: A multi-center trial. Br J Clin Pract 1984 Nov-Dec;38(11-12):394, 398.
Farah DA, Calder I, Benson L, Mackenzie JF. Specific food intolerance: its place as a cause of gastrointestinal symptoms. Gut 1985 Feb;26(2):164-168.
Abstract: Thirteen out of 49 patients suspected of having specific food intolerance after withdrawal and reintroduction of specific foods, were further subjected to double blind placebo controlled food challenges. Only three of these subjects were thus shown to have proven specific food intolerance. Of the remaining 10, nine were strong 'placebo reactors'. The study suggests that a small number of patients with gastrointestinal symptoms have verifiable specific food intolerance but that a greater number have symptoms attributable to psychogenic causes.
Fernandez-Banares F, Esteve-Pardo M, de Leon R, Humbert P, Cabre E, Llovet JM, Gassull MA. Sugar malabsorption in functional bowel disease: clinical implications. Am J Gastroenterol. 1993 Dec;88(12):2044-2050.
Abstract: OBJECTIVE: To investigate the relationship of sugar malabsorption to the development of clinical symptoms in functional bowel disease. METHODS: Twenty-five consecutive outpatients [five men, 20 women; mean age 38.7 +/- 2.6 (SEM) yr] with functional bowel disease and symptoms suggestive of carbohydrate malabsorption were studied. Twelve healthy subjects [six men, six women; mean age 35.7 +/- 3.7 (SEM) yr] acted as the control group. Sugar malabsorption was assessed by breath-hydrogen test after an oral load of various solutions containing lactose (50 g), fructose (25 g), sorbitol (5 g), fructose plus sorbitol (25 + 5 g), and sucrose (50 g). The severity of symptoms developing after sugar challenge was studied. In addition, the effect on clinical symptoms of a diet free of the offending sugars, compared to a low-fat diet, was assessed. RESULTS: Frequency of sugar malabsorption was high in both patients and controls, with malabsorption of at least one sugar in more than 90% of the subjects. Median symptom scores after both lactose [median 6; interquartile (IQ) range 3-7] and fructose plus sorbitol (median 2; IQ range 0-4) malabsorption were significantly higher than after sucrose load (median 1; IQ range 0-1.5) in functional bowel disease patients (p = 0.001 and p = 0.007, respectively). However, there were no differences in healthy controls. In addition, symptoms score after both lactose and fructose plus sorbitol malabsorption was significantly higher in patients than in control subjects (p = 0.02 and p = 0.008, respectively). On the other hand, H2 production capacity, as measured following lactulose load, was significantly higher in patients than in controls. The clinical symptoms improved in 40% of the evaluated patients after restriction of the offending sugars. CONCLUSIONS: These results suggest that sugar malabsorption may be implicated in the development of abdominal distress in at least a subset of patients with functional bowel disease.
Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet 1994;344:39-40.
Hotz J, Plein K. [Effectiveness of plantago seed husks in comparison with wheat bran no stool frequency and manifestations of irritable colon syndrome with constipation.] Med Klin 1994 Dec 15;89(12):645-651. [Article in German]
Abstract: BACKGROUND AND AIM: The importance of dietary fibres in treatment of irritable bowel syndrome increased during the last years. Yet the results of clinical studies on the different dietary fibres are not consistent. Therefore we decided to perform a controlled trial with a well defined group of patients to compare the effectiveness of wheat bran to psyllium seeds. PATIENTS AND METHODS: Thirty patients each with irritable bowel syndrome group II to III were treated in an open, not controlled study design either with 3 times 3.25 g psyllium seeds or 3 times 7 g wheat bran daily. All patients entering the study had not been treated for at least 3 weeks before. The study comprised two treatment phases of two weeks each, separated by two weeks without any treatment, thus leading to a study duration of 6 weeks altogether. Parameters for evaluation were stool frequency and consistency and the symptoms pain and abdominal distention, measured by a score (1 to 4). RESULTS: In both treatments groups stool frequency and consistency improved apparently compared to the starting point or the two weeks treatment free time in between. The improvement of stool frequency was statistically significant (p < 0.0001) for both substances. Furthermore the effect of psyllium seeds exceeded that of wheat bran statistically significant in week 1, 2, 3, 5 and 6 (p < 0.005). Other symptoms such as abdominal pain improved too by therapy, psyllium seeds again tending to show better results. A significant difference between both substances could be observed on the symptom abdominal distension. Whereas abdominal distension decreased under treatment with psyllium seeds it increased with wheat brain. This lead to discontinuation of the study in 5 cases, 3 of which could be changed successfully to psyllium seeds. The difference between psyllium seeds and wheat bran concerning the occurrence of abdominal distension was statistically significant (p < 0.01). CONCLUSION: The results of this study demonstrate the effectiveness of psyllium seeds and wheat bran on stool frequency and consistency of patients with irritable bowel syndrome. Psyllium seeds showed to be superior to wheat brain with respect to stool frequency and abdominal distension so that it should be preferred in treatment of irritable bowel syndrome and constipation.
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 1990 Sep-Oct;5(5):507-513.
Abstract: This placebo controlled, double-blind, cross-over trial involving 20 patients was conducted to assess the effect of ispaghula husk on the major bowel symptoms and the whole gut transit time in irritable bowel syndrome (IBS) and to determine if changes in these parameters were related to global improvement. All 20 patients were interviewed at the end of the treatment periods and 14 patients kept concurrent daily records. Ispaghula therapy resulted in improvement in global symptoms and satisfying bowel movements (P less than 0.001) but produced no change in abdominal pain or flatulence. There was a correlation between the improvement of well-being and the number of days of satisfying bowel movements (P less than 0.001) but not with the indexes of pain, stool frequency or changes in the transit time. The easing of bowel dissatisfaction appears to be a major reason for the therapeutic success of ispaghula in IBS.
King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet 1998 Oct 10;352(9135):1187-1189.
Abstract: BACKGROUND: The cause of irritable bowel syndrome (IBS) is unknown. It may follow gastroenteritis and be associated with an abnormal gut flora and with food intolerance. Our study was designed to assess whether these factors were associated with colonic malfermentation. METHODS: We carried out a crossover controlled trial of a standard diet and an exclusion diet matched for macronutrients in six female IBS patients and six female controls. During the final 72 h on each diet, faecal excretion of fat, nitrogen, starch, and non-starch polysaccharide NSP was measured, and total excretion of hydrogen and methane collected over 24 h in a purpose-built 1.4 m3 whole-body calorimeter. Breath hydrogen and methane excretion were then measured for 3 h after 20 g oral lactulose. FINDINGS: The maximum rate of gas excretion was significantly greater in patients than in controls (2.4 mL/min IQR 1.7-2.6 vs 0.6, 0.4-1.1). Although total gas production in patients was not greater than in controls (median 527 mL/24 h IQR 387-660 vs 412, 234-507), hydrogen production was higher (332, 318-478 vs 162, 126-217, p=0.009). In patients, the exclusion diet reduced symptoms and produced a fall in maximum gas excretion (0.5 mL/min IQR 0.3-0.7). After lactulose, breath hydrogen was greater on the standard than on the exclusion diet. INTERPRETATION: Colonic-gas production, particularly of hydrogen, is greater in patients with IBS than in controls, and both symptoms and gas production are reduced by an exclusion diet. This reduction may be associated with alterations in the activity of hydrogen-consuming bacteria. Fermentation may be an important factor in the pathogenesis of IBS.
Leicester RJ, Hunt RH. Peppermint oil to reduce colonic spasm during endoscopy. Lancet 1982;ii:989. (Letter)
Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol. 1997 Dec;32(6):765-768.
Abstract: To determine the efficacy and tolerability of an enteric-coated peppermint-oil formulation (Colpermin), we conducted a prospective, randomized, double-blind, placebo-controlled clinical study in 110 outpatients (66 men/44 women; 18-70 years of age) with symptoms of irritable bowel syndrome. Patients took one capsule (Colpermin or placebo) three to four times daily, 15-30 min before meals, for 1 month. Fifty-two patients on Colpermin and 49 on placebo completed the study. Forty-one patients on Colpermin (79%) experienced an alleviation of the severity of abdominal pain (29 were pain-free); 43 (83%) had less abdominal distension, 43 (83%) had reduced stool frequency, 38 (73%) had fewer borborygmi, and 41 (79%) less flatulence. Corresponding figures for the placebo group were: 21 patients (43%) with reduced pain (4 were pain-free), 14 (29%) with reduced distension, 16 (32%) with reduced stool frequency, 15 (31%) with fewer borborygmi, and 11 (22%) with less flatulence. Symptom improvements after Colpermin were significantly better than after placebo (P < 0.05; Mann-Whitney U-test). One patient on Colpermin experienced heartburn (because of chewing the capsules) and one developed a mild transient skin rash. There were no significant changes in liver function test results. Thus, in this trial, Colpermin was effective and well tolerated.
Manning AP, Heaton KW, Harvey RF, Uglow P. Wheat fibre and irritable bowel syndrome. Lancet 1977;ii:417-418.
May B, Kuntz HD, Kieser M, Kohler S. Efficacy of a fixed peppermint/caraway oil combination in non-ulcer dyspepsia. Arzneimittelforschung. 1996 Dec;46(12):1149-1153.
Abstract: The efficacy and safety of the standardized herbal combination preparation of Enteroplant, consisting of peppermint oil (90 mg) and caraway (50 mg) in an enteric coated capsule, have been studied in a double-blind, placebo-controlled multicentre trial in patients with non-ulcer dyspepsia. A total of 45 patients were included in the trial after thorough physical and gastro-enterological examination. The primary outcome variables were the change in the intensity of pain and the global clinical impression (Clinical Global Impression [CGI], Item 2), which were evaluated for 39 patients (test preparation: 19, placebo: 20). After four weeks of treatment both target parameters were significantly improved for the group of patients treated with the peppermint oil/caraway oil combination compared to the placebo group (p = 0.015 and 0.008, respectively). Before the start of treatment all patients in the test preparation group reported moderate to severe pain, while by the end of the study 63.2% of these patients were free of pain. The pain symptoms had improved in a total of 89.5% of the patients in the active treatment group. After 4 weeks the Clinical Global Impressions were improved for 94.5% of the patients treated with the peppermint oil/caraway oil combination. The trial medication was also superior to placebo with respect to pain frequency, medical prognosis, the severity of the disorder and the efficacy index (CGI, Items 1 and 3), which were adopted as secondary end-points for evaluation of efficacy. There were similarly favourable findings for the herbal combination, compared with placebo, with respect to the reduction of other gastrointestinal symptoms. The combination preparation was found to be excellently tolerated. There was a total of 7 adverse events (test preparation: 4, placebo: 3), with a causal association with the treatment being ascribed in one case for the test preparation group and one case for the placebo group.
McKee AM, Prior A, Whorwell PJ. Exclusion diets in irritable bowel syndrome: are they worthwhile? J Clin Gastroenterol 1987 Oct;9(5):526-528.
Abstract: Forty patients with irritable bowel syndrome received an antigen-exclusion diet identical to that previously reported to be highly effective in this condition. Only 15% of the group as a whole showed evidence of food intolerance manifested by an improvement in their irritable bowel symptoms. In a further 12.5% only well-being improved and this did not seem to be related to the exclusion of any particular food. Patients whose bowel dysfunction was characterized by diarrhea responded the best (3/8) whereas those with constipation consistently failed to improve.
Moyana T, Lalonde JM. Carrageenan-induced intestinal injury: possible role of oxygen free radicals. Ann Clin Lab Sci. 1991 Jul-Aug;21(4):258-263.
Nash P, Gould SR, Barnardo DE. Peppermint oil does not relieve the pain of irritable bowel syndrome. Br J Clin Pract 1986;40:292-293.
Niec AM, Frankum B, Talley NJ. Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol 1998 Nov;93(11):2184-2190. (Review)
Abstract: OBJECTIVE: We undertook to determine whether adverse food reactions play a role in irritable bowel syndrome (IBS). METHODS: A systematic review of the literature using Medline (1980-1996), targeting IBS and adverse food reactions, was performed. All clinical trials whereby dietary exclusion was followed by food challenge were selected. Each study was reviewed using a structured format to examine methodological issues and study outcomes. RESULTS: Of the seven studies included, the positive response to an elimination diet ranged from 15% to 71%; double-blind placebo-controlled challenges identified problem foods in 6% to 58% of cases. Milk, wheat, and eggs were most frequently identified to cause symptom exacerbation; of the foods identified the most common trait was a high salicylate content. Foods high in amines were also identified. Studies of diarrhea-predominant IBS identified a higher percentage of adverse food reactions. However, all studies had major limitations in their trial designs, including inadequate patient selection, appropriateness of--and duration of--exclusion diets, and methods of food challenge. CONCLUSION: Whether adverse reactions to foods are a key factor in exacerbating IBS symptoms or whether dietary manipulation is a valid treatment option is unclear. Carefully designed controlled clinical trials are now needed to specifically test the potential role of adverse food reactions in diarrhea-predominant IBS.
Paganelli R, Fagiolo U, Cancian M, Sturniolo GC, Scala E, D'Offizi GP. Intestinal permeability in irritable bowel syndrome. Effect of diet and sodium cromoglycate administration. Ann Allergy 1990 Apr;64(4):377-380.
Abstract: We studied 14 patients with irritable bowel syndrome for the presence of increased intestinal permeability to food antigens and their responses to diet with and without disodium cromoglycate. After a standardized oral challenge with cow milk, serum beta-lactoglobulin was increased above control values in three patients. This finding did not correlate with response to hypoallergenic diet or treatment with disodium cromoglycate for 3 weeks. However over 50% of patients improved after diet with and without DSCG (2/5 on diet only and 5/7 with disodium cromoglycate of 12 evaluable cases). Since only two patients had elevated serum IgE levels, our results suggest that intolerance rather than hypersensitivity to foods may play a role in the disease. The tests we used to identify immunologic mechanisms could not predict which patients would do better on the diet and/or the drug.
Parker TJ, Naylor SJ, Riordan AM, Hunter JO. Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet. J Human Nutr Diet 1995;8:159-166.
Pearson DJ, Bentley SJ, Rix KJ, Roberts C. Food hypersensitivity and irritable bowel syndrome. Lancet. 1983 Sep 24;2(8352):746-747.
Prior A, Whorwell PJ. Double blind study of ispaghula irritable vowel syndrome. Gut 1987;11:1510-1513.
Rees WD, Evans BK, Rhodes J. Treating irritable bowel syndrome with peppermint oil. Br Med J 1979;2(6194):835-836.
Rogers J, Tay HH, Misiewicz JJ. Peppermint oil. Lancet 1988;ii:98-99. (Letter)
Smith MA, Youngs GR, Finn R. Food intolerance, atopy, and irritable bowel syndrome. Lancet 1985;ii:1064. (Letter)
Soltoft J, Krag B, Gudmand-Hoyer E, Kristensen E, Wulff HR. A double-blind trial of the effect of wheat bran on symptoms of irritable bowel syndrome. Lancet 1976 Feb 7;1(7954):270-272.
Abstract: 59 outpatients with irritable bowel syndrome participated in a randomised double-blind trial. The patients in the treatment group received three biscuits daily each containing 10 g of ordinary miller's bran, whereas the patients in the control group received wheat biscuits of a similar appearance. The treatment period was 6 weeks. 52% of the patients in the treatment group noted subjective improvement compared with 65% in the control group. The results of this trial do not support the routine use of miller's bran in irritable bowel syndrome.