Dietary Renaissance in IBS: Has Food Replaced Medications as a Primary Treatment Strategy?

Abstract

The medical community has only recently started to focus attention on the role of food in the pathogenesis of irritable bowel syndrome (IBS), though the association between food and gastrointestinal (GI) symptoms has been recognized by patients for decades. Health care providers receive little formal training in the dietary management of IBS and have traditionally viewed dietary interventions with skepticism. There is mounting evidence that links food to changes in motility, visceral sensation, microbiome, permeability, immune activation, and brain-gut interactions-all key elements in the pathogenesis of IBS. The role of specific dietary modification in the management of IBS has not been rigorously investigated until recently. There is now credible evidence suggesting that targeted dietary carbohydrate exclusion provides clinical benefits to IBS patients. There is emerging evidence to suggest that proteins such as gluten, as well as food chemicals, may play a role in IBS.

The role of diet in irritable bowel syndrome: implications for dietary advice

“…These include primary effects, such as osmotic, chemical, mechanical, neuroendocrine, pro‐, pre‐ and postbiotic. Secondary effects suggested include fermentation by‐products, alterations in intraluminal pH and effects on the microbiome .…”

Predictors of response to a low‐FODMAP diet in patients with functional gastrointestinal disorders and lactose or fructose intolerance

“…Numerous publications have investigated the role of allergies and intolerances in FGID, with a wide range of conclusions . Recently, attention has focused on short‐chain fermentable oligo‐, di‐, monosaccharides and polyols (FODMAPs) as a potential cause of the symptoms characteristic of FGID, such as bloating, abdominal fullness and pain, altered stool patterns and consistency and nausea . Higher quality studies are demonstrating the effectiveness of reducing FODMAPs in patients with Irritable Bowel Syndrome (IBS), achieving adequate symptom relief in 60–80% of patients (for recent reviews, see).…”

Use of the Biphasic13C-Sucrose/Glucose Breath Test to Assess Sucrose Maldigestion in Adults with Functional Bowel Disorders

“…This is considered since isomaltase is concurrently expressed with sucrase (same gene product 3q25.2-q26.2) and because starch is the major dietary staple that is difficult to limit. A careful history identifying a link between GI symptoms and starchy food intake, in addition to sucrose intake, should be helpful in predicting the contribution of dietary intolerances to recurrent GI symptomatology [69]. Like sucrose, for adults suffering from carbohydrate malabsorption, a low fermentable diet might be considered in therapeutic planning since maldigestion may promote colonic proliferation of saccharolytic taxa [70].…”