Irritable bowel syndrome and diet

Abstract

Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract and is one of the most commonly diagnosed gastrointestinal diseases. The impact of IBS on the general population is large due to its high prevalence, suboptimal medical treatments and significant economic burden. The pathophysiology of IBS is complex and treatments are often symptom-specific. The most common therapeutic approaches for IBS include education and reassurance, lifestyles (especially nutrition-based interventions), peripherally acting medications (which typically target motility), centrally acting medications (which target visceral hypersensitivity and pain) and psychological interventions (which aim to reduce the effects of stress or symptom-specific anxiety). A beneficial dietary approach might include the following measures: a diet low in fermentable oligo-,di- and monosaccharides and polyols (FODMAPs), limitation or exclusion of gas-producing foods and/or lactose and gluten and fiber supplementation in selected cases. New therapeutic agents, namely nutraceutics, are also an interesting option in the management of IBS patients. This paper will focus on available dietary interventions for IBS and will review the evidence for nutrition-based therapies.

Effects of Bifidobacterium longum BB536 and Lactobacillus rhamnosus HN001 in IBS patients

“…Thus, the production of beneficial short‐chain fatty acids (SCFAs) might contribute to responses of immune cells in diseases associated with alterations in populations of commensal bacteria (dysbiosis) . A better increased probiotic effect and an increased production of SCFA could be also achieved by reaching a dietary intake of foods containing appropriate soluble fibres.…”

“…36 Thus, the production of beneficial short-chain fatty acids (SCFAs) might contribute to responses of immune cells in diseases associated with alterations in populations of commensal bacteria (dysbiosis). 37 A better increased probiotic effect and an increased production of SCFA could be also achieved by reaching a dietary intake of foods containing appropriate soluble fibres. Consequently, a better probiotic effect and an increased production of short-chain fatty acids could be achieved by reaching a better balance of the diet with foods containing appropriate soluble fibres and with reduced intake of animal proteins.…”

Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis

“…[48][49][50][51] For irritable bowel syndrome, lactose is often among the main stressors causing symptoms, with consequences for management, and dietary changes including limited lactose consumption have shown benefits in several studies. 51,52 However, blinded studies have shown that most patients with lactose malabsorption can tolerate 12-18 g of lactose before experiencing symptoms. 53 With intake of exogenous lactase, and to some degree probiotics, lactose is generally better tolerated.…”

Medically unexplained syndromes: irritable bowel syndrome, fibromyalgia and chronic fatigue

“…Lactose, fructose, gluten and sucrose intolerance have also been considered and diets have recently been studied in small trials that exclude these substances (Portincasa 2017). The results of these trials are equivocal.…”