Psychological and Gastrointestinal Symptoms of Patients with Irritable Bowel Syndrome Undergoing a Low-FODMAP Diet: The Role of the Intestinal Barrier

Abstract

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (LFD) improves both gastrointestinal (GI) symptoms and the psychological profile of patients with irritable bowel syndrome with diarrhea (IBS-D). The effects of 12 weeks of LFD on GI symptom and psychological profiles in relation to inflammation and the involvement of the intestinal barrier were studied in twenty IBS-D patients. The IBS Severity Scoring System, the Symptom Checklist-90-Revised, the Italian version of the 36-Item Short-Form Health Survey, the IBS-Quality of Life (QoL) questionnaire, and the Psychophysiological questionnaire were administered. The GI barrier function was assessed by sugar absorption test, the serum and fecal zonulin levels, and the serum levels of intestinal fatty-acid binding protein and diamine oxidase. Interleukins (ILs) and lipopolysaccharide (LPS) serum levels were evaluated along with dysbiosis. At the end of LFD, GI symptoms, psychological state (mainly anxiety, somatization, psychoticism, and interpersonal sensitivity), and QoL significantly improved in these patients. Simultaneously, an improvement in small intestinal permeability and intestinal mucosal integrity occurred, while IL-6, Il-10, LPS, and fermentative dysbiosis significantly decreased. The LFD can modify the immune-inflammatory features and enhance intestinal permeability and mucosal integrity, thus determining a concurrent improvement in the clinical and psychological conditions.

Psychological Considerations in the Dietary Management of Patients With DGBI

“…For example, gluten-free and lactose-free diets are commonly recommended for patients with irritable bowel syndrome (IBS) ( 2 ), despite limited understanding of the role these foods play in the pathogenesis or maintenance of DGBI symptoms, especially over the long term. The low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet may have a stronger scientific premise in DGBI (specifically for IBS) ( 3 – 5 ) but without properly designed meal planning, and a plan for food reintroduction could be harmful over the long term ( 6 , 7 ). Several “popular diets” have also been adopted by patients with DGBI that involve significant food restriction with little or no scientific justification and could worsen symptoms (e.g., excess fructose consumption in the Whole 30 diet) or other health outcomes (e.g., higher saturated fat intake in “the Plant Paradox” diet) ( 8 , 9 ).…”

Effects of visual aid on state anxiety, fear and stress level in patients undergoing endoscopy: a randomized controlled trial

“…females reported more concern about endoscopy procedure as compared to men [ 22 ]. There was association between stress and GI diseases [ 23 ]. During this study, experience and seniority level of endoscopist was considered and it was established that patients’ stress and anxiety scores had a relation with the seniority of the endoscopist as evidenced in other studies [ 24 ].…”

Poria cocos polysaccharide prevents alcohol-induced hepatic injury and inflammation by repressing oxidative stress and gut leakiness

“…As we mentioned, leaky intestinal-derived LPS acts as a “second strike” to exacerbate hepatic steatosis and activate Kupffer to induce inflammation ( 9 ). DAO is a highly active intracellular enzyme in the upper villi of the human and mammalian small intestinal mucosa that reflects the integrity and degree of damage of the intestinal mechanical barrier ( 37 ). Simultaneously, D-LA is a product of intrinsic bacteria in the gastrointestinal tract that reflect changes in intestinal mucosal permeability ( 38 , 39 ).…”