Richard A. Feely, D.O. FAAO, FCA, FAAMA

There are many nutritional influences that trigger and maintain an irritable bowel. These nutritional influences can be of a general nature affecting many people with irritable bowel syndrome or they can be specific to the person.

The role of allergic food reactions in irritable bowel syndrome has been disputed. However, there is research that indicates that there is definitely an influence.

In a study of 375 adult patients with digestive problems it was found that 32% complained of adverse reactions to food as a cause of their abdominal symptoms. In 14.4%, the diagnosis of intestinal food allergy could be confirmed by laboratory testing. This suggests that allergic reactions to food may be a causative factor in irritable bowel syndrome. (1)

Researchers have also looked at elimination diets as a treatment of irritable bowel syndrome. The results of their study showed that symptoms related to irritable bowel syndrome (diarrhea type) improved in 60% of patients treated with the elimination diet. (2)

In another study, two hundred patients (156 women) with irritable bowel syndrome were treated with an elimination diet for three weeks. Of the 189 who completed the study, 91 (48.2%) showed symptomatic improvement. (3)

Dairy products are often identified as an important factor contributing to an irritable bowel. The effect of a lactose-free diet was studied on 230 patients with irritable bowel syndrome. Dairy intake problems were seen in 157 patients (68.2%).

There was a significant improvement in 48 (43.6%) of the 110 patients who complied with the diet. In 43 patients the symptoms were somewhat reduced and in 17 they remained unchanged. Those patients who did not comply with the diet did not show any improvement in symptoms. (4)

Increasing consumption of refined sugar has been implicated in many digestive disorders. A research study compared the effects of a diet containing 165 grams of refined sugar per day with a diet of only 60 grams per day.

In the high sugar diet, mouth-to-anus time was significantly prolonged indicating a tendency to produce constipation. Breath hydrogen tests showed significantly enhanced hydrogen production on the high sugar diet. High hydrogen production is an indication of malabsorption. (5)

Another study looked at the influence of fructose, sorbitol, and a fructose-sorbitol combination. Ingestion of fructose caused marked abdominal distress in patients. Sorbitol had the same effect. Ingestion of sucrose in these patients gave less pronounced symptoms of abdominal distress. Mixtures of of fructose and of sorbitol also caused significantly increased abdominal distress This study shows that pronounced gastrointestinal distress may be provoked by malabsorption of small amounts of fructose, sorbitol, and fructose-sorbitol mixtures in patients with functional bowel disease. (6)

Fat acts as major dietary stimulant for the colon. Patients with irritable bowel syndrome react excessively to a fatty meal increasing the frequency of watery stool. This relationship was more pronounced in patients who had diarrhea as a major symptom. On the other hand, patients who had constipation as the major complaint were found to be less reactive to a fatty meal. (7)

References:

1. Prevalence of adverse reactions to food in patients with gastrointestinal disease. Bischoff SC, Herrmann A, Manns MP. Allergy 1996 Nov;51(11):811-81

2. Oral cromolyn sodium in comparison with elimination diet in the irritable bowel syndrome, diarrheic type. Multicenter study of 428 patients. Stefanini GF, Saggioro A, Alvisi V, Angelini G, Capurso L, di Lorenzo G, Dobrilla G, Dodero M, Galimberti M, Gasbarrini G, et al. Scand J Gastroenterol 1995 Jun;30(6):535-541

3. Food intolerance and the irritable bowel syndrome. Nanda R, James R, Smith H, Dudley CR, Jewell DP. Gut 1989 Aug;30(8):1099-1104

4. Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet. Vernia P, Ricciardi MR, Frandina C, Bilotta T, Frieri G. Ital J Gastroenterol 1995 Apr;27(3):117-121

5. Effect of diets low and high in refined sugars on gut transit, bile acid metabolism, and bacterial fermentation. Kruis W, Forstmaier G, Scheurlen C, Stellaard F. Gut 1991 Apr;32(4):367-371

6. Functional bowel disease: malabsorption and abdominal distress after ingestion of fructose, sorbitol, and fructose-sorbitol mixtures. Rumessen JJ, Gudmand-Hoyer E. Gastroenterology 1988 Sep;95(3):694-700

7. Dysmotility of the small intestine in irritable bowel syndrome. Kellow JE, Phillips SF, Miller LJ, Zinsmeister AR. Gut 1988 Sep;29(9):1236-1243

Page modified on 5/15/2011