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Role of Alimentation in Irritable Bowel Syndrome

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Abstract

Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between alimentation, food items (including fibers) and IBS symptoms. Food allergy remains a difficult diagnosis, but medical and general history, presence of general symptoms such as skin rash, and hypersensitivity tests may help in achieving a positive diagnosis. On the other hand, food intolerance is more confusing because of the subjectivity of the relationship between ingestion of certain foods and the appearance of clinical symptoms. Different food items which are commonly implicated in adverse reactions mimicking IBS were found to be stimulants for the gut, suggesting that patients with predominant diarrhea IBS have to be carefully questioned about consumption of different kinds of food (i.e., coffee, alcohol, chewing gum, soft drinks) and not only on lactose ingestion. Gas production is discussed on the basis of retention of intestinal gas as well as on malabsorption of fermentable substrates. The role of a large amount of this kind of substrate reaching the colon is suggested as a potential mechanism of IBS-type symptoms in overeating patients. Regarding the role of fiber in IBS, the expert group concluded that fibers are not inert substances and that they could trigger pain or bloating in some IBS patients. Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dieteticians may have a positive role in managing such patients.
... Diet seems to play a pivotal role in IBS patients and 84% of them reported that their symptoms were linked to the foods they ingested [84][85][86], particularly fermentable carbohydrates and fats [86]. Moreover, some patients try to modify autonomously their usual diet by excluding some categories of foods that cause symptoms, thus leading to nutritional and energetic deficiencies [87,88]. Different foods could be responsible of several effects such as osmotic, chemical, mechanical and neuroendocrine effects but also of fermentation and of an alteration in the intraluminal pH and microbiome [89]. ...
... To date, an "ideal diet" for IBS subjects has not yet been identified, so clinical practitioners usually suggest general advice such as [88,90,94]: ...
... Especially for IBS-D patients it is important to control the assumption of fructose and sorbitol, coffee (independently of caffeine content) and alcohol [88] and they should avoid aloe vera (for its laxative properties), acupuncture and reflexology [90]. ...
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Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by abdominal pain associated with defecation or a change in bowel habits. Gut microbiota, which acts as a real organ with well-defined functions, is in a mutualistic relationship with the host, harvesting additional energy and nutrients from the diet and protecting the host from pathogens; specific alterations in its composition seem to play a crucial role in IBS pathophysiology. It is well known that diet can significantly modulate the intestinal microbiota profile but it is less known how different nutritional approach effective in IBS patients, such as the low-FODMAP diet, could be responsible of intestinal microbiota changes, thus influencing the presence of gastrointestinal (GI) symptoms. The aim of this review was to explore the effects of different nutritional protocols (e.g., traditional nutritional advice, low-FODMAP diet, gluten-free diet, etc.) on IBS-D symptoms and on intestinal microbiota variations in both IBS-D patients and healthy subjects. To date, an ideal nutritional protocol does not exist for IBS-D patients but it seems crucial to consider the effect of the different nutritional approaches on the intestinal microbiota composition to better define an efficient strategy to manage this functional disorder.
... Approximately eighty-four percent (84%) of people with IBS attribute their symptoms to the foods they consume particularly fermentable carbohydrates and lipids [34][35][36]. Patients who try to identify the foods they think are triggering their symptoms and exclude them entirely from their diet risk falling nutritionally short and becoming physically exhausted [37,38]. Eating some meals may result in fermentation, altering intraluminal pH and the microbiota, in addition to osmotic, chemical, mechanical and neuroendocrine effects [39]. ...
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Introduction: IBS-D is a common gastrointestinal illness that causes lower abdominal discomfort, bloating, changed bowel patterns and poor quality of life. Despite no physical or biochemical problems, IBS-D is debilitating. Objectives: This review examined the effects of low-FODMAP, gluten-free, lactose-free and fructose-free diets on IBS-D symptoms. We also examined how these diets affected gut microbiota composition and their mechanisms of action. Methods: A comprehensive literature review was conducted, utilizing databases such as PubMed and Google Scholar. MeSH terms and keywords related to IBS-D, dietary management, gut microbiota and specific dietary approaches were employed in the search. The inclusion criteria were studies published between January 1, 2008 and September 1, 2023, to ensure the inclusion of recent and relevant research. Selected studies were critically reviewed for their findings on the effects of dietary interventions on IBS-D symptoms and the gut microbiota. Results: Several dietary strategies, including the gluten-free diet, fructose-free diet, lactose- free diet and low-FODMAP diet have demonstrated promise in alleviating IBS-D symptoms, particularly diarrhea, bloating and abdominal pain. These diets have shown varying degrees of success, with some individuals experiencing significant symptom improvement. Furthermore, alterations in gut microbiota composition have been observed in response to dietary modifications, although the exact mechanisms remain to be fully elucidated. Conclusion: This review suggests dietary changes may improve IBS-D symptoms and the gut microbiome. However, the intricacy of dietary impacts on IBS-D requires further investigation to determine their effectiveness and gut microbiota impact. Individualized diets may help IBS- D patients relieve symptoms and improve gut health. Dietary suggestions for IBS-D treatment need more study.
... Approximately eighty-four percent (84%) of people with IBS attribute their symptoms to the foods they consume particularly fermentable carbohydrates and lipids [34][35][36]. Patients who try to identify the foods they think are triggering their symptoms and exclude them entirely from their diet risk falling nutritionally short and becoming physically exhausted [37,38]. Eating some meals may result in fermentation, altering intraluminal pH and the microbiota, in addition to osmotic, chemical, mechanical and neuroendocrine effects [39]. ...
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Duke University was founded in 1930 primarily due to funds generated from James B Duke’s tobacco business. Duke achieved great financial wealth primarily due to the early application of machine rolled cigarettes, as opposed to hand rolled. This early adoption of technology allowed Duke Tobacco to out-produce other companies still selling hand rolled cigarettes. By making smoking more inexpensive and easier than pipe smoking, the cigarette formed the foundation for nicotine addiction in the 1900s, generating huge profits for the tobacco industry. At the time Duke University was founded, little was known about the connection between nicotine, cigarettes and respiratory diseases such as emphysema and lung cancer. Through James Duke’s philanthropy, the devastating harm from cigarettes has been mitigated in part through the founding of one of the world’s most prominent medical centers and research universities.
... On the other hand, the consumption of dairy products containing probiotics is thought to have positive effects on IBS patients. In the studies, the intake of calcium and magnesium in IBS patients was found to be lower than the Recommended Dietary Allowance (RDA) (30)(31)(32). Similarly, in the present study, calcium and magnesium intake was below the recommended value. ...
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ABSTRACT Objective: Irritable bowel syndrome (IBS) is one of the most common chronic functional diseases of the gastrointestinal tract. There is no organic disorder in IBS. The pathogenesis of IBS is not fully understood. Although the symptoms of IBS patients are mostly diet-related, there are not many studies evaluating nutrient intake. In this study, it was aimed to determine nutrient intake and nutrition habits of IBS patients.Methods: A total of 70 IBS patients, 52 females and 18 males, were included in the study. Three-day food records were compiled. Besides, foods that reduced symptoms of IBS and foods that caused sitophobia were interrogated in the study.Results: The mean age of the patients was 37.8±10.03 years and 40% of them were IBS-mixed subtype. Daily intake of energy and some nutrients were found to be similar to the recommended levels. The mean intake of energy, protein, carbohydrate, saturated fatty acid, vitamin B1, vitamin B2, vitamin B6, vitamin B12, calcium, magnesium, phosphorus, iron, copper (p<0.001), total folic acid, carotene, sodium, and potassium (p<0.05) showed statistically significant differences according to gender. It was determined that 85.7% of the patients had sitophobia. In both genders, apricot was the most reported food to have reduced IBS symptoms. The foods causing sitophobia were raw vegetables-fruits (35.7%), spicy foods (34.3%), and legumes (27.1%).Conclusions: Although IBS avoids consuming certain foods for fear of increasing their symptoms, energy, and nutrient intake is found to be similar to generally recommended levels. Keywords: diet, gastrointestinal diseases, irritable bowel syndrome, nutrition, nutrition habits
... Moreover, it can be difficult to determine whether symptoms could be explained by a mechanism other than food intolerance (e.g., bowel distension after overeating or bloating due to overconsumption of gas-producing foods). Therefore, it is very difficult to give dietary advice to patients diagnosed with IBS [10]. In practice, many physicians recommend a trial of a lactose-free diet for all patients newly diagnosed with IBS. ...
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Irritable bowel syndrome (IBS) is a poorly understood gastrointestinal disorder that affects a significant percentage of the population and has a strong negative effect on the quality of life. The lack of known pathophysiologic mechanisms has made finding effective treatment strategies difficult. One of the common recommendations by clinicians is a trial of a lactose-free diet. We have wondered if there was sufficient evidence in the currently available literature to support such a recommendation. We have also looked into other possible relationships between malabsorption syndromes and IBS. All the articles used for this review have been found in the PubMed database. We have taken into consideration the possibility that there may be both genetic differences and differences in the gut microbiome between populations living in different geographic regions. Therefore, we have included articles from different geographic regions to increase the generalizability of the findings. While there is a plethora of evidence that IBS patients commonly report milk intolerance, we have not found any conclusive evidence to suggest an objective link between IBS and any known malabsorption syndromes, including lactose malabsorption. Furthermore, trials of lactase supplementation have not led to clinical benefit. We concluded that there was no evidence to support routinely recommending a lactose-free diet for patients diagnosed with IBS, but including hydrogen breath testing in routine workup of IBS is a reasonable clinical decision. Ultimately, we believe that more clinical trials and chemical studies of the feces are needed to determine the pathophysiology and explore possible dietary recommendations for patients with IBS.
... This postprandial worsening of symptoms typically occurs within 3 hours of eating (7). Fiber, caffeine, spicy foods, alcohol, and fatty food items have been reported as triggers for symptoms, in part, because of their ability to affect gastrointestinal motility (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). There is limited and conflicting evidence to support these observed and patient-perceived food-related gastrointestinal symptoms (6). ...
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Introduction: Patients with irritable bowel syndrome (IBS) identify food as a trigger for the onset or worsening of gastrointestinal symptoms. Despite this, there is no published validated contemporaneous food and symptom diary to investigate the association between diet and IBS symptoms. The objective of this prospective observational study was to assess the construct validity of a novel food diary and symptom questionnaire, the Food and Symptom Times (FAST) diary, and the predictive validity of the food diary component with relation to fiber and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols consumption and subsequent gastrointestinal symptoms. Methods: Fifty-one participants with IBS completed the FAST diary and several legacy instruments. The relationship between the FAST gastroenterological symptoms and legacy instruments was examined using Spearman correlation coefficients. Further statistical analysis investigated the relationship between diet and postprandial gastrointestinal symptoms. Results: Consistent with a priori predictions, the FAST symptoms showed moderate correlations with the most similar Patient-Reported Outcome Measurement Information System gastrointestinal scales (0.328-0.483, P < 0.05) and the most similar Gastrointestinal Symptom Rating Scale questions (0.303-0.453, P < 0.05), with the exception of the weakly correlated subscale constipation for both instruments (-0.050 to -0.119, P > 0.05). The IBS-Quality of Life instrument showed moderate correlations with the FAST symptom abdominal swelling/distension (0.313-0.416, P < 0.05). The consumption of a high fermentable oligosaccharides, disaccharides, monosaccharides, and polyols meal was associated with participants with IBS-D experiencing abdominal bloating and participants with IBS-C not experiencing abdominal swelling (P < 0.05). The consumption of fiber was correlated with abdominal fullness and bloating in participants with IBS-C (P < 0.05). Discussion: The FAST diary validly measures gastrointestinal symptoms as they occur in people with IBS and correlates these symptoms with specific aspects of diet.
... Food intolerance is very common in functional digestive disorders (FDDs), both in functional dyspepsia and irritable bowel syndrome (IBS). Many patients with IBS associate the ingestion of a wide range of foods with the development of abdominal bloating and pain (2,3), and 62% make dietary adjustments (4) such as reduced consumption of dairy products, spicy foods, wheat, alcohol, and some fruits or vegetables rich in poorly absorbable short-chain carbohydrates and sugar alcohols, and increased consumption of fruits rich in fermentable oligosaccharides, monosaccharides, and polyols (FODMPAPs) (5,6). Up to 4.7% of patients may have latent celiac disease, and while malabsorption of lactose and other sugars does not seem to be more common in IBS patients than in the general population, patients often attribute their symptoms to ingestion of wheat and dairy products, hence other mechanisms may be involved. ...
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This paper summarizes the contents of a consensus document on exclusion diets in irritable bowel disease that was developed by a task force from SEPD, FEAD, SENPE, FESNAD, SEÑ, SEEN, SEGHNP, SEDCA and ADENYD. The complete document is available at the FEAD and in SENPE websites. Irritable bowel syndrome is a highly prevalent functional digestive disorder where, in addition to drugs, therapy includes diet and acquisition of healthy habits as basic elements for its control. In order to facilitate dietary counseling for these patients in daily practice, the present consensus document on the role of exclusion diets was developed. To this end, consensus opinions were collected from various experts in the national scientific societies aiming at establishing recommendations applicable to the health care of patients with irritable bowel syndrome.
... A l'inverse, une consommation importante de glucides à chaîne courte faiblement absorbés (FODMAP « Fermentable Oligo-, di-, and monosaccharides and polyols ») pourrait entraîner l'apparition de phénomènes inflammatoires (Gearry et al., 2009;Prince et al., 2016). Le rôle de l'alimentation dans la physiopathologie du SII a été mis en évidence (Dapoigny et al., 2003). ...
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Les pathologies intestinales sont des maladies multifactorielles dont l’incidence ne cesse d’augmenter. Les maladies organiques regroupent les maladies inflammatoires chroniques de l'intestin telle que la maladie de Crohn (MC) et les pathologies fonctionnelles digestives comprennent les différentes formes du syndrome de l'intestin irritable (SII). Ces pathologies présentent des caractéristiques communes comme des troubles du transit, des douleurs abdominales, un dysfonctionnement de la barrière intestinale et des modifications de la communication bidirectionnelle de l’axe intestin-cerveau et une altération de la composition du microbiote intestinal (dysbiose). Cette dernière peut être en partie associée à un déficit de production en peptides et protéines antimicrobiennes (PAMs) par les cellules de Paneth. Parmi les cibles thérapeutiques stratégiques, une réduction de la dysbiose dans le but de réduire l’état inflammatoire ou micro-inflammatoire de la muqueuse font aujourd’hui l’objet de différentes études. Ces traitements alternatifs montrent l’efficacité d’un régime nutritionnel adapté, d’un apport en probiotiques ou en prébiotiques sur le microbiote intestinal des patients MC et SII, et sur l’intégrité de leur barrière intestinale. Parmi les matrices alimentaires présentant une composition nutritionnelle intéressante proche du lait maternel humain, le lait d’ânesse (LA) contient également une forte teneur en PAMs (lysozyme). En parallèle, un observatoire économique et social de la filière asine commandité par l’Institut National Âne et Mulet fait le diagnostic d’une activité grandissante autour du LA chez les éleveurs français et montre, face à une concurrence italienne et chinoise importante, la nécessité d’une meilleure organisation de la filière via une meilleure valorisation du LA. L’objectif de cette thèse était d’évaluer un potentiel effet santé du LA et d’apporter des preuves scientifiques robustes pour permettre une meilleure valorisation de ce dernier. Ainsi, l’effet d’une consommation orale chronique de LA a été évalué sur deux modèles précliniques murins distincts : un modèle d’iléite expérimentale induite par une administration per os d’indométacine et un modèle de stress psychologique chronique (Water Avoidance Stress, WAS). Dans ce travail, le rôle clé de l’activité du lysozyme dans les effets observés a également été évalué. Des essais de traitements thermiques ont aussi été réalisés pour optimiser un barème de pasteurisation permettant de proposer un LA répondant aux normes réglementaires microbiologiques et sanitaires tout en conservant l’activité du lysozyme contenue dans le lait. Les travaux de cette thèse montrent que le LA possède des propriétés anti-inflammatoires se traduisant par une réduction significative des lésions inflammatoires macroscopiques et microscopiques de l’iléon. Cet effet est associé à une réduction de la dysbiose intestinale et normalise les niveaux de PAMs dans les cellules de Paneth drastiquement réduits lors de l’iléite. Dans le modèle WAS, le LA et la fraction contenant l’activité en lysozyme réduisent l’hypersensibilité viscérale, l’état micro-inflammatoire induites par le stress et restaurent les niveaux de PAMs dans les cellules de Paneth réduits par le stress. Un traitement thermique de 2 min/72°C permet d’augmenter la durée de vie du LA tout en conservant l’activité du lysozyme et ses propriétés santé sur la muqueuse intestinale chez la souris.
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This paper summarizes the contents of a consensus document on exclusion diets in irritable bowel disease that was developed by a task force from SEPD, FEAD, SENPE, FESNAD, SEÑ, SEEN, SEGHNP, SEDCA and ADENYD. The complete document is available at the FEAD and in SENPE websites. Irritable bowel syndrome is a highly prevalent functional digestive disorder where, in addition to drugs, therapy includes diet and acquisition of healthy habits as basic elements for its control. In order to facilitate dietary counseling for these patients in daily practice, the present consensus document on the role of exclusion diets was developed. To this end, consensus opinions were collected from various experts in the national scientific societies aiming at establishing recommendations applicable to the health care of patients with irritable bowel syndrome.
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This paper describes a low-flatulence diet developed by an extremely flatulent patient. Based on meticulous recording of each passage of flatus, the patient employed an elimination diet to determine what foods were responsible for his gas production. The diet reduced the frequency of his gas passage from 34±7 to 17±5 times per day (normal: 14±6) and similar reductions were observed by two other flatulent patients during adherence to the diet. The rectal gas of each of these subjects largely consisted of two gases (CO2 and H2) which result from bacterial fermentation of carbohydrates. The diet, which is low in lactose and wheat products, presumably minimizes the quantity of carbohydrates delivered to the colonic bacteria.
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