Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet

Abstract

Food intolerance is an important cause of abdominal symptoms. As no objective tests are available to identify the foods concerned, diets are essential for the management of these patients. The fewer foods allowed in the diet, the greater is the chance of success. Our original studies of 182 patients between 1979 and 1982, using a diet of lamb, rice and pears, had resulted in a 67% success rate. The foods most commonly involved were wheat (6O%), cows' milk (44%) and corn (44%). A less restrictive exclusion diet was developed from the results of this work, avoiding all those foods to which 20% or more of the patients had been intolerant. Of 253 patients (79%), 200 were able to complete 2 weeks on this diet and 100 (50%) were successful in controlling their symptoms. The exclusion diet was modified in the light of this experience and in a subsequent study of 129 patients, 96 (75%) were able to comply for 2 weeks, but only 39 (41%) improved on the basic diet. However, examination of the food diaries of these patients enabled the identification of less frequent food intolerances in 21 (22%) giving an overall success rate of 60 (63%). In this way, equally good results can be obtained using a nutritionally adequate exclusion diet and avoiding the difficulties of following a more rigorous elimination regime.

Perspectives on the role of the human gut microbiota and its modulation by pro- and prebiotics

“…It has no diagnostic markers but symptoms include excessive¯atus, bloating and variable bowel habit (Parker et al 1995). The aetiology of IBS is unknown although it has been suggested that the gut micro¯ora have a role in development.…”

“…More than 50% of patients with CD reacted positively to such diets, suggesting that microbial fermentation in the gut is a factor in the pathogenesis of the disease (Parker et al 1995).…”

Do Interventions Which Reduce Colonic Bacterial Fermentation Improve Symptoms of Irritable Bowel Syndrome?

“…Long-term follow-up of the flora of IBS patients suggests that the flora is unstable, with alteration in the rank order of species (10) in contrast to healthy individuals (11a). Many IBS patients report exacerbation of symptoms by specific foods, and restrictive diets avoiding such foods may lead to improvement of their symptoms (12)(13)(14). Exposure to intolerant foods results in changes in the gut flora and an increase in bacterial metabolic activity as demonstrated by increased production of short-chain fatty acids (15).…”

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“…O gastroenterologista deve explicar as implicações deste diagnóstico ao paciente e, assim, assegurar-lhe que não foi encontrada nenhuma doença estrutural e que, em alguns casos, há eventualmente uma melhora espontânea (49) . Deve ser oferecida orientação sobre a redução de elementos potencialmente laxativos na dieta (por exemplo, cereais e certas frutas contendo frutose e oligossacarídeos) (50) e redução na ingestão de álcool. Abster-se de produtos lácteos pode ajudar, se forem consumidos mais de 240 mL de leite ou o seu equivalente por dia (41) .…”