elimination diet

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Ideally, to create an optimal Irritable Bowel Syndrome (IBS) diet, all you’d have to do is avoid a certain food or food group to discover whether it was triggering your IBS. Unfortunately this is easier said than done.

It takes a great deal of time, persistence, and education to properly construct a diet that will adequately treat IBS. Proper lab testing can help you avoid all of this.

The purpose of an elimination diet is to identify whether or not specific food groups trigger your IBS symptoms. Essentially, during an elimination diet you stop eating the foods you normally eat until your symptoms improve. If you feel better after you’ve eliminated a food or stopped eating altogether, then you might strongly suspect that your diet is involved. You may have gone on a fast or a cleansing diet, or simply avoided food for a day or two and discovered that your IBS was much better. Of course, eventually you have to eat, and the trick is figuring out exactly what you can eat.

If, when you reintroduce a food, your symptoms return, then it’s likely that the food or one of its ingredients is an IBS trigger for you. It’s sounds simple enough, but it can be a very slow process and very time consuming. And even after going through this process you may still not see a pattern or you may still be confused about which foods are causing your problems.

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This Chinese study certainly seems to get it right.

From NIH.gov:

OBJECTIVE:
This study investigated the role of food intolerance in irritable bowel syndrome with diarrhoea (D-IBS).

METHODS:
Specific immunoglobulin G (IgG) antibodies against 14 common food antigens in the serum were measured in 77 patients with D-IBS and 26 healthy controls. Food-specific IgG antibodies were identified in 39 (50.65%) patients with D-IBS patients compared with four (15.38%) controls. For 12 weeks following the serological testing, 35 patients with D-IBS and food intolerance consumed diets that excluded the identified food. Changes in the main symptoms of D-IBS were evaluated before treatment and regularly during treatment in these patients.

RESULTS:
After 4 weeks’ dietary therapy, most symptoms of D-IBS had improved. By 12 weeks, all symptom scores had decreased significantly compared with the baseline scores.

CONCLUSIONS:
The 12-week specific-food exclusion diets resulted in significant improvements in abdominal pain (bloating level and frequency), diarrhoea frequency, abdominal distension, stool shape, general feelings of distress and total symptom score compared with baseline in patients with D-IBS.

Authors: Guo H, Jiang T, Wang J, Chang Y, Guo H, Zhang W.

Source
Department of Gastroenterology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.

Image thanks to redcedarwellness

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This study was published in the Journal of the American College of Nutrition.

Objective

In Irritable Bowel Syndrome, the gut-associated immune system may be up-regulated resulting in immune complex production, low-grade inflammation, loss of Class I bacteria, and translocation of inflammatory mediators and macromolecules outside of the GI lumen. Since food intolerance may be one of the reasons for this upregulation, our goal was to investigate the role of food intolerance in IBS patients.

Methods

In this open label pilot study, we enrolled 20 patients with IBS by Rome II criteria (15 women, ages 24–81) who had failed standard medical therapies in a tertiary care GI clinic. Baseline serum IgE and IgG food and mold panels, and comprehensive stool analysis (CSA) were performed. Breath-hydrogen testing and IBS Quality-of-Life (QOL) questionnaires were obtained. Patients underwent food elimination diets based on the results of food and mold panels followed by controlled food challenge. Probiotics were also introduced. Repeat testing was performed at 6-months. We followed up with this cohort at 1 year after trial completion to assess the reported intervention and for placebo effect.

Results

Baseline abnormalities were identified on serum IgG food and mold panels in 100% of the study subjects with significant improvement after food elimination and rotation diet (p < 0.05). Significant improvements were seen in stool frequency (p < 0.05), pain (p < 0.05), and IBS-QOL scores (p < 0.0001). Imbalances of beneficial flora and dysbiotic flora were identified in 100% of subjects by CSA. There was a trend to improvement of beneficial flora after treatment but no change in dysbiotic flora. The 1-year follow up demonstrated significant continued adherence to the food rotation diet (4.00 ± 1.45), minimal symptomatic problems with IBS (4.00 ± 1.17), and perception of control over IBS (4.15 ± 1.23). The continued use of probiotics was considered less helpful (3.40 ± 1.60).

Conclusion

These data demonstrate that identifying and appropriately addressing food sensitivity in IBS patients not previously responding to standard therapy results in a sustained clinical response and impacts on overall well being and quality of life in this challenging entity.

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