Some people with IBS likely have food intolerances but at present the evidence base is not strong enough to restrictive diets. Many different dietary modifications have been attempted to improve the symptoms of IBS. Some are effective in certain sub populations. As lactose intolerance and IBS have such similar symptoms a trial of a lactose free diet is often recommended.
Definitive determination of dietary issues can be accomplished by testing for the physiological effects of specific foods. The ELISA food allergy panel can identify specific foods to which a patient has a reaction. Other testing can determine if there are nutritional deficiencies secondary to diet that may also play a role.
Removal of foods causing IgG immune response as measured using the ELISA food panel has been shown to substantially decrease symptoms of IBS in several studies. There is no evidence that digestion of food or absorption of nutrients is problematic for those with IBS at rates different from those without IBS.
However, the very act of eating or drinking can provoke an overreaction of the gastrocolic response in some patients with IBS due to their heightened visceral sensitivity, and this can lead to abdominal pain, diarrhea, or constipation. Several of the most common dietary triggers are well-established by clinical studies at this point.
Research has shown that IBS patients are hypersensitive to fats and fructose. It also appears that some foods are more difficult for the gut as evidenced by elevated food-specific IgG4 antibodies being present, while others increase colonic contractions, which may be painful, due to increased visceral sensitivity in IBS sufferers.
There is convincing evidence that soluble fiber supplementation is effective in the general IBS population but insoluble fiber has not been found to be effective for IBS. However, in some people fiber supplementation may even aggravate symptoms. Fiber might be beneficial in those who have a predominance of constipation.
In patients who have constipation predominant irritable bowel, soluble fiber at doses of 20 grams per day can reduce overall symptoms but will not reduce pain. The research supporting dietary fiber contains conflicting, small studies that are complicated by the heterogeneity of types of fiber and doses used.
Medications may consist of stool softeners and laxatives in constipation-predominant IBS, and antidiarrheals in diarrhea-predominant IBS for mild symptoms. Drugs affecting serotonin in the intestines can help reduce symptoms. Serotonin stimulates the gut motility and so agonists can help constipation-predominate irritable bowel, while antagonists can help diarrhea-predominant irritable bowel.
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