# Food-Related Gastrointestinal Symptoms in IBS



## eric (Jul 8, 1999)

FYI:Food-Related Gastrointestinal Symptoms in the Irritable Bowel Syndrome. Simren M, Mansson A, Langkilde AM, Svedlund J, Abrahamsson H, Bengtsson U, Bjornsson ES Department of Internal Medicine, Sections of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Goteborg, Sweden. [Record supplied by publisher] Background/Aims: Postprandial symptoms are common in patients with irritable bowel syndrome (IBS). However, existing studies have come to different conclusions about the role of food in the pathophysiology of IBS. We explored the prevalence of subjective food-related gastrointestinal (GI) symptoms and its relationship to clinical characteristics and psychological factors in IBS. Methods: 330 patients with IBS and 80 healthy volunteers completed a food questionnaire developed for this study. The subjects graded their subjective symptoms after 35 different foods and a food score was obtained by adding the item scores. The relationship between subjective food-related GI symptoms and referral status, IBS subgroup (predominant bowel pattern), sex, anxiety, depression and body mass index (BMI) was estimated. Results: In 209 (63%) of the patients the GI symptoms were related to meals. Gas problems and abdominal pain were the most frequently reported symptoms. Foods rich in carbohydrates, as well as fatty food, coffee, alcohol and hot spices were most frequently reported to cause symptoms. The food score was higher in patients than in controls (p < 0.0001). In the IBS group higher scores were observed in patients with anxiety (p = 0.005), and females (p < 0.001), but the results were unrelated to IBS subgroup, referral status or BMI. The BMI did not differ between groups. Conclusion: A majority of IBS patients consider their symptoms to be related to meals. Especially foods rich in carbohydrates and fat cause problems. Nevertheless, the majority of IBS patients are normal or overweight. Female sex and anxiety predict a high degree of food-related symptoms in IBS. Copyright 2001 S. Karger AG, Basel PMID: 11244249 ------------------I work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


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## SteveE (Jan 7, 1999)

To me, the most interesting thing here is the weight finding. (BTW: Thanks again Eric for another interesting post!)There are many of us on this board (myself included) who perceive ourselves as being underweight. I definately include myself in that category (130-135lbs at 5' 8-9" for a male is rather smallish...or at least looks it with my long arms and legs).During flare-ups of IBS, I sometimes worry a little about retaining what little weight I have. Between flare-ups, I wish I could put on a few pounds. I'm often encouraged by relatives to eat more because of that. The irony of that is that I think I eat MORE than they do, I just don't eat as many hot fudge sundaes and stuff.Of course it is only one study and statistics sometimes distort things a bit, but it might suggest that my being underweight has little or nothing to do with my IBS. IF that's the case, then why am I so skinny?!


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## Mike NoLomotil (Jun 6, 2000)

STEVE:This is probably the only 'epidemiolgc study' Bengtsson has done on the subject...he is very actively involved in in-vivo studies utilizing jejunal isolation for 5-6 years now...very familiar with his work as our consulting immunologists such as Brostoff are associates of his, so information is exchanged as a matetr of course.Now in the jejunal studies of food-intolerant patients who are confimed reactive by oral challenge but NOT allergic (they separate out the classic food allergy patients with RAST, Phadiotope, SPT, depends on which study is looked at)you get an actual snaphsot of the immune responses occurring in the small bowel mucosa and microvasculature.In those responses, the chemicals released, in and of themselves will cause fluid retention...the sometime-called "leaky gut" phenom. This was confirmed with findings of albumen leaking out of the blood vessels into the small bowel lumen.The thousands we have seen "go by" during clinical development also confirmed that MOST of the patients with IBS who come for treatment are female and MANY of them have a comorbid weight control problem. But not all.I'll come back to that...there are several factors working here. But your apparent skinniness is probably like mine, yet we still retain water. I lost 6 pounds my first month on an allergen elimination diet. I was 6' 1'' and weighed no more than 155-160. This is/was strictly due to the cessation of the release of mediators in the small bowel mucosa and microvasculature which will result in fluid retention, so the excess water simply is removed in the normal course of maintaining fluid and electrolyte balance.IF the wieght loss plateaus, as it should, then you are at the patients actual homeostatic condition....this is their weight absent the water.SOME patients, especially the females, usually would lose MORE weight after the plateau. A second stage of slower weight loss would and could continue. Studies on this phenomena in food intolerance were published a couple years back in a Bariatrics Journal using the older ALCAT test our immunologist first invented.There are all kinds of theories for weight loss in these patients after the initial water phase...but what it usually came down to clinically is that the patients (again primarily female) each suffered to a greater or lesser degree of food-dependency, food cravings, all the way up to and including food addiction. There is a complex interconnection between the immunologically reactive foods and the mediators released in the reaction and their psychological effects, coupled with the hormonal cycle and prostoglandin release, and the tendency of some foods to be serotonergic and endorphinergic.Put simply, the forms many of the ladies with IBS and weight control consumed their reactive foods in were forms associated with high-caloric density comfort foods which also are known to elicit serotonin and/or endorphin responses. Now in some the psychosocial issues in the patients life led them to the pattern which precipiatated the cycle they were in, and some were led to the cycle by their physical ills and the consequences of same. Both types were seen.Dr. Bengstsson et al just confirmed epidemiologically what all doctors who "treat" patients with food intolerance know by practice.In your case, if your weight is stable in simple terms your food intake now matches your metabolic rate. This may have been altered by you altering your eating patterns in response to your IBS symptoms. That is a person starts to experience symptoms, associates them with eating in one way or another and ends up eating less to avoid the symptoms. The body weight can drop up to 10% before the metabolic rate will automoatically adjust to the caloric intake and the weight loss stabilizes. In the male patients experience has been that the weight changes stay within that narrow range of +/- 10%. The female patients are more prone to addictive eating patterns and some can gain a substantial amount of excess weight over the course of the unresolved syndrome....and then lose it steadily the longer they exclude the test positive foods.We have seen losses of 40, 50 pounds or more before the patient stabilizes. I will tell you what, these were/are some happy ladies afterward.Eat Well. Think Well. Be Well.MNL________________ www.leapallergy.com [This message has been edited by Mike NoLomotil (edited 03-17-2001).]


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