Food sensitivities, probiotics, and IBS.
Subject: Food allergy (Risk factors)
Food allergy (Care and treatment)
Irritable bowel syndrome (Risk factors)
Irritable bowel syndrome (Care and treatment)
Probiotics (Health aspects)
Author: Klotter, Jule
Pub Date: 04/01/2012
Publication: Name: Townsend Letter Publisher: The Townsend Letter Group Audience: General; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 The Townsend Letter Group ISSN: 1940-5464
Issue: Date: April, 2012 Source Issue: 345
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 286257196
Full Text: Jeanne Drisko, MD, CNS, and colleagues at the University of Kansas Medical Center conducted an open-label 2006 pilot study to investigate the use of an individualized food elimination diet and probiotics to treat irritable bowel syndrome (IBS). Twenty IBS patients who had not responded to standard medical care took part in the study. Participants completed IBS quality-of-life questionnaires and underwent breath-hydrogen testing at baseline. The breath-hydrogen test measures hydrogen and methane in breath samples, taken every 15 minutes for three hours, after a fasting patient ingests 30 cc of glucose syrup. "A peak within 90 minutes of hydrogen or methane concentration of > 20 ppm, or a baseline level of hydrogen or methane of > 10 ppm, which subsequently continued to increase after glucose challenge" indicates bacterial overgrowth in the small intestine, the authors explain. Abnormal microbial colonies in the Gl tract can increase inflammation and immune response, which are typical of IBS. Study participants also underwent serum IgE (allergic reactions) and IgG (delayed hypersensitive reactions) food and mold panels as well as comprehensive stool analysis at baseline. Foods that tested positive on the IgE/IgG test were eliminated from the individual's diet. After two to four weeks, each IgG food was reintroduced in a controlled food challenge. Patients had to keep detailed symptom diaries because reactions can appear hours, even days after ingestion. "If a food was tolerated during the challenge phase, the food was reintroduced back into the diet with instructions to adhere to a rotation diet [eating the food once every three to four days]/' the authors explain. "If IBS symptoms returned with food challenge, the food was eliminated from the diet for 6 months with instructions to re-challenge at a later date." Rotations diets prevent antigen-antibody complexes from building up in the body. Some foods will never be tolerated. After food reactions were identified, participants were given a commercial probiotic to take during months two through six of the study.

At the one-year follow-up, most of the participants reported minimal IBS symptom problems and felt more control over their symptoms because of their continued use of the rotation diet. Probiotics had reportedly relieved symptoms during the trial, but participants did not judge probiotics to be as useful as the diet at the one-year follow-up. The researchers had not found a significant improvement in beneficial colony counts after four months of supplementation.

The researchers suggest that the probiotic used in the study may not have been taken in sufficient dosage. It is also possible that the product did not contain the most beneficial strain for the patients' conditions. A 2008 Finnish study, for example, found that "live Bifidobacterium lactis bacteria can counteract directly the harmful effects exerted by celiac-toxic gliadin ..." while Lactobacillus fermentum had no effect. The probiotic in the Kansas study did not include B. lactis.

The Kansas researchers discuss several limitations of this small trial, the greatest being the controversial (and nonblinded) use of IgG testing to identify delayed hypersensitivities. They would like to see blinded food challenges in hypersensitive patients and healthy controls to evaluate the sensitivity and specificity of IgG food testing. They also point out that IgG is just one part of the body's immune response system: "... there may be other causes of food hypersensitivity or increased inflammation in the Gl tract besides the antigen/antibody complex formation." Nonetheless, this small study offers a very systematic, nonpharmaceutical approach for dealing with a multifaceted, distressing condition.

Drisko J, Bischoff B, Hall M, McCallum R. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics.J Am Coll Nutr. 2006;25(6):514-522. Available at www.jacn.org/content/25/6/514.full.pdf.html. Accessed January 31, 2012.

Lindtors K, Blomqvist T, Juuti-Uusitalo K, et al. Live probioric Bifidobacterium lactis bacteria inhibit the toxic effects induced by wheat gliadin in epithelial cell culture. Clin Exper Immunol. 2008;152:552-558. Available at CINAHI. Plus with Full Text. Accessed January 25, 2012,
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