Population studies show 20-45% of adults believe they experience adverse reactions to food. The majority of these reactions are categorised as food intolerance, being non-immunologic in origin (not food allergy). The most common symptoms reported to be associated with food intolerance are gastrointestinal including increased flatulence, abdominal pain, bloating or diarrhoea, similar to IBS. Extra-intestinal symptoms such as migraine, asthma or eczema are sometimes also reported.
Accurately recognising the food components that induce these symptoms is challenging because of the complexity of food composition
and many potential mechanisms
involved. For example, there could be enzyme defects (lactose) or pharmacological effects from food chemicals (found naturally or used as additives). There are many dietary approaches
(gluten-free, wheat-free, anticandidal, carbohydrate-free and other complex exclusion diets) attempted to alleviate symptoms. High quality scientific data exists to support reducing the intake of a group of poorly absorbed, short-chain carbohydrates (called the low FODMAP diet) as an efficacious approach for managing IBS-type symptoms. FODMAPs are found naturally in a range of foods and include fructose (in excess of glucose), lactose, polyols, fructans and galacto-oligosaccharides.
The most helpful diagnostic test for food intolerance is food exclusion to achieve symptom improvement, followed by gradual food reintroduction. Exclusion diets should be followed for as short a time as possible. Seeking the assistance of an experienced, specialised dietitian
is recommended to help with reintroduction and to establish individual tolerance, also to ensure dietary variety and nutritional adequacy.
Many questions remain in our understanding of the role of food intolerance in IBS. Are there any tests to help diagnose food intolerance? Are there ways of predicting which dietary approach will help best? Will combination with other treatments or therapies help? What are the effects of long term removal of specific foods?
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