(3) Irritable bowel syndrome
Irritable bowel syndrome is a motility disorder of unknown
origin, in which no evidence of disease can be seen when the colon is
examined. Factors implicated include previous gastrointestinal infection,
stress, psychosomatic disorders, food intolerance and low fibre intake.
Symptoms include abdominal pain, altered stool frequency and bloating
or abdominal distension. The effects of dietary treatment are hard to
evaluate because of the placebo effect and the fact that symptoms of the
condition tend to be vague and non-specific. However the following factors
should be considered:
- Dietary fibre intake — Traditional
advice was to avoid high fibre foods because of a supposed irritant
effect. However, high fibre diets now tend to be advocated, although
it should be emphasised that sufferers vary enormously in their response
to dietary fibre. It seems likely that patients whose symptoms are predominantly
abdominal pain and constipation could benefit from an increased fibre
intake, whereas those who suffer from diarrhoea may be less likely to
benefit. If fibre is increased, this should be done gradually. Excessive
amounts of fibre, especially bran, can make symptoms worse.
- Food intolerance — Food intolerance
may be a factor in some patients and dietary manipulation may help to
identify possible causes. Common culprits include wheat, corn, oats,
milk and dairy products, citrus fruit, onions, coffee and eggs. In patients
with food intolerance, four or more foods may be implicated, and large
quantities of these foods may need to be consumed over a prolonged period
of time to identify what may well be a slow reaction to a large volume
of food. Identification of possible food intolerances may take up to
three months and therefore demands time and commitment from the patient.
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This series of “dietary advice tips” is intended
to be a reminder of the main points to be made by pharmacists when giving
nutritional information to the public. The conditions included in the
series are those where diet is a well recognised risk factor, those in
which diet contributes to the management of the condition, and others
for which patients may welcome sound dietary advice.
Written by Dr Pamela Mason (a pharmacist with a postgraduate qualification
in nutrition)
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