Irritable Bowel Syndrome (IBS) and Elimination Diets

Foods Can Cause Symptoms of Irritable Bowel Syndrome (IBS): Most doctors in the United States have been and continue to be skeptical that foods cause symptoms of IBS (IBS) and that elimination of specific foods can improve these symptoms. This is despite the fact that almost 70% of people diagnosed with IBS report symptoms related to specific foods. There is growing evidence, although still criticized due to study limitations that make it difficult to prove, that specific foods may be the cause of symptoms in many people labeled as having IBS.

Food intolerance testing and the IgG antibody-based elimination diet may be beneficial: Atkinson et al. (Gut, 2004) randomized people to either an elimination diet based on high levels of IgG antibodies (YorkTest Laboratories) for specific foods, or a sham diet. Those who avoided specific foods based on their IgG antibody tests had an improvement in IBS symptoms (10-26% reduction) and a significant improvement in overall quality of life. The reintroduction of foods for which they tested positive led to a worsening. Zar et al. (Am J Gastro, 2005) reported significant improvement in IBS symptoms such as pain, bloating, and altered bowel habits based on six-month clearance of elevated food-specific IgG4 antibodies in 25 people .

Irritable bowel syndrome (IBS) is very commonly diagnosed in adults: no diagnostic test can confirm IBS. It is a diagnosis of exclusion. It is a syndrome, that is, a set of symptoms that cannot be explained by other diseases leading to the diagnosis of IBS. Common missed diagnoses that are blamed on IBS include lactose intolerance, celiac disease, gluten sensitivity or gluten intolerance, colitis, Crohn’s disease, parasitic infections such as giardia, bacterial overgrowth in the intestine or alterations in the levels and types of intestinal bacteria (dysbiosis), food allergies, food intolerances and food hypersensitivities.

Celiac disease, colitis, and Crohn’s disease should be ruled out before diagnosing IBS: Celiac disease, colitis, and Crohn’s disease can be diagnosed or ruled out by blood tests, stool tests, and biopsies of the liver. ‘intestine. Food allergy, intolerance, and sensitivity are not only harder to confirm or rule out, but often missed due to the limitations of blood tests, stool tests, allergy skin tests, and biopsies. Adverse food reactions should be considered as a potential cause of symptoms attributed to IBS.

There are common foods that cause adverse food reactions: Common foods reported by IBS sufferers whose symptoms improve with elimination are wheat, barley, and rye (gluten); dairy products, including cow’s milk protein (casein) and/or lactose (milk sugar); legumes (peanuts) and soybeans; yeast used to cook or infuse food; but; shells and fish; nuts (almond, Brazil nut, cashew and walnut); fruits (apple, orange and strawberry); vegetables (celery, cabbage and lettuce); meats (pork, beef and chicken); and Solanaceae (potato and tomato).

Individual, food-specific elimination diets are based on a variety of tests and a diet diary of food symptoms: elimination diets based on common foods causing allergic reactions and non-allergic food reactions have been used for some time and are often prescribed. with or without food symptom diet diary. Interestingly, to my knowledge, no one has considered addressing these people and their adverse food reactions individually, based on testing for celiac disease, gluten intolerance or sensitivity (anti-gliadin IgA or IgG antibodies elevated blood and/or stool anti-gliadin IgA antibodies without blood diagnosis). tests or biopsy for celiac disease), casein intolerance (anti-casein IgA antibodies in the stool or IgG antibodies in the blood), history of oral allergy syndrome (OAS) and extensive food allergy testing (skin tests, IgE RAST or CAP RAST, intradermal skin tests or patch skin test).

Specific trials of food elimination diets based on this information (see table at has been helpful in my experience. The food-pollen cross-reaction in OAS is well documented. A food symptom diary combined with specific food elimination based on food allergy test results, food intolerance from food sensitivity tests, and known pollen allergies should be considered as a possible approach to the elimination diet. This should not exclude the evaluation and treatment of established celiac disease, lactose intolerance, dysbiosis, colitis or Crohn’s disease.


Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized controlled study. Gut 2004;53:1459-1464.

Choung RS, Talley NJ. Food allergy and intolerance in IBS. Gastroenterology and Hepatology Oct 2006;2(10):757-760.

Zar S, Benson MJ, Kumar D. Specific serum IgG4 and IgE titers to common food antigens in irritable bowel syndrome. American Journal Gastroenterology 2005;100:1550-1557.

Zar S, Mincher L, Benson MJ, Kumar D. Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome. Scandinavian Journal of Gastroenterology. 2005;40:800-807.

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