Introduction
Among patients with functional gastrointestinal disorders (FGID), food intake is often identified as a symptom trigger. Common foods known to cause gastrointestinal (GI) symptoms include fatty foods (1) and fermentable carbohydrates (FODMAPs) (2), but the evidence is limited and may vary among different FGID.
Aims & Methods
The aim of this study was to explore if certain foods are considered more tolerable, and which specific foods are identified as triggers of GI symptoms among participants with irritable bowel syndrome (IBS) and functional dyspepsia (FD). An online survey was conducted including n=537 participants from the Swedish general population with symptoms compatible with a functional bowel disorder. The survey included questions on demographics and an adapted food frequency questionnaire that assessed intakes of 38 different food items or aggregated food groups. For each food, participants had to answer whether or not they considered the specific food to be a trigger for GI symptoms.
Results
Among the respondents, a total of 220 participants with IBS and/or FD (mean age 34.7 years, body mass index 26.8 kg/m2, women: 78.2%) were included in the analyses, of whom n=128 fulfilled criteria for FD and n=136 for IBS. Foods that were least commonly reported to cause GI symptoms included hard bread, fish and shellfish, berries, nuts, and seeds (Figure). The most frequently reported food triggers included pizza, crisps, confectionery, candy, ice cream, white bread, dairy, french fries, pie, and sausages. White bread, more often than whole grain bread, was reported to cause GI symptoms. Most vegetables and fruits were well tolerated in FD. A few FODMAP-rich vegetables, such as onion, garlic, beans, lentils, cauliflower and cabbage were more often reported as food triggers in IBS compared with FD. Having overlapping IBS and FD increased the prevalence of foods that were considered to cause symptoms.
| FD n=128 | IBS n=136 | FD+IBS n=44 | | FD n=128 | IBS n=136 | FD+IBS n=44 |
| Dairy, milk, yoghurt | 47 (36.7%) | 58 (42.6%) | 17 (38.6%) | Apples, pears | 29 (22.7%) | 34 (25%) | 15 (34.1%) |
| Ice gream | 51 (39.8%) | 50 (36.8%) | 21 (47.7%) | Bananas | 17 (13.3%) | 19 (14%) | 11 (25%) |
| Cheese | 31 (24.2%) | 31 (22.8%) | 13 (29.5%) | Grapes | 18 (14.1%) | 31 (22.8%) | 12 (27.3%) |
| White bread | 51 (39.8%) | 54 (39.7%) | 19 (45.5%) | Peach, plums, cherries | 23 (18.0%) | 32 (23.5%) | 15 (34.1%) |
| Whole grain bread | 27 (21.1%) | 34 (25%) | 14 (31.8%) | Watermelon | 14 (10.9%) | 17 (12.5%) | 8 (18.2%) |
| Hard bread | 17 (13.3%) | 23 (16.9%) | 8 (18.2%) | Cauliflower, aspargus | 25 (19.5%) | 37 (27.2%) | 12 (27.3%) |
| French fries | 39 (30.5%) | 55 (40.4%) | 20 (45.5%) | Berries | 15 (11.7%) | 19 (14.0%) | 7 (15.9%) |
| Pasta, couscous | 35 (27.3%) | 39 (28.7%) | 11 (25%) | Tomatoes, cucumber | 15 (11.7%) | 20 (14.7%) | 11 (25%) |
| Pizza | 55 (43.0%) | 76 (55.9%) | 26 (59.1%) | Cabbage, kale, fennel | 27 (21.1%) | 44 (32.4%) | 15 (34.1%) |
Conclusion
In individuals with IBS and/or FD, foods traditionally associated with a healthy dietary pattern were less commonly reported to cause GI symptoms, whereas foods associated with western food/junk food were more commonly reported to cause GI symptoms. Promoting healthy food choices seem compatible with dietary treatment of patients with IBS and FD.
References
1, Feinle-Bisset C, Azpiroz F. Dietary and lifestyle factors in functional dyspepsia. Nature reviews Gastroenterology & hepatology. 2013 Mar;10(3):150-7.
2. van Lanen AS, de Bree A, Greyling A. Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis. European journal of nutrition. 2021 Sep;60:3505-22.
