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Randomized Controlled Trial
. 2021 Jan 28;13(2):416.
doi: 10.3390/nu13020416.

Assessment of a 4-Week Starch- and Sucrose-Reduced Diet and Its Effects on Gastrointestinal Symptoms and Inflammatory Parameters among Patients with Irritable Bowel Syndrome

Clara Nilholm  1 , Ewa Larsson  1 , Emily Sonestedt  2 , Bodil Roth  1 , Bodil Ohlsson  1
Affiliations
Randomized Controlled Trial

Assessment of a 4-Week Starch- and Sucrose-Reduced Diet and Its Effects on Gastrointestinal Symptoms and Inflammatory Parameters among Patients with Irritable Bowel Syndrome

Clara Nilholm et al. Nutrients. .

Abstract

Dietary advice constitutes a treatment strategy for irritable bowel syndrome (IBS). We aimed to examine the effect of a starch- and sucrose-reduced diet (SSRD) on gastrointestinal symptoms in IBS patients, in relation to dietary intake and systemic inflammatory parameters. IBS patients (n = 105) were randomized to a 4-week SSRD intervention (n = 80) receiving written and verbal dietary advice focused on starch and sucrose reduction and increased intake of protein, fat and dairy, or control group (n = 25; habitual diet). At baseline and 4 weeks, blood was sampled, and participants filled out IBS-SSS, VAS-IBS, and Rome IV questionnaires and dietary registrations. C-reactive protein and cytokines TNF-α, IFN-γ, IL-6, IL-8, IL-10, and IL-18 were analyzed from plasma. At 4 weeks, the intervention group displayed lower total IBS-SSS, 'abdominal pain', 'bloating/flatulence' and 'intestinal symptoms´ influence on daily life' scores (p ≤ 0.001 for all) compared to controls, and a 74%, responder rate (RR = ΔTotal IBS-SSS ≥ -50; RRcontrols = 24%). Median values of sucrose (5.4 vs. 20 g), disaccharides (16 vs. 28 g), starch (22 vs. 82 g) and carbohydrates (88 vs. 182 g) were lower for the intervention group compared to controls (p ≤ 0.002 for all), and energy percentages (E%) of protein (21 vs. 17 E%, p = 0.006) and fat (47 vs. 38 E%, p = 0.002) were higher. Sugar-, starch- and carbohydrate-reductions correlated weakly-moderately with total IBS-SSS decrease for all participants. Inflammatory parameters were unaffected. IBS patients display high compliance to the SSRD, with improved gastrointestinal symptoms but unaltered inflammatory parameters. In conclusion, the SSRD constitutes a promising dietary treatment for IBS, but needs to be further researched and compared to established dietary treatments before it could be used in a clinical setting.

Keywords: IBS; dietary intervention; inflammation; starch; sucrose.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
CONSORT 2010 Flow Diagram.
Figure 2
Figure 2
Boxplots representing change in (a) total irritable bowel syndrome-symptom severity score (IBS-SSS) [23] and (b) visual analog scale for irritable bowel syndrome (VAS-IBS) [24] for the intervention group and controls after the starch- and sucrose-reduced dietary intervention study. Mann–Whitney U test. p < 0.05 was considered statistically significant.
Figure 3
Figure 3
Correlations between changes in total irritable bowel syndrome-symptom severity score (IBS-SSS) [23] and carbohydrate and starch intake (in grams). Calculations were performed with the AIVO Diet computer program [20]. R2 = correlation coefficient. p < 0.05 was considered significant.
See this image and copyright information in PMC

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