A Starch- and Sucrose-Reduced Diet in Irritable Bowel Syndrome Leads to Lower Circulating Levels of PAI-1 and Visfatin: A Randomized Controlled Study

Abstract

Irritable bowel syndrome (IBS) is characterized by gastrointestinal symptoms. Overweight and increased risk of metabolic syndromes/diabetes are observed in IBS, conditions associated with plasminogen activator inhibitor-1 (PAI-1) and visfatin. The aim of this study was to measure blood levels of AXIN1, cholecystokinin (CCK), enkephalin, ghrelin, neuropeptide Y (NPY), PAI-1, and visfatin before and after a 4-week intervention with a starch- and sucrose-reduced diet (SSRD). A total of 105 IBS patients were randomized to either SSRD (n = 80) or ordinary diet (n = 25). Questionnaires were completed, and blood was analyzed for AXIN1 and hormones. AXIN1 (p = 0.001) and active ghrelin levels (p = 0.025) were lower in IBS than in healthy volunteers at baseline, whereas CCK and enkephalin levels were higher (p < 0.001). In the intervention group, total IBS-symptom severity score (IBS-SSS), specific gastrointestinal symptoms, psychological well-being, and the influence of intestinal symptoms on daily life were improved during the study, and weight decreased (p < 0.001 for all), whereas only constipation (p = 0.045) and bloating (p = 0.001) were improved in the control group. PAI-1 levels tended to be decreased in the intervention group (p = 0.066), with a difference in the decrease between groups (p = 0.022). Visfatin levels were decreased in the intervention group (p = 0.007). There were few correlations between hormonal levels and symptoms. Thus, this diet not only improves IBS symptoms but also seems to have a general health-promoting effect.

Keywords: AXIN1; cholecystokinin (CCK); enkephalins; ghrelin; irritable bowel syndrome (IBS); plasminogen activator inhibitor-1 (PAI-1); starch- and sucrose-reduced diet (SSRD); visfatin.

Figure 1

Study design, inclusion and exclusion criteria, and recruitment process of patients with irritable bowel syndrome (IBS) at primary healthcare centers and at one tertiary healthcare center.

Figure 2

CONSORT flow chart.

Figure 3

Sweet craving, estimated on a VAS-scale 0–100 mm, in the control and intervention group before and after a 4-week dietary intervention. Wilcoxon signed ranks test. p < 0.05 was considered statistically significant.

Figure 4

Basal levels (pg/mL) of AXIN1, cholecystokinin (CCK), enkephalin, and active ghrelin in healthy volunteers and IBS patients at baseline. Mann–Whitney U-test. p < 0.05 was considered statistically significant.

Figure 5

The differences in plasminogen activator inhibitor-1 (PAI-1) (ng/mL) changes during the study between the control and intervention group. Mann–Whitney U-test. p < 0.05 was considered statistically significant.