FOOD INTOLERANCE NETWORK FACTSHEET
Irritable Bowel Symptoms (IBS)
Introduction and symptoms covered in this factsheet
More about 'a feeling of incomplete evacuation'
Foods and food chemicals associated with IB symptoms
FODMAP or failsafe?
Fibre and sugar-free sweeteners: approach with caution
How to eat fibre, fibre supplements and dried beans
Bloating and flatulence due to legumes
Laxatives for people with food intolerance
Probiotics for irritable bowel symptoms
Coeliac disease (CD) and gluten intolerance
Lactose and dairy intolerance
diarrhoea, constipation, sneaky poos, bloating
mouth ulcers and tongue
Keywords: irritable bowel, bloating, gas, reflux, mouth ulcer, diarrhoea, constipation
Irritable Bowel is a diagnosis for a group of symptoms with no known cause - otherwise called functional gastrointestinal disorders. As one reader says 'it basically means we don't know'. There is increasing evidence that IBS is caused by the side effects of antibiotics (1).
You don't have to be diagnosed with IBS to have the symptoms described below. However, before using dietary management, check with your doctor that symptoms such as a change in bowel habits are not due to a known condition such as bowel cancer.
GI (gastrointestinal) symptoms covered in this factsheet
- reflux, colic (in babies and adults), heartburn, indigestion
- stomach aches, stomach cramps, bloating, flatulence
- nausea, vomiting, bad breath
- mouth ulcers, swollen, sore or geographic tongue
- diarrhoea and/or constipation, can be either or both
- constipation, faecal retention, enlarged bowel
- toddler diarrhoea, sneaky poos (encopresis, soiling)
- sticky poos (hard to clean up), 'a feeling of incomplete evacuation', spastic colon, sluggish bowel, lazy bowel
Childhood constipation appears to be increasing. According to a 2013 study, constipation was the most common general paediatric outpatient referral in a UK hospital in 2006.
Estimates of the prevalence of functional (meaning cause unknown) childhood constipation varies from 4% to 37%, with the highest in the world in Great Britain (34%) and Brazil (28% to 37%). In the USA, the prevalence rates in 2004 in a children's hospital clinic were 22.6% for constipation, 4.4% for faecal incontinence and 10.5% for urinary incontinence.
In the USA in 2010, Johns Hopkins Children’s hospital announced the opening of a new clinic to deal with a 30-percent jump in constipation-related visits between 2008 and 2009. However, in this facility, experts continue to blame constipation on lack of physical activity, inadequate water intake and low fibre diets, while recommending higher fruit intake, thus ignoring the possible role of salicylate and/or amine intolerance.
Thompson E, Todd P, Ni Bhrolchain C. The epidemiology of general paediatric outpatients referrals: 1988 and 2006. Child Care Health Dev. 2013 Jan;39(1):44-9.
Loening-Baucke V.Prevalence rates for constipation and faecal and urinary incontinence.Arch Dis Child. 2007;92(6):486-9.
This distressing condition (2) is often misunderstood by parents and medical professionals. When children with this condition switch to failsafe eating they will say 'now I feel as if all the poo comes out', adults will say 'it always used to feel as if there was more to come'.
One woman wrote: 'Sometimes I feel as if I have a heavy stomach (slightly bloated at times) continuously for about a week and going to the toilet doesn't solve the problem. It is like having a bit of diarrhoea and being slightly constipated at the same time.' Another said: 'I don't think he empties his bowel properly. He does try to go to the toilet but it is often just small amounts and sticky.' X rays may show a 'bowel loaded with faeces'.
Children and adults with these symptoms may be told by doctors to take daily laxatives, fibre supplements, to eat a high fruit diet – and when that doesn't work – weekly enemas. Yet the high fruit diet and fibre supplements may actually worsen the problem and there are numerous reports of children and adults with these symptoms improving within a week of starting their elimination diet, see story  Sneaky poos July 2005 below.
As with all food intolerance symptoms, people are different and may need a trial of the RPAH Elimination Diet with challenges to find out exactly what is causing the problem. Although salicylates are often implicated (3,4,5,6,7), they are usually overlooked.
The following table shows the foods and food chemicals most commonly associated with irritable bowel symptoms.
salicylates, MSG, preservatives
colours, synthetic antioxidants, amines
dairy and/or wheat
from Loblay and Swain 1976 (4)
Most people are affected by 3-6 of these items.
Note that colours include one natural colour: annatto 160b (8,9)
If you are new to the idea of salicylates, amines and glutamates, see Introduction to Food Intolerance. Reader reports below contain many stories illustrating the effects of salicylates, amines, glutamates, additives, dairy foods, wheat, gluten and others on various GI symptoms.
We hear that dietitians increasingly recommend both the RPAH Elimination diet and FODMAP diet at the same time. The FODMAP (Fermentable Oligo-, Di- and Mono-saccharides and Polyols) diet avoids short-chain carbohydrates such as fructose, lactose, fructo- and galacto-oligosaccharides (fructans and galactans) and sugar alcohols or polyols (e.g. sorbitol, mannitol, xylitol and maltitol) which can ferment in the gut to cause bloating, abdominal pain and diarrhoea (10,11). (See FODMAP diet at http://onlinelibrary.wiley.com/)
The FODMAP diet is useful only for symptoms of irritable bowel. If there is a family history of food intolerance symptoms such as headaches, migraines, itchy rashes, irritability, restlessness or sleep disturbance, we recommend a trial of the RPAH Elimination Diet.
In our experience, trying to combine the FODMAP diet with the RPAH Elimination Diet can be unnecessarily difficult.
Breath hydrogen testing can measure fructose absorptive capacity but is of no value for diagnosis of intolerances. Improvements in non-IBS symptoms such as behaviour after going on a low fructose or FODMAP diet are most likely due to a reduction of salicylates, amines and glutamates (see Story ).For more information see the PRAH Elimination Diet Handbook with food and shopping guide 2009, page 14, available from www.allergy.net.au.
If other food intolerance symptoms are present it may be better to start with the strict RPAH elimination diet (avoiding gluten and dairy if symptoms are severe, also avoiding sugar-free sweeteners such as sorbitol in processed foods). Note that pears - the only low salicylate fruit - contain sorbitol, so failsafers who seem to be reacting to pears with IB symptoms may need to avoid pears. If improvement is insufficient, you can proceed to full FODMAP avoidance, supervised by an experienced dietitian.
Some FODMAP foods such as fibre, legumes (dried beans, lentils, chickpeas) and sugar-free sweeteners including sorbitol, xylitol, mannitol (12, 13, 14) are called low-digestible carbohydrates because they are incompletely absorbed in the small intestine. Although permitted on the RPAH Elimination Diet, they may cause gastrointestinal symptoms such as abdominal discomfort, bloating, flatulence and watery stools or diarrhoea when consumed in large amounts or by susceptible people (11) and some are in fact sold as laxatives (guar gum) or fibre supplements (psyllium, spaghula husks).
Some fibre supplements have been found to do more harm than good.
Psyllium helps more people than bran (15). See Psyllium factsheet for some more information.
Benefiber (guar gum, plain not orange flavour) is also recommended by in the RPAH handbook.
Fibre and fibre supplements are likely to be best tolerated when they are:
- consumed in solid foods with a meal (rather than with liquid)
- started in small daily amounts and gradually increased
- used in smaller portions throughout the day rather than one large dose (11).
For the extra sensitive, this advice also applies to 'healthy' wholefoods such as wholewheat bread, wholewheat cereals, brown rice and dried beans.
Dried beans and other legumes are rich in nutrition and fibre but for people who have irritable bowel symptoms or those not used to a lot of beans in one sitting, they can also cause bloating, stomach discomfort and flatulence as shown in the famous Farting Cowboys Baked Beans Scene from Blazing Saddles http://www.youtube.com/watch?v=KMibdeOZ3_s
This is due to complex sugars called alpha-galactosides which humans cannot digest in the small intestine due to a natural lack of an enzyme called alpha-galactosidase. As undigested alpha-galactosides pass into the large intestine, fermentation by gas-producing bacteria can lead to intestinal flatulence. This hard-to-digest effect of legumes is considered healthy because it controls blood sugar levels, but it can result in painful bloating and loose bowel motions for people with IB symptoms.
The windy effects of beans can be reduced by:
- eating alpha-galactosidase-producing lactobacilli which may be why Indian meals that contain legumes are usually accompanied by yoghurt. Not all yoghurts have this effect, and it could be that none of the Australian yoghurts contain suitable cultures - for example, research has shown that Lactobacillus fermentum is effective (16) but as far as I can see this strain is patented and not available in Australia.
- taking Beano - this US product contains the enzyme (alpha-galactosidase) that can reduce the flatulence associated with bean eating in some people. However, because it works by breaking down indigestible sugars into simpler, more digestible sugars, it may negate the health benefits of eating beans on blood sugar levels. Diabetics are warned to consult their doctor before use. In a controlled trial of Beano, the number of flatulence events in the 5th hour after a meal was reduced, but there was no difference found in the extent of bloating or pain following the meal (17) www.beanogas.com
- Soaking beans and discarding soaking water before cooking has been found to reduce indigestible sugars (18).
- start slowly, e.g. 3-4 beans or chickpeas or 1 tsp of failsafe hummus or bean paste per day and increase slowly over a few weeks as recommended by dietitians.
Reader report: We have been seeing the dietitian you recommended since mid last year. Under her guidance, our daughter is eating a few more foods - including a couple of moderates - due to very starting with very small amounts and increasing gradually. This worked for low chemical legumes and pulses too (our daughter previously had IBS reactions to them) - she now eats good quantities of beans etc including the delicious Howard's Bean paste! - thanks to Carol
Once the diet has kicked in, you shouldn't need to use these very often:
- Epsom salts
- Glycerine suppositories
- Duphalac (lactulose)
- Parachoc (vanilla and chocolate flavour, liquid paraffin contains benzoates, not for long term use)
Psyllium is well tolerated by failsafers and is useful as a fibre supplement especially for those on a gluten free or low wholegrain diet and also to prevent constipation. http://fedup.com.au/factsheets/symptom-factsheets/constipation-and-psylliumSee more in the RPAH Elimination Diet Handbook with food and shopping guide 2009 (available from www.allergy.net.au)
The beneficial effects of probiotics on the gut have only recently been accepted in mainstream medicine, and are now the subject of numerous recent studies. There is strong evidence that probiotics may be beneficial for the prevention of antibiotic-associated diarrhoea (19, 20, 21) and traveller's diarrhoea (22), but studies regarding probiotics for IBS have produced contradictory results (23, 24). It is now understood that some strains are more beneficial than others and that for a particular patient, effectiveness may depend on the strain, the size of the dose and the condition. Despite sometimes variable results, irritable bowel specialist and Manchester University Professor Peter Whorwell considers that probiotics are 'worth trying' due to their beneficial effect on bloating (25,26).
Eating commercial yoghurt containing common live cultures appears to be less effective than taking probiotic capsules for the prevention of antibiotic-associated diarrhoea (27). Yoghurt is not suitable for the strict elimination phase of the RPAH Elimination Diet as it has recently been upgraded to moderate in amines.
Although probiotics are not listed in the RPAH Elimination Diet handbook, we have heard that some dietitians have recommended probiotics during the strict elimination diet. Dairy-based probiotics are not suitable for people who need to avoid dairy products. Also, it is possible that some probiotics may contain some amines (28). Probiotics are generally thought to be safe and free of side effects, with the exception of one report regarding very ill hospitalised patients (20,28).
More information is available on our probiotics factsheet.
CD is an immunological reaction to gluten in wheat, rye, barley and related cereal grains such as spelt and triticale. Your GP can refer you for a blood test for CD but be warned: it only works while you are currently eating gluten. If you think you may have coeliac disease, do not go gluten-free until you have had the test.
If you have a first degree relative with coeliac disease, you have a higher chance of being a coeliac yourself.
Some possible signs of coeliac disease in self or relatives, but be warned, you may have any or none of these: bulky, greasy, foul-smelling stools; exceptionally skinny and/or short stature; type 1 diabetes; Down syndrome; unexplained anaemia, calcium deficiency or other nutritional deficiencies; bone pain; unexplained male and female infertility; alopecia patchy baldness, (Alopecia factsheet), bowel cancer; skin rashes (dermatitis herpetiformis and others).
More symptoms and photos of rash: http://www.aafp.org/afp/980301ap/pruessn.html (29)
Undiagnosed coeliacs who continue to eat gluten have an increased risk of bowel cancer.
Until recently, it was thought that all coeliacs should avoid oats but it is now recognised that the majority of people with coeliac disease can tolerate moderate amounts of pure oats - that is, if free from contamination by wheat, rye or barley (30, 30a).
However, some researchers have found that some coeliacs may react to pure uncontaminated oats (30b). For now, advice from Coeliac Australia is that since we don't know which coeliacs may be affected by oats, and damage can occur in the absence of symptoms, oats should not be consumed by coeliacs without a biopsy prior to and during consumption.
Coeliac Australia's Oat FAQ http://www.coeliac.org.au/coeliac-disease/faq.html
Coeliac Australia's Oat Position Statement http://www.coeliac.org.au/content/downloads/Oats%20Position%20Statement.pdf
However, there may be some good news. Analyses of nine different oat varieties from Spain and Australia in 2011 found a wide range of results with one particular variety called OF720 that seemed to be particularly safe for coeliacs (30c). Differences between oat varieties would explain the contradictory findings so far. More testing needs to be done, but it seems that oats suitable for all coeliacs may be available in the future.
Gluten intolerance can exist without coeliac disease. You don't have to be a diagnosed coeliac to have problems with gluten. People with severe symptoms are normally advised to do the gluten-free version of the elimination diet. In my experience, relatives of coeliacs often do better - with a variety of symptoms - on gluten-free diets, whether coeliac or not.
Gluten intolerance has many of the same symptoms as those suffered by coeliacs but has no known genetic basis. It is sometimes called "non-coeliac gluten intolerance".
eg Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011 Mar;106(3):508-14; quiz 515. doi: 10.1038/ajg.2010.487. Epub 2011 Jan 11. http://www.ncbi.nlm.nih.gov/pubmed/21224837
Some of those who think they are reacting to gluten, however, may be reacting to fructans - research results are still coming in this area eg http://www.ncbi.nlm.nih.gov/pubmed/23648697
Lactose intolerance is the inability to digest lactose – milk sugar - due to low levels of an enzyme called lactase. Lactase levels vary according to race and age. Lactose intolerance is rare in people of Northern European descent but common among Australian Aborigines and people from Asia, Africa, the Middle East, Hispanics and some Mediterranean countries. Lactase levels can decrease with age and can be temporarily reduced by gastroenteritis. Symptoms can range from mild abdominal discomfort, bloating and flatulence to abdominal cramps and diarrhoea and may occur after ingesting dairy products especially milk, ice-cream and milk powder in products such as bread and biscuits. Babies are often wrongly thought to have lactose intolerance http://www.breastfeeding.asn.au/bfinfo/lactose.html.
People with lactose intolerance may be able to tolerate low lactose milk (e.g. Lactaid, Balance) from supermarkets, in the Longlife milk section. The following drops may assist with lactose absorption:
- Lact-easy Drops by Pharmotech 03 9531 6667 or ordered through pharmacies
- Lacteeze Drops (we don't recommend Lacteeze Tablets for people with other food intolerances due to mint flavouring) http://www.alternativehealth.com.au/Product/lacteeze.htm
More information: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Lactose_intolerance
Lactose intolerance is often wrongly blamed for problems with milk but dairy intolerance can be different from lactose intolerance. Cows' milk consumption has been associated with constipation in young children (31) as well as other symptoms of food intolerance.
A1 protein intolerance
People who have irritable bowel symptoms associated with 'normal' supermarket milk may unknowingly be sensitive to A1 beta-casein which breaks down to form a peptide called beta casomorphin7 (BCM7). This peptide is known to cause particular problems for people with an impaired digestive system (32, 33). It may be worth a trial of A2 milk (www.a2milk.com.au/) which contains a different kind of milk protein, see Success story  A2: Irritable bowel symptoms transformed by A2 milk (July 2010) and A2 milk factsheet.
During an A2 milk trial it is important to avoid the many other sources of A1 milk protein in foods such as icecream, yoghurt, milk solids or skim milk powder in many products including bread and biscuits, and also casein in many products including muesli bars.
For people with dairy rather than lactose intolerance, dairy-free substitutes include
· Soymilk (e.g. Sanitarium So Good)
· Nuttelex margarine
· So Good Vanilla Bliss soy icecream substitute
· Mototo dairy-free icecream substitute (moderate in salicylates because the vegetable fat is copha or coconut fat)
· Darifree calcium fortified potato drink - you can get it as a tin of powder, see http://www.biomedcafe.com.au/index.php?process=shop/productView.php&itemId=20013
See 18 page story collection on encopresis, sneaky poos/poohs, soiling, wetting, incontinent (includes those below)
 Sneaky poos and severe constipation improve within a week (July 2005)
My son is 6 years old and for the past year he has suffered from Sneaky Poos and has also suffered from SEVERE constipation. His bowel was so enlarged that he dirtied his pants on a daily basis. He claimed he could not feel it when he messed his pants.
As you can imagine, this was an extremely embarrassing problem for my little boy. I had taken him to the doctor on numerous occasions and was given Parachoc and Duphalac which I administered on a daily basis, and even though they did work, they did not solve the problem as to why he was dirtying his pants EVERY day. I also took him to the Continence Clinic to determine whether or not he had a psychological problem with going to the toilet. Although they were wonderful and supportive, my son still continued to mess his pants.
I was at my wits end, and very near hysterical when I was blamed for my son's behaviour. I went and saw my doctor who mentioned that he had heard of a "lady who deals with food additives' and referred me to a dietitian.
The results are amazing …my son was placed on the strict elimination diet, and the results were clearly seen by the end of the first week. He is now going to the toilet every second morning and not messing his pants during the day. He has lost weight, and his concentration span has slightly improved. I am only in week 3 and still sticking to the diet with him. He loves coming shopping with me and purchasing his special "Treats". He tasted Brussels sprouts for the first time in his life and actually liked them (no sorry I cannot succumb to them!) I will continue on the diet and commence the challenges soon. I am so pleased with the results. – Anna, Qld
 Sneaky poos and salicylates (October 2010)
Regarding my son and salicylates, he found the last of the watermelon yesterday and today we had the worst case of soiling I can ever recall. He told me it just slipped out. He is nearly 6! He did try to clean himself up but as they do he made a bigger mess. We are very strict with his diet, well, normally. There's no watermelon left now, the chooks enjoyed it. Thanks heaps.
 Sneaky poos and salicylates (October 2010)
We did the failsafe diet as a family for our seven year old's behaviour issues. I would have said there was nothing wrong with the four year old. He used to poo in his pants sometimes but I just put it down to being too busy to listen to what his body was telling him. Now we've just finished our salicylate challenge, I realise how wrong I was. It was salicylates! And I used to nag at him to eat fruit and vegetables thinking I was doing the right thing!
 Sneaky poos and amines (October 2010)
I'm writing to say thank you for your work that has made such a huge difference to our twelve year old son. He used to live on stuff like cheese, ham, bacon but now he knows his sneaky poos are related to amines, he sticks to his diet really strictly. Of all the problems caused by foods, soiling really is the worst. No one ever talks about it but the stigma at school is terrible. The other kids used to call him names and make fun of him. My heart breaks for him when I think of what he had to go through, and no one else has been able to help us.
 Stomach pains from Nurofen and salicylates in food (February 2008)
My son began getting diarrhoea and severe stomach pains from tomatoes and other high salicylate foods upon introduction of these foods from 6 months. My GP wasn't concerned about my son having constant foaming revolting smelling poo for three months but I certainly was! Thank you for your wonderful website which helped us to sort out this problem. He has shown similar reactions to salicylates in foods as he has to Nurofen – stomach pain that makes him scream for hours in agony and diarrhoea within 24 hours. This was when he was younger and we now know better than to give it to him. – Kate, by email
FROM  Sneaky poos and salicylates (November 2005)
I am continuing to stick to low sals vegies and I think it has made a big difference for my son's sneaky poos, his stools are now firm and well-formed and he has been going to the toilet everyday (finally!) - failsafer, Vic
FROM  Sore big farts due to salicylates in a breastfed baby (November 2005)
I cried when I read the stories on breastfeeding babies because that's our world since my son was born 16 months ago - screaming and arching his back until sore big farts release all day and night. I thought we were low salicylate (avoiding citrus, broccoli, tomato...) but it turns out it's all the things we were eating - grapes, watermelon, spinach - a difference is already obvious since cutting out high salicylates. - by email, Tasmania
 IBS after a virus (November 2006)
Seven years ago at the age of 55 I had a very nasty gastro-intestinal virus which led to CFS and IBS. Because of the severity of the IBS, I had many tests - some nasty, with scary implications. Finally, a very helpful dietitian (who works closely with the RPAH allergy unit) put me onto the elimination diet nearly 2 years ago. We have found that I have numerous intolerances: lactose, gluten, salicylates, amines, soy, MSG, sorbitol, sulphites, benzoates, annatto - to name a few.... – by email
 Salicylate intolerance misdiagnosed as Irritable Bowel Syndrome? (January 2007)
I have completed the elimination diet and found that I have an intolerance to salicylates.
My father is a gastroenterologist and when first had symptoms of this intolerance (stress, constipation, headaches, sinusitis etc) he thought it was Irritable Bowel Syndrome (IBS). He referred me to his colleague, who also stated the diagnosis was IBS. Both of these gastroenterologists never considered that the problem may be related to diet, and they didn't even know what salicylates were! I might add that both of them are very professional doctors and have both been head of the gastroenterology department at hospital - so you would think they would know something about it. It took my dad a long time to recognise that salicylates exist - I had to show him websites and papers that linked it to behavioural problems for him to really believe me. He just thought I was on some crazy diet and that there was no real basis to it!
My concern is this – that there are many people out there, particularly young women, who may have this food intolerance and be provided with the easy diagnosis of IBS. As you would be aware, an IBS diagnosis really doesn't help anyone because there isn't much you can do for it. And unless you keep searching for a solution (which I did, and my GP eventually came up with it) then you may never know you have an intolerance because salicylates are in everything!
 Fructose or salicylates? (October 2010)
When my son was a baby, he suffered with reflux and eczema and was a terrible sleeper. He was breastfed, so I removed salicylates from both my diet and his. He became more settled and his eczema cleared up; particularly his dry, red cheeks. Gradually the salicylates crept back into the diet, and since he has outgrown most of his eczema and I d forgotten all about them.
However, I have a hunch that salicylates contribute to him being so defiant and angry when things don't go his way. His behaviour has always been challenging, but has been particularly bad in recent weeks.
After complaining of bloating, diarrhoea etc a breath test revealed that he was fructose intolerant. So we started on the strict fructose elimination diet. My GP asked me a couple of weeks later how the diet was going. I responded that it was going well and that my son had not complained of bloating, stomach pains, etc since. However the thing I had noticed the most was his improved behaviour. I'm sure my GP thought I was a little odd, and commented that it wasn't something he'd heard of before but perhaps my son's behaviour is better because he doesn't have tummy pains. I wasn't convinced.
After a few weeks, we started a challenge by reintroducing the high fructose foods. He seemed to tolerate them well as long as he doesn't eat too much fruit each day. However, his behaviour has been foul! He seems more angry than ever, and last week I was wondering if he may be ODD. The 123 Magic which worked well for so long, now has no impact as he is just so defiant.
So, I started failsafe eating 6 days ago. We haven't done it perfectly as his diet is very restricted due to food allergies and the fructose intolerance. But I've removed the high salicylate items, particularly tomatoes, strawberries and cantelope; and we re really just having the good ol meat and 3 veg for tea every night. I've cut his fruit intake to 1 serve every 2-3 days.
Day 1 perfect behaviour although it was still like walking on egg shells.
Day 2 bad morning, good afternoon.
Day 3 good behaviour a little less eggshells!
Day 4, 5, 6 great behaviour.
When things are good he is the perfect gentleman, well mannered a real angel. But when things aren't going his way he still gets grumpy but most of the time he can now control the anger. A week or more ago, he just couldn't. It s early days, and of course we haven't followed the diet properly, but I can see a difference already. – by email, Vic
 160b: Marlene's story: annatto 160b and IBS (November 2009)
First, may I tell you my husband is a retired Allergist and Immunologist and he observed my IBS experiences then elimination of symptoms. For more than 40 years I had diarrhea and severe intestinal pain. The symptoms changed as the years passed. It went from occasional to frequent and from mild to severe. This leads me to believe it is dose and frequency related. The four years prior to my discovery that annatto was the problem for me, it was daily and severe. I would get an excruciating stomach ache with bloating after 20 minutes of ingestion of an annatto product. After another 20 minutes I had an emergency run to the WC and a long bout with painful diarrhea followed by many more trips to the WC. Then, I was enervated and just wanted to do nothing and sometimes for days after. I wasn't lactose intolerant nor did I have Celiac Sprue (which the doctors considered). In 2005, after a colonoscopy, my GI diagnosed me with IBS. The symptoms continued until 2006, when I was able to pinpoint what caused my IBS symptoms.
On a 37 day trip to Europe, I had no symptoms and was "normal". I thought about what I was eating in the States and not in Europe. Coffee Mate came to mind. I was asymptomatic the entire trip except for one cup of coffee with a non-dairy product on the plane. Aha! Back in the States, I stayed off Coffee Mate and was fine. 30 days later I tried it and the IBS returned. A few weeks later I ate a scoop of vanilla ice cream; IBS again. What they had in common was annatto, so I researched annatto. There are hundreds of papers on annatto but not one linking annatto to IBS. My husband ordered pure annatto and experimented on me. I got the full-blown IBS when we shared a glass of water with annatto. He didn't. Annatto predictably results in IBS symptoms of intestinal pain and diarrhea in me. It doesn't make sense I could be the only one who gets IBS symptoms from Annatto! - Marlene Stein, US (see Marlene's website www.ibsnomore.com with lists of annatto containing foods in the US)
 160b: Annatto and IBS in a 3 yo (October 2010)
I first noticed the annatto/IBS connection (bad smelling gas, diarrhea, loose stools) with my 3 year old son specifically with processed cheese singles, so I try to keep him away from those and generally don't have a problem, or if so, it is only small. Recently, we were away for almost a week, and when we came back, he started taking these "gummy vites" children's vitamins ("all natural" and sure enough colored with all natural annatto) he hadn't had for some time, and it was like a switch went off and the symptoms were back full force. - Anna, US
FROM  635: Severe irritable bowel symptoms and nausea (June 2006)
… I would occasionally get severe irritable bowel symptoms, a slight but very itchy rash and a severe feeling of nausea.
From looking at the responses on your website and finding a lady who said 635 in soups was the problem for her I went and checked the packaging of what I was eating and I realised flavour enhancer 635 was the common link for me. At the times I had sudden reactions I had been eating foods like Continental cuppa soups, packaged noodles, and beef stock, which all had 635 in them. Thanks for helping me find and kick this unhelpful additive out of my diet – Selina by email.
 635: Irritable bowel symptoms from packet soups (December 2005)
A few weeks ago I started having a Continental Low Carb instant soup every day. I knew the 635 was in there, but thought I didn't react to it. BIG mistake. No doubt you're expecting a description of the rash and swelling. Yes, I did get those, but not until week 2.
In week 1 my stomach progressively got sicker and sicker. By the end of the week I could only lie on the lounge and visit the loo. The doctor diagnosed mild food poisoning that turned into a very nasty stomach bug. Antibiotics and no food for three days cleared the bug. So what did I do? I had a miso soup from a local Japanese restaurant. A few hours later my stomach started going odd again and I began to itch. By that night the typical 635 rash and unbearable itch had set in. For some bizarre reason I didn't think of 635 with the miso.The next day I had one of those damn instant soups again and of course the same thing happened but worse.
Needless to say I have ditched the soup and banned 635. My son is actually quite pleased because one of the things that make him itch makes Mummy itch, so he feels a little less alone about it. The itch and rash have gone, but my lips are still very dry and cracked. But I have LEARNT MY LESSON! – Megan NSW.
FROM  IBS: colostomy for 11-month-old baby (May 2007)
… Four months had passed and we were increasingly worried for our daughter who still suffered from the terrible nappy rash and constant visible straining when using her bowel (most unusual in a baby) and was generally unsettled. By now we had tried cows' formula (which resulted in vomiting) and soy formula (which resulted in diarrhea) and we had also noticed that with fruits the problem was worse. Things didn't improve and after many calls and visits to our GP and Paediatrician we decided to see another Paediatrician.
The next Paediatrician suggested we trial a prescribed formula for 2 weeks. This resulted in violent vomiting and trip back to him whereby an ultrasound was performed and we were informed that she in fact had chronic constipation, with a large mass in her colon. Our daughter was now 11 months-old and had to have immediate surgery to remove the mass which resulted in her having a colostomy for 3 months.
We were assured by the Paediatric Surgeon that in fact her problems were not food related and that she was born with an 'anorectal anomaly' and that all would be ok once the colostomy was reversed. To our disappointment as soon as the colostomy was reversed we went straight back to the problems of severe nappy rash and excoriation on her full diet. Our daughter at 15 months was then seen by a Professor at the hospital who diagnosed disaccharidase deficiency (sucrose intolerance) to be the cause of the excoriation and unsettled behaviour; not the case.
Somehow eventually after breaking down many times and a visit again to our GP's rooms in desperation we were finally sent with a referral to the RPA Allergy Clinic (daughter now 21months old). This was like a dream come true, they did a skin prick test for allergies; which showed no positive reactions (as suspected it would by the clinic Paediatrician). We were then talked through food intolerances and naturally occurring chemicals in foods which caused intolerances in some people! The evidence was there in front of us and we couldn't believe it we finally had answers. Our daughter is now a healthy 6.5 year old, on a low salicylate and mainly low chemical diet who continues to thrive and hasn't looked back. We do trial new foods occasionally and are starting to add small amounts of moderate salicylates to her diet and some dairy (her main drink is now rice milk). We know straight away if she has overloaded as this results in usually loose motions or not being able to control her motions. For us the evidence is overwhelming and we are just very grateful we have our daughter and we can now give her answers and solutions so that she continues to enjoy good health and happiness. - by email. (full story in Reader Stories pdf)
For the past 18+ months my wife has suffered from an increasing problem with gut issues and chronic diarrhea and related symptoms. She has tried various milks and milk substitutes (soy, etc). None have made any difference to her gut problems. Her GP has not found any specific cause and has recommended a range of tests and indicated it was probably "irritable bowel syndrome" which I'm sure you know is one of the catch-all medical labels which basically means "we don't really know".
On pure chance my wife (who had seen your report a couple of years ago on A2) decided about 6 weeks ago she had nothing to lose by trying A2 milk.
Our life has been transformed and this happened literally overnight! Gut patterns are back to normal, a far far cry from many daily urgent dashes to the loo, usually immediately after eating or drinking almost anything but particularly things containing dairy products. Literally life became normal within 4 hours of her first bowl of oatmeal with A2 milk. Absolutely amazing. The transformation has been astounding and we are very grateful to the people that have figured out the A2 story - Russell by email.
FROM  One-liners (January 2007)
"If no one's told you recently, thanks so much for all the work you do - you have changed our lives! It's good to have an asthma-free, medication-free, tummy ache and diarrhoea-free child after many wasted futile hours and $$$$ spent in specialist surgeries!! And even now I've found the answers (thanks to you), still the doctors are not interested in hearing about it. That's what I find so hard to believe! - Fran, NSW.
FROM  Irritable bowel symptoms due to sulphites (March 2006)
… In 2001 I gave up smoking and went through a lot in my life while living overseas and in 6 months went from 55kg to 72 kg. I started getting bowel problems (flatulence, constipation, cramps and diarrhoea) and no matter what I tried I could not lose the weight.
By the end of 2003 I had moved back to Australia and was on a wheat-free diet. My rash went away but I was still having bowel problems and irritability. Sometimes I would buckle over in so much pain I couldn't walk, have terrible wind and then diarrhoea. I always needed to be near a toilet. That is when I went on the elimination diet and found that I was incredibly sensitive to sulphites and that the cramps and diarrhoea were from sulphites. The bad wind was caused by amines, and artificial antioxidants were a mixture of the two. My rash is staying away too. I am also back down to 55kg after coming back to Australia, going off wheat but also enjoying the active Australian lifestyle. I can now eat wheat as long as it has no preservatives - maybe it was never wheat that was the problem! – aged 23, by email
FROM  IBS and amines: Chocolate was my drug of choice (Sept 2004)
… Whenever I was under stress my 'drug of choice' was chocolate. I was sure chocolate could get me through anything and could eat up to a block a day ….A year and a half ago my sister suggested that I try failsafe eating for symptoms that my doctors were calling irritable bowel. I had gone off antidepressants for about six months before testing for IBS, but the first thing the doctors did when looking into my bowel problems was to put me back on antidepressants. During this time I had still been eating my old diet of chocolate, plus other foods that are high in amines …. – by email, NZ
FROM  Effects of MSG (April 2003)
I have worked out that my son's bad behaviour is all due to added MSG. He is OK on cheese and other natural MSG products - but give him a KFC chicken nugget packet and their chicken salt chips with the so called "secret herbs and spices" and you can see the reaction within 30 to 60 minutes. I'm not surprised as I get very similar reactions with MSG although my reaction is different. I have Irritable Bowel and my reaction to MSG is to have a bad IBS attack. - by email
FROM [203b] Severe constipation from bread preservative 282 (September 2002)
… I developed a very irritable bowel in my early forties. Trying a rotation diet showed that commercial sliced bread caused severe constipation. Other foods, obtained from the delicatessen, also caused overwhelming sleepiness, headaches and bouts of stomach aches and malaise. It is now so bad that eating any commercial bread or products such as commercial schnitzels, causes an attack which is characterised by bowel cramps, pain, burning sensations in the gut, nausea, headache and muscle spasms in my neck, back and legs. It usually takes three days of fasting, or a rice diet, before the symptoms subside. My medical advisers would never take seriously my claim that bread, cakes and pastries were associated with the problem, although I underwent food challenges under the direction of a respected dietician. Semolina and some home made bread does not cause me any problems. The received view still seems to be that there is a psychiatric component to irritable bowel syndrome, especially as it seems a majority of women are diagnosed with this disorder! Consequently, there is little sympathy for the sufferer, and no treatment other than antispasmodics and anti-flatulence drugs …. -- by email, Sydney
FROM  Colonoscopy was the turning point (August 2001)
… But worst of all was my bloated stomach, which most times looked like I was 7 months pregnant, and the related bowel problems. Looking back I had been gradually getting worse for a couple of years.
I had been to my doctor a couple of times for other things and always mentioned the vague symptoms. I was told not to worry. As the bowel problems persisted I started to worry as my grandfather had died of colon cancer. A Rotary test was negative but I still worried. I went to my doctor again and although she agreed that the bloated stomach was unusual she could find nothing wrong. However, she realised that I was really starting to worry about cancer, so she suggested I have some tests, just to set my mind at rest. I had an abdominal scan and full blood tests. Nothing wrong. But my worry was increasing, so she sent me for a colonoscopy, warning me that it would be unpleasant.
That was my turning point. The specialist could not understand my mixed reactions when he told me there was nothing wrong. However, I had had the colonoscopy on a Monday so had arranged to also have Tuesday off work as I imagined I would still feel pretty awful a day later. I woke up on Tuesday feeling fantastic. I packed so much into that one day it was amazing. I also did not eat, as I so much enjoyed feeling "empty". I wondered whether my symptoms were being caused by something I was eating.
Coincidentally, I had recently read an article about food intolerance, and your book was recommended. I bought your book and realised that all my symptoms fitted the pattern. I even had belatedly-diagnosed giardia for several weeks a couple of years before. I went back to the doctor, and suggested I go on an elimination diet. She was very lukewarm about the idea but I was determined so I followed your instructions and went on the strict diet for several weeks. I tried the challenges and narrowed my causes down to dairy and salicylates (both of which I had normally in large quantities). I then got caught up in a round of end of year work functions and lunches, so I was not able to be so strict with myself. I went backwards quickly.
Now I avoid all processed foods, eat failsafe at home, and make informed choices when out. I love wine but have cut down to a couple of glasses per week, have decaf coffee, soy milk etc.
The result has been a new zest for life - new role at work, back to studying part time and lots of activities. I'm back to size 12 clothes (have bought lots of new ones). I turn 50 next week and feel like 40. I'm a bit evangelical when I tell people why I've lost so much weight, so I don't mind you sharing my story if it is of interest to others. Thanks again for providing the tools for me to get my life back. - NSW
 Daniel's story: severe colic and reflux (June 1999)
From the minute Daniel was born, he was a very unsettled baby. We went home on day three and I expected he would improve when my milk came in. I work as a midwife, so I had some idea of sleepless nights etc, but nothing had prepared me for a baby who screamed constantly when awake and slept very little. My mum said I had been a very colicky baby and my mother-in-law said my husband had been an extremely colicky baby - so we presumed Daniel was the same … - Jenny, Vic (see Success Stories for the rest of this long saga including unnecessary surgery. Eventually Daniel's problem was found to be food intolerance especially salicylates.)
 Silent reflux, gastro, extreme nappy rash – months of needless medication (February 2008)
WINNER OF THE COURAGE AWARD
My 13 month-old son has had silent reflux (just weaned him off losec now), and yet still has bad gastro problems - excessive burping, difficulty swallowing/coordination with swallow and breathing, tummy aches (frequent back arching, screaming and night waking all the time). My paed has recommended an immunologist but reading your website it seems we need to do a diet approach for intolerances.
I have always been careful with my diet as I breastfed him avoiding foods that were known to cause wind. I even saw a dietitian out of desperation when he was a little babe - who took my money and told me breastmilk is not affected by what Mum eats. My instincts told me otherwise. I know that strawberries, tomatoes, stock, gravy (to some extent), sausages (two nights in a row), citrus, onion and ham produces bad painful gastro reactions in him. Yet despite avoiding these, our problems still continue. If we eat out, guaranteed he will have a bad night in the next 24 hrs and bad poos for days after. My son has never had a normal poo - even on breastmilk. Acid smell is very common, and it produces the worst nappy rash I've ever seen with skin completely gone and large patches of exposed sores.
Two weeks later …
In the two weeks since I first emailed you from sheer desperation, I almost cry every time I think about how my little son's severe gastro problems have so simply and easily disappeared. He slept through the night 48 hrs from our first meal of chicken fried in golden syrup with pasta (the only quick makeshift meal I could make the first night after I emailed you!). His reactions of reflux, pain in tummy, badly burnt bottoms (v. extreme), excessive night waking and festy burps have all disappeared!!!! I have spent the past 13 months in a sleep deprived land (lasting on about 4 random hours a night on average), with my daughter not getting much quality mum attention and my husband declaring 'no more, this is it re: kids'.
Now I have a son who in two weeks has spoken five extra words, gained 600g weight, sleeps hard, eats hard, plays hard (every mum's dream), plus two new teeth - and generally very alert, smart, and most of all, wakes from his sleep playing in his cot – no screaming. Two days after I started with that first crude meal I woke in the morning to hear his toy whizzing around, and not him – a dark cloud just physically lifted from my body and I just knew this was the last piece of the puzzle of our long journey. I continued the diet from the info on your internet site and saw the dietitian you mentioned. The other amazing thing is that my husband is a completely different man (see story  'No need for Beyond Blue due to diet').
I have now seen three dietitians, three paed's and a whole swank of GPs. I could have saved my son months and months of pain and high levels of losec medication. The medical profession has a lot to answer for, not listening to Mum's intuition. We had attended a feeding clinic where they have sessions with a dietitian, speech pathologist, and child health nurse (3 with you and bub) to work out reflux issues. My son had all three problems - still has swallow/coordination problems, and is very very cautious with food textures.
I spent most my time in these clinics (been 3 times already) talking diet - and you know I remembered this morning out of nowhere that the dietitian in these clinics did say something like: 'tomatoes, strawberries, stock - yes they contain salicylates, ahh but you don't need to worry about that. That's too much detail.' I did question her again on it, but I forgot what the 'salicylate' word was at our next visit and ended up sounding stupid. I was nearly there with my list of existing reacting foods but did not have the expertise to link them together. I thought it was acids affecting my son and sugar affecting my husband. Oh well. Move forward. At least I have my husband back again and a gorgeous boy we can all enjoy. :) – Fiona, ACT
 Reflux, gastroscopy and the failsafe approach (May 2006)
Some years ago now, I remember reading a message from a failsafer who'd had a gastroscopy before he went failsafe, which showed scarring and evidence of reflux, and he was put on strong antacids and told he might eventually need an operation (presumably to repair the gastric sphincter).
Exactly the same happened to me. I had years of gastric symptoms and had had two gastroscopies before I discovered failsafe eating. The first one showed no ulcer but that the lining was inflamed. After the second I had exactly the same diagnosis as in the story above. I remember the gastroenterologist telling me that although the symptoms weren't typical, the problem was definitely reflux, and suggesting the operation.
After I had been on the diet for some years, I had another gastroscopy to investigate the possibility of coeliac sprue. This wasn't found (thank heavens) but it did demonstrate that the scarring and inflammation that had previously been there was now gone. The diet had resolved about 10 years of painful gastric symptoms for me.
 Severe colic and reflux (September 2000)
I am currently reading your book "Fed Up". I have a 3-year-old as well as an 8-month-old whom I'm breast-feeding. Both my children have suffered with severe colic and reflux as well as skin allergies. I have been convinced for a while now that it had something to do with their diet. I did not know where to start in finding out what may be the cause as every doctor that I have been to see just wanted to give me more medication. I have started both my children as well as myself on the elimination diet. It has been three days now and I am noticing a big change in my 3-year-old's behaviour where she is not depressed when she wakes in the morning. My 8-month-old has stopped vomiting. Last night I actually got to sleep six hours straight without having to see to the baby two or three times … I would like to seek help from a dietitian who agrees with the elimination diet … Thank you so much for your book. It makes so much sense to me. – by email
Mouth and tongue
 Mouth ulcers – flavoured chips (February 2008)
I started my family on the diet three months ago – successfully - for my son. After a weekend away, just me and my hubby, eating all the things we haven't eaten for some time, most of all flavoured chips, I got mouth ulcers back again. This is something I have suffered with for many years, I have often feared it to be cancer, and had swabs taken etc to no avail. I hadn't really noticed that they had gone away, till they came back again within 2 days - unbelievable! – Rachael, by email
 Mouth ulcers - salicylates (February 2008)
I just had to tell you!!! For the last two months I've had no additives, no kiwi fruit, no oranges, no strawberries, no tomatoes, no juice and have had 7 weeks without a mouth ulcer. Usually I only go about 2 weeks pain-free before the skin on the roof of my mouth peels, the tip of my tongue becomes extremely sore together with a badly infected ulcer anywhere in the mouth. Last week I ate 3/4 tomato - within 24 hours I was starting to get an ulcer. Fortunately, this time it hasn't developed into anything nasty - probably because I went back on the strict diet. - Di, Vic
 635: Skin peeled off my tongue (January 2006)
I am not game to even contemplate eating anything with 635, as once I knew what my reaction to MSG was like, I found out the hard way, and saw the flavour enhancer 635, so I thought it may be OK. My face swelled up, I developed a rash all over my face and neck, and consequently all the skin peeled off my tongue, inside of my lips and gums. You have never seen such a mess!! At least I didn't have to go through what these little kids had to suffer and their poor parents. I just couldn't eat anything much for a few days!! – reader by email.
FROM  Snoring, sleep apnea, swollen tonsils and macroglossia due to additives (June 2010)
Before removing additives, my daughter's face was always a little chubby-looking with a double chin, although she wasn't chubby. It was the swollen tonsils that were causing the double chin. Now she is more normal in appearance without chubby cheeks and oversized swollen tongue that made her speak oddly. – Maree, Canada
 Geographic tongue (October 2010)
We have noticed our 3 yo has geographic tongue when he is at the Dr for his ears - which is related to dairy. - by email, Tas
 Ulcerated tongue improves on diet (October 2010)
My son (aged 4) is very food intolerant. His symptoms include nose bleeds, ulcerated tongue, grumpyness, headaches, oppositional defiance symptoms and the list goes on. My daughter (aged 7) suffers from stomach aches, headaches and ulcerated tongue - although not as bad. We have followed the elimination diet in the past and have had success. But after being off the diet for 6 months both children's tongues are ulcerated again …
FROM  Sorbitol and bloating (January 2006)
A few months ago I started chewing sugar-free chewing gum several times a day and since then, my stomach has been almost continuously bloated. On occasions the amount of gas in my stomach is so extreme that I have to force myself to burp to relieve the pressure in my stomach - Male, 30s, Australia, sorbitol and maltitol, twice daily.
FROM  Sorbitol and spastic colon (January 2006)
I was suffering with a sort of what I thought was "gastritis", causing extreme obnoxious embarrassing gas and bloating, and after an hour or two, constant gas every 10 minutes for hours and hours .... it was so bad I wanted to run away from myself, I know that's funny but it was quite disgusting, the doctors told me I had a spastic colon but I noticed the "health" food candy bars I thought were healthy had sorbitol and my stomach feels perfect since I've been reading the labels and staying away from the sorbitol - female, 30s, USA, sorbitol, daily
FROM  Maltitol: excruciating stomach pains and sudden diarrhea (January 2006)
I ate 5 caramels that I thought were safe because they were free of artificial colours and other additives. A few hours later I had excruciating stomach pains and sudden diarrhea – female, 40s, Australia, maltitol, one serve
1. Dethlefsen L and others, The pervasive effects of an antibiotic on the human gut microbiota, as revealed by deep 16S rRNA sequencing. PLoS Biol. 2008 Nov 18;6(11):e280.
In this study from Stanford University in California, more than 50 stool samples were collected from three healthy volunteers over a 10-month period that included two 5-day courses of the antibiotic ciprofloxacin (considered more bowel-friendly than most antibiotics). Microbial strains present in each sample were identified by gene sequencing. Researchers found that the unique set of microbial flora in each person was disrupted by each course of antibiotics and some strains were permanently altered by the end of the trial. Each round of antibiotics is a roll of the dice that could lead to lasting changes in a person's gut microbes, say the researchers who recommend that antibiotics should be used only when truly necessary. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586385/?tool=pubmed
2. Francis CY, Whorwell PJ. The irritable bowel syndrome. Postgrad Med J. 1997 Jan;73(855):1-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2431185/pdf/postmedj00145-0002.pdf
3. Feingold BF. Behavioral disturbances linked to the ingestion of food additives. Del Med J. 1977 Feb;49(2):89-94.
Dr Ben Feingold was the first to link food additives and salicylates with behavioural and other adverse effects including heartburn, flatulence, heartburn, mouth ulcers and inflammation of the tongue. http://www.feingold.org/bio.html
4. Loblay RH, Swain AR. Food Intolerance. In: Recent Advances in Clinical Nutrition' Vol 2, 1986. Libbey, London. Eds: Wahlqvist ML and Truswell AS, pp169-177. A report of research based on patients with irritable bowel symptoms at Sydney's Royal Prince Alfred Hospital Allergy Clinic. http://www.slhd.nsw.gov.au/rpa/allergy/research/foodintolerance_racn.pdf
5. Clarke L and others. The dietary management of food allergy and food intolerance in children and adults. Austr J Nutr Diet 1996;53(3):89-94. http://www.slhd.nsw.gov.au/rpa/allergy/research/daareview.pdf
6. Raithel M and others. Significance of salicylate intolerance in diseases of the lower gastrointestinal tract. J Physiol Pharmacol. 2005;56 Suppl 5:89-102.
This paper describes the possible effects of nonsteroidal anti-inflammatory drugs (NSAID) intolerance on gastroenterological symptoms (e.g. abdominal pain, diarrhea) and recommends avoidance of salicylate-containing foods (e.g. pineapple, berries, curry, spices, potatoes, citrus fruits etc.) as well as food additives (colorants and preservatives) for patients with salicylate intolerance. http://www.jpp.krakow.pl/journal/archive/09_05_s5/pdf/89_09_05_s5_article.pdf
7. Loraschi A and others. An unusual systemic reaction associated with topical salicylic acid in a paediatric patient. Br J Clin Pharmacol. 2008 ;66(1):152-3.
A report of a 9-year-old boy who suffered from weeks of abdominal pain, nausea and constipation as well as increasing weakness and general illness including mildly impaired mental performance associated with the use of patches containing salicylic acid for a plantar wart. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2485242/?tool=pubmed
8. Stein HL. Annatto and IBS. J Clin Gastroenterol. 2009 ;43(10):1014-5. An account of irritable bowel syndrome due to unrecognised sensitivity to annatto, see story  above.
9. Floch MH. Annatto, diet, and the irritable bowel syndrome. J Clin Gastroenterol. 2009;43(10):905-6. Professor Floch is Clinical Professor of Medicine at Yale University School of Medicine.
He comments 'It is clear that annatto is common in our foods, it is clear that it is not known as a significant producer of allergic responses, and it is unknown to most of our practitioners dealing with allergies and the irritable bowel syndrome. Therefore, it behooves us to begin studies in investigating the role of dyes such as annatto in the production of the symptoms of the irritable bowel syndrome'.
10. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010 Feb;25(2):252-8. http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2009.06149.x/full
11. Grabitske HA, Slavin JL. Low-digestible carbohydrates in practice. J Am Diet Assoc. 2008;108(10):1677-81. A presumably food industry funded article for dietitians about the benefits and side effects of LDCs http://www.polyol.org/pdf/Slavin%20article.pdf
12. Breitenbach RA, Simon J. Cases from the aerospace medicine resident teaching file. Case #59. A case of "unbearable" gremlinenteritis, Aviat Space Environ Med, 1994 ;65(5):432-3.
A flight surgeon presented with severe diarrhea of sudden onset that was traced to sorbitol. A clinic patient in an early season of House MD appeared with these symptoms.
13. Jain NK and others. Sorbitol intolerance in adults, Am J Gastroenterol. 1985;80(9):678-81.
In a study with 42 healthy adults, clinical sorbitol intolerance was detected in 43% of the whites and 55% of the nonwhites. The authors concluded that a large number of adults could be suffering from sorbitol-induced nonspecific abdominal symptoms and diarrhea. These symptoms could lead to an extensive diagnostic work-up and lifelong diagnosis of irritable bowel syndrome.
14. Hill RE and Kamath KR. "Pink" diarrhoea: osmotic diarrhoea from a sorbitol-containing vitamin C supplement. , Med J Aust, 1982;1(9):387-9.
An account of protracted diarrhoea in seven children seen in two paediatric-gastroenterology outpatient departments due to sorbitol in a vitamin C supplement.
15. Bijkerk CJ and others. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ. 2009;339:b3154.
This study showed that soluble fibre (psyllium) can improve the symptoms of irritable bowel whereas insoluble fibre (bran) can worsen the condition. http://www.bmj.com/content/339/bmj.b3154.long
16. LeBlanc JG and others. Ability of Lactobacillus fermentum to overcome host a-galactosidase deficiency, as evidenced by reduction of hydrogen excretion in rats consuming soya a-galacto-oligosaccharides. BMC Microbiol. 2008; 8: 22. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2270848/?tool=pubmed
17. Ganiats TG and others. Does Beano prevent gas? A double-blind crossover study of oral alpha-galactosidase to treat dietary oligosaccharide intolerance. J Fam Pract. 1994 Nov;39(5):441-5. http://www.ncbi.nlm.nih.gov/pubmed/7964541
18. Queiroz Kda S and others. Soaking the common bean in a domestic preparation reduced the contents of raffinose-type oligosaccharides but did not interfere with nutritive value. J Nutr Sci Vitaminol (Tokyo). 2002 Aug;48(4):283-9. http://www.ncbi.nlm.nih.gov/pubmed/12489819
19. Kale-Pradhan PB and others. Role of Lactobacillus in the prevention of antibiotic-associated diarrhea: a meta-analysis. Pharmacotherapy. 2010;30(2):119-26.
The use of a Lactobacillus single-agent in varying doses throughout the entire antibiotic treatment (5-14 days) reduced the risk of developing antibiotic associated diarrhoea compared with placebo in adults but not children.
20. Doron SI and others. Probiotics for prevention of antibiotic-associated diarrhea. J Clin Gastroenterol. 2008;42 Suppl 2:S58-63.
Lactobacillus GG, Saccharomyces boulardii, and certain probiotic mixtures have been shown to be effective for prevention of AAD in adults. In children, Lactobacillus GG, Bacillus coagulans, and S. boulardii appeared to be most effective. Probiotics are generally thought to be safe, however, they should be used with caution in patients who have compromise of either the immune system or the integrity of the intestinal mucosa, and in the presence of a central venous catheter. http://www.ncbi.nlm.nih.gov/pubmed/18542041
21. Lönnermark E and others. Intake of Lactobacillus plantarum reduces certain gastrointestinal symptoms during treatment with antibiotics. J Clin Gastroenterol. 2010;44(2):106-12.
This study showed that intake of L. plantarum could have a preventive effect on milder gastrointestinal symptoms during treatment with antibiotics.
22. McFarland LV. Meta-analysis of probiotics for the prevention of traveler's diarrhea. Travel Med Infect Dis. 2007;5(2):97-105.
Probiotics were found to significantly prevent traveller's diarrhoea, in particular Saccharomyces boulardii and a mixture of Lactobacillus acidophilus and Bifidobacterium bifidum.
23. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008;14(17):2650-61.
Studies of probiotics for IBS have yielded contradictory results, which may be due to a variety of factors: small sample size; variability in trial design; heterogeneity of probiotic strain, dose and treatment duration; and patient characteristics. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709042/?tool=pubmed
24. McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010;16(18):2202-22.
In adults, Saccharomyces boulardii (S. boulardii) can be strongly recommended for the prevention of antibiotic associated diarrhoea and traveler's diarrhea; S. boulardii also shows promise for the prevention of C. difficile disease recurrences; treatment of irritable bowel syndrome, acute adult diarrhea, Crohn's disease, giardiasis, and human immunodeficiency virus-related diarrhea. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868213/?tool=pubmed
25. Agrawal A and others. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173-010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther.
This study showed that this particular probiotic was helpful for symptoms of bloating and distension. http://www.ncbi.nlm.nih.gov/pubmed/18801055?dopt=Abstract&holding=npg
26. Whorwell PJ and others. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol. 2006 Jul;101(7):1581-90.
A four week trial of freeze dried Bifidobacterium infantis 35624 at three dose levels for 362 women with irritable bowel symptoms found that the middle dose (1 x 10(8) cfu) was significantly superior to placebo and the higher and lower bifidobacterium doses for abdominal pain, bloating, bowel dysfunction, incomplete evacuation, straining, and the passage of gas. These researchers say 'probiotics are worth a try' but note that not all species or dosage will necessarily have the same therapeutic potential in a particular condition.
27. Conway S and others, Does eating yogurt prevent antibiotic-associated diarrhoea? A placebo-controlled randomised controlled trial in general practice. Br J Gen Pract. 2007;57(545):953-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2084134/?tool=pubmed
28. Mullan WMA. (2002) . Probiotic microorganisms in food. Properties, benefits, safety and enumeration - European Community Regulation no 1924/2006 and health and nutrition claims. [On-line]. Available from: http://www.dairyscience.info/probiotics/50-probiotics.html?start=14 Accessed: 8 November, 2010. last update December 2008.
On page 8, this article discusses how some lactic acid bacteria can produce biogenic amines such as putrescine, cadaverine, histamine, tyramine and 2-phenylethylamine, which can cause reactions in people with reduced monoamine oxidase (MAO) activity like us or those taking MAO inhibitors. According to Mullan, if strains are screened properly biogenic amine formation should not be a problem.
29. Pruessner HT. Detecting celiac disease in your patients. Am Fam Physician. 1998;57(5):1023-34, 1039-41.
30. Pulido OM and others. Introduction of oats in the diet of individuals with celiac disease: a systematic review. Adv Food Nutr Res. 2009;57:235-85.
30a Rashid M and others, Consumption of pure oats by individuals with celiac disease: a position statement by the Canadian Celiac Association.Can J Gastroenterol. 2007;21(10):649-51. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658132/?tool=pubmed
30b. Arentz-Hansen H and others. The molecular basis for oat intolerance in patients with celiac disease. PLoS Med. 2004;1:84-92. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC523824/?tool=pubmed
30c. Comino I et al, Diversity in oat potential immunogenicity: basis for the selection of oat varieties with no toxicity in coeliac disease. Gut. 2011 ;60(7):915-22. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3112367/?tool=pubmed
The term gluten covers a range of proteins that can affect people with coeliac disease: gliadin in wheat, secalin in rye, hordein in barley and avenin in oats. Avenin peptides from the nine oat varieties were tested for how strongly they bind to the G12 antibody, used because it binds strongly to gliadin. Binding strengths of avenin peptides covered a wide range from below the limit of detection with OF720 to 250 times more reactive with the most reactive oat variety and OF720 peptides were over 10,000 times less reactive than those from wheat gluten. Results were similar with the R5 ELISA assay.
31 Andiran F and others. Cows milk consumption in constipation and anal fissure in infants and young children. J Paediatr Child Health. 2003;39(5):329-31.
32. Kaminski S and others, Polymorphism of bovine beta-casein and its potential effect on human health. J Appl Genet. 2007;48(3):189-98. http://jag.igr.poznan.pl/2007-Volume-48/3/pdf/2007_Volume_48_3-189-198.pdf
33. Woodford K, Devil in the Milk, Craig Potton Publishing, 2007, Nelson NZ, pp142-151.
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Video: Marg talks about IBS and salicylates (1:16)
The information given is not intended as medical advice. Always consult with your doctor for underlying illness. Before beginning dietary investigation, consult a dietician with an interest in food intolerance. You can see our list of experienced and supportive dietitians http://fedup.com.au/information/support/dietitians
© Sue Dengate update December 2012