The recommended diet maintained optimal amounts of protein, carbohydrates, and fats, and it achieved a reduction in TRP by excluding or drastically reducing products high in TRP, such as wheat bread, sweets, hard cheeses, light and dark meats, and fish, as well as raw fruits and vegetables. Low TRP was defined as a reduction of tryptophan intake by at least 25% for 8 weeks. Investigators directed Group IIB, also consisting of 40 IBS-D participants, to follow a low-TRP, low-FODMAP diet. The interventional groups were randomly divided into 2 groups of 40 participants each: Group IIA consisted of IBS-D participants assigned to the FODMAP diet for 8 weeks after educational instruction. Group I was the control group, consisting of healthy participants consuming their usual diets, which investigators tracked for overall nutrient comparisons. Group IIA followed a low-FODMAP diet, and Group IIB followed the same low-FODMAP diet, except it was also low tryptophan. Group II was divided into 2 arms based on nutritional intervention. Patients were excluded if they used antibiotics, probiotics, or psychotropics in the month before the enrollment study. Participants were excluded if diagnosed with colitis, celiac disease, Crohn's disease, allergy, food intolerance, parasitic and bacterial disease, liver and renal disease, diabetes, severe anxiety, or depression. Small intestinal bacterial overgrowth (SIBO) was ruled out via lactulose hydrogen breath test (LHBT). They all had an intensity of pain with bowel movements of above 4 on the Gastrointestinal Symptom Rating Scale (GSRS), along with Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) scores above 11 points.Įxclusionary criteria for Group II: Investigators excluded participants from the trial if endoscopic and histological examination revealed pathology of gastric, duodenal, small intestinal, and colonic mucosa. Inclusion criteria for Group II: Those who met the criteria of Rome IV for IBS-D and had loose or watery stools at least 25% of the time for the last 6 months. The intervention groups consisted of 80 patients with confirmed IBS-D, divided into Group IIA and Group IIB. Group I consisted of 40 healthy people without IBS who served as the control. Open-label, cross-sectional clinical trial Participants To determine if low-tryptophan (TRP) foods, in addition to a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, would lead to improved clinical outcomes in irritable bowel syndrome–diarrhea subtype (IBS-D) Key TakeawayĪ low-tryptophan diet may improve global symptoms of IBS-D, including symptoms related to the microbiota-gut-brain axis however, long-term implications are unclear. The usefulness of the low-FODMAP diet with limited tryptophan intake in the treatment of diarrhea-predominant irritable bowel syndrome. Chojnacki C, Poplawski T, Blonska A, Konrad P, Chojnacki J, Blasiak J.
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