In lieu of a full low-FODMAP diet, a lactose-free diet could be empirically tried, even in patients with no known lactose intolerance. Gastrointestinal reactions to lactose-free dairy or very low levels of lactose may be due to a milk protein allergy rather than lactose intolerance. [1]
Some patients may find gluten avoidance improves some of their symptoms. “Non-celiac gluten sensitivity” is used to describe patients who have gluten sensitivity but do not have celiac disease. In IBS-D, this improvement may be due to reduction in consumption of fructans, rather than gluten, as both are present in similar food items.[2][3]
References
- ^Yang J, Deng Y, Chu H, Cong Y, Zhao J, Pohl D, Misselwitz B, Fried M, Dai N, Fox MPrevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome.Clin Gastroenterol Hepatol.(2013-Mar)
- ^Gry I Skodje, Vikas K Sarna, Ingunn H Minelle, Kjersti L Rolfsen, Jane G Muir, Peter R Gibson, Marit B Veierød, Christine Henriksen, Knut E A LundinFructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten SensitivityGastroenterology.(2018 Feb)
- ^Fedewa A, Rao SSDietary fructose intolerance, fructan intolerance and FODMAPs.Curr Gastroenterol Rep.(2014-Jan)