Elsevier

Nutrition Research

Volume 86, February 2021, Pages 23-36
Nutrition Research

A carbohydrate-restricted diet for patients with irritable bowel syndrome lowers serum C-peptide, insulin, and leptin without any correlation with symptom reduction

https://doi.org/10.1016/j.nutres.2020.12.001Get rights and content
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Abstract

Alterations in gut endocrine cells and hormone levels have been measured in patients with irritable bowel syndrome (IBS). The hypothesis of the present study was that hormone levels would change after 4 weeks of a starch- and sucrose-reduced diet (SSRD) intervention corresponding to decreased carbohydrate intake and symptoms. Among 105 IBS patients from primary and tertiary healthcare, 80 were randomized to SSRD, while 25 followed their ordinary diet. Food diaries, Rome IV, and IBS-symptom severity score (IBS-SSS) questionnaires were completed, and blood samples were collected at baseline and after the intervention. Serum C-peptide, gastric inhibitory peptide, glucagon, glucagon-like peptide-1, insulin, leptin, luteinizing hormone, polypeptide YY, and glucose were measured, along with the prevalence of autoantibodies against gonadotropin-releasing hormone; its precursor, progonadoliberin-2, and receptor; and tenascin C. Carbohydrate intake was lower in the intervention group than in controls at week 4 (median: 88 [66-128] g vs 182 [89-224] g; P < .001). The change in carbohydrate intake, adjusted for weight, was associated with a decrease in C-peptide (β: 14.43; 95% confidence interval [CI]: 4.12-24.75) and insulin (β: 0.18; 95% CI: 0.04-0.32) levels. Glucose levels remained unchanged. The IBS-SSS scores were lower in the intervention group but not in controls (P < .001), without any association with changes in hormone concentrations. There was no difference in autoantibody prevalence between patients and healthy controls. In conclusion, the hypothesis that reduced carbohydrate intake corresponded to altered hormonal levels in IBS was accepted; however, there was no relationship between hormonal concentrations and symptoms.

Keywords

Carbohydrate-restricted diet
Dietary intervention
Gonadotropin-releasing hormone
Hormones
Irritable bowel syndrome
Starch- and sucrose-reduced diet

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Abbreviations: CI, confidence interval; CSID, sucrase-isomaltase deficiency; ENS, enteric nervous system; ELISA, enzyme-linked immunosorbent assays; FGID, functional gastrointestinal disorders; GIP, gastric inhibitory peptide; GnRH, gonadotropin-releasing hormone; GLP-1, glucagon-like peptide-1; IgM, immunoglobulin M; IBS, irritable bowel syndrome; IBS-SSS, irritable bowel syndrome-symptom severity score; LH, luteinizing hormone; SSRD, starch- and sucrose-reduced diet; TNC, tenascin C; PYY, polypeptide YY; PCC, primary healthcare centers; VAS, visual analog scale.