The Usefulness of the Low-FODMAP Diet with Limited Tryptophan Intake in the Treatment of Diarrhea-Predominant Irritable Bowel Syndrome

(1) Background: A low-FODMAP diet is often recommended in the treatment of irritable bowel syndrome, but it does not improve abdominal symptoms in all patients, and an alternative diet is desirable. The purpose of this study was to evaluate the efficacy of a low-FODMAP diet with a concomitant reduction in tryptophan (TRP) intake in irritable bowel syndrome with diarrhea predominance (IBS-D) in relation to its metabolism via the serotonin and kynurenine pathways. (2) Methods: 40 healthy people (Group I, Controls) and 80 patients with IBS-D were included in the study. IBS-D patients were randomly divided into two groups of 40 each (Groups IIA and IIB). In Group IIA, the low-FODMAP diet was recommended, while in Group IIB, the same diet was recommended but with limited TRP intake for 8 weeks. The TRP intake was analyzed with the use of the nutritional calculator. Abdominal complaints were assessed using the Gastrointestinal Symptom Rating Scale (GSRS-IBS), and psychological status was simultaneously determined using two scales: the Hamilton Anxiety Scale (HAM-A) and the Hamilton Depression Scale (HAM-D). TRP and its metabolites: 5-hydoxyindoleacetic acid (5-HIAA), kynurenine (KYN), kynurenic acid (KYNA), and quinolinic acid (QA) were measured in urine using liquid chromatography tandem mass spectrometry (LC-MS/MS). (3) Results: The consumption of TRP per mg/kg/b.w./24 h has decreased in Group IIA from 20.9 ± 2.39 to 17.45 ± 2.41 (16.5%) and in Group IIB from 21.3 ± 2.33 to 14.32 (34.4%). Significantly greater improvement was found after nutritional treatment in patients in Group IIB as compared to Group IIA (GSRS score: 38.1% vs. 49.8%; HAM-A: 38.7% vs. 49.9%; HAM-D: 13.8% vs. 35.0%; p < 0.01). Reducing TRP intake showed a negative correlation with the degree of improvement in the GSRS score. (4) Conclusions: Lowering the TRP content in a low-FODMAP diet may be useful in treating IBS-D

A Reduced Tryptophan Diet in Patients with Diarrhoea-Predominant Irritable Bowel Syndrome Improves Their Abdominal Symptoms and Their Quality of Life through Reduction of Serotonin Levels and Its Urinary Metabolites

(1). An essential component of any treatment for patients with irritable bowel syndrome (IBS) is an adequate diet. Currently, a low FODMAP diet is recommended as a first-line therapy, but it does not relieve abdominal discomfort in all patients, and alternative nutritional treatment is required. The purpose of this study was to evaluate the effect of a tryptophan-lowering diet (TRP) on abdominal and mental symptoms in patients with irritable bowel syndrome with predominant diarrhea (IBS-D). (2). The study included 40 patients with IBS-D, and 40 healthy subjects served as a baseline for IBS-D patients, after excluding comorbidities. The TRP intake was calculated using the nutritional calculator. The severity of abdominal symptoms was assessed using the gastrointestinal symptom rating scale (GSRS-IBS). Mental state was assessed using the Hamilton anxiety rating scale (HAM-A), the Hamilton depression rating scale (HAM-D), and the insomnia severity index (ISI). The serum levels of serotonin and melatonin and the urinary excretion of their metabolites 5-hydroxyindoleacetic acid (5-HIAA) and 6-sulfatoxymelatonin (aMT6) were determined by the ELISA method. The severity of symptoms and laboratory data were analyzed before and after a 12 week diet with tryptophan restricted to a daily dose 10 mg per kilogram body weight. (3). Compared to the control group, patients with IBS-D had a higher serum level of serotonin (198.2 ± 38.1 vs. 142.3 ± 36.4 ng/mL; p p > 0.05). The urinary excretion of 5-HIAA was also higher in patients with IBS-D patients (7.7 ± 1.5 vs. 6.0 ± 1.7 mg/24 h; p p < 0.001). The severity of the abdominal symptoms and anxiety also decreased, while the HAM-D score and the ISI score remained unchanged (4). Lowering the dietary intake of tryptophan may reduce abdominal complaints and does not alter the mental state of IBS-D patients

DEVILS (Diably)

"Women are a mistake of nature... with their excess of moisture and bodily heat that indicates physical and mental deficiency... they are a kind of invalid, misbegotten and failed man... The full realisation of human kind is man”. These words by St Thomas Acquinas could be used as a motto of crusade launched over two millennia by the Catholic Church against women. Agnieszka Błońska and Joanna Wichowska seek out the sources, symptoms and consequences of this continuing offensive, particularly intensified in rent years in Poland. The story of possessed and exorcised nuns serves as a pretext for research into the long history of colonization of female body, sexual repression, stigmatization of difference and imposition of rigid gender roles. In this investigation a woman becomes a representative of all those, who are left behind a superior norm of human kind, which is man – a heterosexual father, thinker, warrior, priest, god; she is an agent of all “misfits” – those expelled from the privileged majority. In this performance the Church Fathers, Mothers Joans and devils living in their bodies and minds will speak. But most importantly, contemporary women and men who willingly or not take part in a supposedly defensive cultural war fought all over Europe and Poland; a war declared by the Church and politicians. The alleged aggressor in here is “gender ideology”, also called “genedrism”. The alleged victim – religious people, defended by far-sighted “shepherds”. The battleground – a family, femininity and masculinity, treated by bishops as given by God and similarly as body (is that so?) non discussable and unchangeable. Which role in this battle is assigned to each and all of us? Which role are we accept, consciously or not? To what extend are we upholding patriarchy ourselves? And finally, does particular female perspective have to indicate exclusion from common “human” experience? The performance is inspired by motifs from Jarosław Iwaszkiewicz’s story „Mother Joan of the Angels”. It was made for the 4th Art and Community Festival Happy City and premiered on the 7th of December in Teatr Powszechny in Warsaw, Poland. The research involved Dr. Anna Szwed from Jagiellonian University in Cracow, Dr. Agnieszka Koscianska from Warsaw University and Marta Abramowicz, writer