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14 December 2012

Food elimination diet may ease migraine, IBS

For patients with migraine and irritable bowel syndrome (IBS), an immunoglobulin G (IgG)-based food elimination diet may effectively reduce symptoms of both disorders.

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For patients with migraine and irritable bowel syndrome (IBS), an immunoglobulin G (IgG)-based food elimination diet may effectively reduce symptoms of both disorders, a small Turkish study suggests.

IgG antibodies against various food antigens have been linked to migraine; avoiding IgG-reactive foods has been shown to curb headache attacks. Dietary intolerance is also thought to be a significant contributor to IBS symptoms and there is some evidence that eliminating IgG-reactive foods may help calm IBS symptoms.

Because migraine and IBS often occur together, the Turkish team, led by Dr Elif Ilgaz Aydinlar, from Acibaden University School of Medicine in Istanbul, evaluated the benefit of an IgG-based elimination diet in 21 patients with both migraine and uncomplicated IBS.

How the study was done

The double-blind, randomised, controlled, crossover study had three phases: baseline phase (usual diet, run-in); first diet phase (elimination or provocation diets, customised based on sensitivity results), and second diet phase (interchange of elimination or provocation diets).

In IgG antibody tests against 270 food allergens, the mean reaction count (abnormally high titer) was 23.1 mg/L. All values above 7.5 mg/L were considered as positive reaction to the corresponding food. Seeds and nuts and grains with gluten were the foods with the most frequent IgG positivity.

The investigators reported online December 6 in Headache that the IgG-based elimination diet was associated with significant improvement both in migraine (attack count, mean and maximum attack duration, maximum attack severity, and number of attacks with acute medication) and IBS parameters (frequency and severity of pain/bloating and quality of life) when compared with baseline as well as provocation diet.

What the study found

The study was small and the investigators urge caution in translating their results into daily clinical practice, pending further studies. They note that food elimination diets and food challenges are time-consuming for patients and clinicians and require a high degree of patient motivation and compliance.

Nonetheless, for motivated patients, they say assay of IgG antibodies to food "seems to have a role in helping patients with concomitant presence of migraine and IBS to identify candidate foods for elimination."

Dr Aydinlar said, "We made a phone interview with each of the patients after one year, and surprisingly, although we haven't suggested so, almost all of them continued their diet, due to improvement of life quality."

"I personally observed improvement of symptoms of migraineurs in our outpatient migraine clinic, as a result of an elimination diet," he continued. "If the patient has frequent attacks, no analgesic overuse and concomitant IBS, I highly recommend to take blood for identifying IgG antibodies against food."

The study was supported by Immuno Diagnostic Laboratories, Istanbul, Turkey. The authors have declared no conflicts of interest.

(Reuters Health, December 2012)

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