Food intolerance related to gastrointestinal symptoms amongst adults living with bile acid diarrhoea: A cross-sectional study

BackgroundThe role of food in managing bile acid diarrhoea (BAD) is poorly understood. The present study explored the prevalence of food intolerance amongst adults with BAD.MethodsThe study comprised a cross-sectional survey of adults with BAD determined by the 75selenium homotaurocholic acid test (SeHCAT) living in the UK. Participants anonymously completed an online questionnaire on 39 food items. Frequency of food in general affecting BAD symptoms, as well as frequencies of diarrhoea, abdominal pain, bloating, flatulence and consequential food avoidance after food item ingestion, were assessed. Food group avoidance was also assessed.ResultsThere were 434 participants who completed the questionnaire between April and May 2021 of whom 80% reported moderate to severe chronic diarrhoea. Food intolerances were reported by 88.0% (95% confidence interval [CI] = 84.6-90.9) of participants. Diarrhoea was reported most frequently after take-away food, fish and chips, creamy sauces, cream and large quantities of fruit (range 41.0%-33.6%). Lowest frequencies were for potato, avocado, mango, watermelon and pear (range 3.7%-7.4%) for the foods listed in the questionnaire. Similar trends were found for abdominal pain, bloating, flatulence and consequential food avoidance. Symptom-triggering within 30 min of ingestion was more prevalence than after 30 min for almost all foods. Food group avoidance was highest for fatty foods (81.2%; 95% CI = 77.8-85.3) followed by dairy (53.9%; 95% CI = 49.1-58.7).ConclusionsPerceived food intolerance amongst adults with BAD and persisting diarrhoeal symptoms is high. Important triggers were meals with a higher fat content and higher-fat dairy products. Diets amongst those with persisting diarrhoeal symptoms may be overly restrictive. Bile acid diarrhoea is a common, underappreciated disorder, with an unmet need to improve treatment. The present study explored the prevalence of food intolerance amongst adults with BAD. Important triggers were meals with a higher fat content and higher-fat dairy products. Diets amongst those with persisting diarrhoeal symptoms may be overly restrictive.image This cross-sectional online study identified a very high prevalence of perceived food intolerance amongst 434 UK adults living with self-reported 75selenium homotaurocholic acid test (SeHCAT)-diagnosed bile acid diarrhoea.Out of 39 foods explored, take-aways and fish and chips were most frequently blamed for provoking overall gut symptoms and diarrhoea.Potato, avocado, mango, watermelon and pear were perceived to be the least frequently provocative for onset of diarrhoea, abdominal pain, bloating and flatulence.These findings indicate that further studies are needed to better understand the tolerance to dietary fat in bile acid diarrhoea, supporting the inclusion of lower-fat milk and dairy products, fruits and vegetables.