Assessment of the effect of sachet formulation of almond (Amygdalus dulcis L.) on diarrhea prominent irritable bowel syndrome (IBS-D) symptoms: A clinical trial.

Objectives: Almond has been listed in the low FODMAPs (Fermentable Oligo-, Di-, Mono saccharides And Polyols) and is recommended for infant diarrhea and gastrointestinal problem in Iranian folk medicine. In this work, sachet of almond has been designed, formulated and is studied on the clinical symptoms of diarrhea prominent irritable bowel syndrome (IBS-D).

Design: almond was standardized on the basis of total protein and carbohydrate content. A sachet of almond and wheat flour (placebo) was formulated and their physicochemical characteristics were investigated.

Intervention: In a double blind randomized trial, fifty IBS-D patients were randomly enrolled into the almond and placebo groups, ranked in respect to the severity of symptoms to mild-moderate and severe disease. The patients received almond or placebo sachet (40 g/day,20 days) respectively.

Main Outcome Measure: Patients were assessed for bowel habit, pain severity and frequency and bloating and data was recorded in a data collecting form.

Results: The results showed that none of the primary outcomes of the disease is improved in the patients treated with almond. The bowel movement and severity of the pain was significantly increased in the almond treated patients compared to the placebo and baseline (p < 0.05).

Conclusion: Almond contains high content of oligo-fructan which in high intake might result in a large amount of fermentable carbohydrates that can exacerbate the symptoms of the disease. So, despite the almond inclusion in the low-FODMAPs, the amount of almond intake is a determining factor and here we have controversial results for almond intake in patients with IBS. Mental health and physical activity of patients are also involved in the disease.