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[DOI] [PubMed] [Google Scholar] Weinreb, O

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The symptom onset timeline from challenge studies: 30 minutes to 2 hours: fat-mediated diarrhea (bile salt mechanism) 2 to 6 hours: protein-mediated inflammation 6 to 12 hours: fiber-mediated osmotic effect (peaks as fiber reaches distal colon) Most patients report onset within 1 to 4 hours, suggesting fat and protein mechanisms dominate