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Baranguán Castro ML, Ros Arnal I, García Romero R, Lorenzo Garrido H, Delgado Sanzonetti L, Tutau Gómez C, Oliver Goicolea P. Low FODMAP diet in children with functional abdominal pain disorders. Is it always worth trying?: Low FODMAP diet in children with functional abdominal pain disorders. Arch Pediatr 2025; 32:153-156. [PMID: 39988545 DOI: 10.1016/j.arcped.2024.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 06/19/2024] [Accepted: 12/08/2024] [Indexed: 02/25/2025]
Abstract
OBJECTIVE Our aim was to assess the use of a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet in children with different types of functional abdominal pain disorders (FAPD) and to identify predictive factors of response to this diet. METHODS This was a multicenter, experimental, uncontrolled, prospective trial. Patients with irritable bowel syndrome (IBS), functional dyspepsia, and functional abdominal pain followed a low FODMAP diet for 2 weeks. We collected data on abdominal pain before and after the diet. Patients who showed a ≥ 50 % reduction in abdominal pain frequency were considered responders. RESULTS A total of 48 patients with FAPD participated in this trial. They all showed a significant decrease in the frequency (p < 0.05) and intensity (p < 0.05) of abdominal pain after the diet. We considered 41.7 % of patients to be responders. Among children with functional dyspepsia, 66.6 % responded to the diet, and so did 71.4 % of those with IBS. On the contrary, 71.8 % of children with functional abdominal pain were non-responders, and this diagnosis was considered a predictive factor of poor response to the diet (OR: 9.87, CI [1.52; 63.97], p = 0.016). CONCLUSION In children with FAPD, a diagnosis of functional abdominal pain is a predictive factor of poor response to a low FODMAP diet. Better results were achieved with this diet in children with IBS or functional dyspepsia.
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Affiliation(s)
| | - Ignacio Ros Arnal
- Gastroenterology and Nutrition, Pediatrics, Miguel Servet University Hospital, Zaragoza, Spain
| | - Ruth García Romero
- Gastroenterology and Nutrition, Pediatrics, Miguel Servet University Hospital, Zaragoza, Spain
| | | | | | - Carlos Tutau Gómez
- Gastroenterology and Nutrition, Pediatrics, Cruces Hospital, Barakaldo, Spain
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Zhang H, Su Q. Low-FODMAP Diet for Irritable Bowel Syndrome: Insights from Microbiome. Nutrients 2025; 17:544. [PMID: 39940404 PMCID: PMC11819959 DOI: 10.3390/nu17030544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 01/24/2025] [Accepted: 01/26/2025] [Indexed: 02/16/2025] Open
Abstract
Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder characterized by chronic abdominal pain, bloating, and altered bowel habits. Low-FODMAP diets, which involve restricting fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, have emerged as an effective dietary intervention for alleviating IBS symptoms. This review paper aims to synthesize current insights into the impact of a low-FODMAP diet on the gut microbiome and its mechanisms of action in managing IBS. We explore the alterations in microbial composition and function associated with a low-FODMAP diet and discuss the implications of these changes for gut health and symptom relief. Additionally, we examine the balance between symptom improvement and potential negative effects on microbial diversity and long-term gut health. Emerging evidence suggests that while a low-FODMAP diet can significantly reduce IBS symptoms, it may also lead to reductions in beneficial microbial populations. Strategies to mitigate these effects, such as the reintroduction phase and the use of probiotics, are evaluated. This review highlights the importance of a personalized approach to dietary management in IBS, considering individual variations in microbiome responses. Understanding the intricate relationship between diet, the gut microbiome, and IBS symptomatology will guide the development of more effective, sustainable dietary strategies for IBS patients.
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Affiliation(s)
- Haoshuai Zhang
- Microbiota I-Center (MagIC), Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Qi Su
- Microbiota I-Center (MagIC), Hong Kong SAR, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
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Sigall Boneh R, Park S, Soledad Arcucci M, Herrador-López M, Sarbagili-Shabat C, Kolonimos N, Wierdsma N, Chen M, Hershkovitz E, Wine E, Van Limbergen J. Cultural Perspectives on the Efficacy and Adoption of the Crohn's Disease Exclusion Diet across Diverse Ethnicities: A Case-Based Overview. Nutrients 2024; 16:3184. [PMID: 39339784 PMCID: PMC11434781 DOI: 10.3390/nu16183184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/09/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The Crohn's Disease Exclusion Diet (CDED) is a whole-foods regimen that has demonstrated efficacy in inducing remission among children and adults with mild-to-moderate disease. While initial studies predominantly originated from Israel, recent years have witnessed the expansion of experiences to diverse cultures, culminating in the recognition of CDED in the latest ESPEN guidelines. However, implementing dietary therapy poses significant challenges across various cultures, necessitating adaptations. AIM AND METHODS This case-based study aims to present the collective experience from different cultures, shedding light on the encountered challenges and the corresponding solutions devised to surmount them by convening healthcare providers (dietitians and physicians across six countries and eight cultural settings) with extensive experience in utilizing the CDED. RESULTS AND CONCLUSIONS Our findings underscore the efficacy of CDED across diverse cultural contexts and emphasize the pivotal role of dietitians in tailoring the diet to accommodate patients' cultural behaviors and traditions. We highlight challenges encountered and delineate strategies for overcoming them by customizing the diet and offering tailored guidance. Additionally, we provide insights into implementing CDED in various regions through adjusted recipes and personalized counseling from dietitians. This study contributes to the growing body of literature on CDED, and offers practical guidance for its effective adoption in diverse cultural settings.
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Affiliation(s)
- Rotem Sigall Boneh
- Pediatric Gastroenterology and Nutrition Unit, The E. Wolfson Medical Center, Holon 8820027, Israel;
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology and Metabolism, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam Public Health Research Institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Sowon Park
- Severance Pediatric IBD Research Group, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Children’s Hospital, Seoul 03722, Republic of Korea;
| | - Maria Soledad Arcucci
- Gastroenterology Service, Department of Pediatrics, Hospital de Niños Ricardo Gutierrez, Buenos Aires C1425EFD, Argentina;
- Pediatric Gastroenterology, Hepatology and Liver-Intestinal Transplantation Unit, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Marta Herrador-López
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain;
| | - Chen Sarbagili-Shabat
- Pediatric Gastroenterology and Nutrition Unit, The E. Wolfson Medical Center, Holon 8820027, Israel;
- The Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Nitzan Kolonimos
- IBD Unit, Gastroenterology Institute, Haemek Medical Center, Afula 1834111, Israel; (N.K.); (E.H.)
| | - Nicolette Wierdsma
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam Gastroenterology Endocrinology Metabolism, 1105 AZ Amsterdam, The Netherlands
| | - Min Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Alberta, 11405 87th Ave., Edmonton, AB T6G 1C9, Canada; (M.C.); (E.W.)
| | - Einat Hershkovitz
- IBD Unit, Gastroenterology Institute, Haemek Medical Center, Afula 1834111, Israel; (N.K.); (E.H.)
| | - Eytan Wine
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Alberta, 11405 87th Ave., Edmonton, AB T6G 1C9, Canada; (M.C.); (E.W.)
| | - Johan Van Limbergen
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology and Metabolism, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam Public Health Research Institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Emma Children’s Hospital, 1105 AZ Amsterdam, The Netherlands
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Tunali V, Arslan NÇ, Ermiş BH, Derviş Hakim G, Gündoğdu A, Hora M, Nalbantoğlu ÖU. A Multicenter Randomized Controlled Trial of Microbiome-Based Artificial Intelligence-Assisted Personalized Diet vs Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Diet: A Novel Approach for the Management of Irritable Bowel Syndrome. Am J Gastroenterol 2024; 119:1901-1912. [PMID: 38717025 PMCID: PMC11365594 DOI: 10.14309/ajg.0000000000002862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/26/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Personalized management strategies are pivotal in addressing irritable bowel syndrome (IBS). This multicenter randomized controlled trial focuses on comparing the efficacy of a microbiome-based artificial intelligence-assisted personalized diet (PD) with a low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (FODMAP) for IBS management. METHODS One hundred twenty-one patients participated, with 70 assigned to the PD group and 51 to the FODMAP diet group. IBS subtypes, demographics, symptom severity (IBS-SSS), anxiety, depression, and quality of life (IBS-QOL) were evaluated. Both interventions spanned 6 weeks. The trial's primary outcome was the within-individual difference in IBS-SSS compared between intervention groups. RESULTS For the primary outcome, there was a change in IBS-SSS of -112.7 for those in the PD group vs -99.9 for those in the FODMAP diet group ( P = 0.29). Significant improvement occurred in IBS-SSS scores ( P < 0.001), frequency ( P < 0.001), abdominal distension ( P < 0.001), and life interference ( P < 0.001) in both groups. In addition, there were significant improvements in anxiety levels and IBS-QOL scores for both groups ( P < 0.001). Importantly, PD was effective in reducing IBS SSS scores across all IBS subtypes IBS-Constipation (IBS-C; P < 0.001), IBS-Diarrhea (IBS-D; P = 0.01), and IBS-Mixed (IBS-M; P < 0.001) while FODMAP diet exhibited comparable improvements in IBS-C ( P = 0.004) and IBS-M ( P < 0.001). PD intervention significantly improved IBS-QOL scores for all subtypes (IBS-C [ P < 0.001], IBS-D [ P < 0.001], and IBS-M [ P = 0.008]) while the FODMAP diet did so for the IBS-C ( P = 0.004) and IBS-D ( P = 0.022). Notably, PD intervention led to significant microbiome diversity shifts ( P < 0.05) and taxa alterations compared with FODMAP diet. DISCUSSION The artificial intelligence-assisted PD emerges as a promising approach for comprehensive IBS management. With its ability to address individual variation, the PD approach demonstrates significant symptom relief, enhanced QOL, and notable diversity shifts in the gut microbiome, making it a valuable strategy in the evolving landscape of IBS care.
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Affiliation(s)
- Varol Tunali
- Department of Parasitology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Naciye Çiğdem Arslan
- Department of Gastrointestinal Surgery, Medipol Bahçelievler Hospital, Istanbul, Turkey
| | - Beyza Hilal Ermiş
- Faculty of Nutrition and Dietetics, Adnan Menderes University, Aydın, Turkey
| | - Gözde Derviş Hakim
- Department of Gastroenterology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Aycan Gündoğdu
- Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Hora
- Bioinformatics Division, Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey
| | - Özkan Ufuk Nalbantoğlu
- Bioinformatics Division, Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey
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Qadri H, Shah AH, Almilaibary A, Mir MA. Microbiota, natural products, and human health: exploring interactions for therapeutic insights. Front Cell Infect Microbiol 2024; 14:1371312. [PMID: 39035357 PMCID: PMC11257994 DOI: 10.3389/fcimb.2024.1371312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/03/2024] [Indexed: 07/23/2024] Open
Abstract
The symbiotic relationship between the human digestive system and its intricate microbiota is a captivating field of study that continues to unfold. Comprising predominantly anaerobic bacteria, this complex microbial ecosystem, teeming with trillions of organisms, plays a crucial role in various physiological processes. Beyond its primary function in breaking down indigestible dietary components, this microbial community significantly influences immune system modulation, central nervous system function, and disease prevention. Despite the strides made in microbiome research, the precise mechanisms underlying how bacterial effector functions impact mammalian and microbiome physiology remain elusive. Unlike the traditional DNA-RNA-protein paradigm, bacteria often communicate through small molecules, underscoring the imperative to identify compounds produced by human-associated bacteria. The gut microbiome emerges as a linchpin in the transformation of natural products, generating metabolites with distinct physiological functions. Unraveling these microbial transformations holds the key to understanding the pharmacological activities and metabolic mechanisms of natural products. Notably, the potential to leverage gut microorganisms for large-scale synthesis of bioactive compounds remains an underexplored frontier with promising implications. This review serves as a synthesis of current knowledge, shedding light on the dynamic interplay between natural products, bacteria, and human health. In doing so, it contributes to our evolving comprehension of microbiome dynamics, opening avenues for innovative applications in medicine and therapeutics. As we delve deeper into this intricate web of interactions, the prospect of harnessing the power of the gut microbiome for transformative medical interventions becomes increasingly tantalizing.
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Affiliation(s)
- Hafsa Qadri
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar, India
| | - Abdul Haseeb Shah
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar, India
| | - Abdullah Almilaibary
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar, India
- Department of Family and Community Medicine, Faculty of Medicine, Al Baha University, Al Bahah, Saudi Arabia
| | - Manzoor Ahmad Mir
- Department of Bioresources, School of Biological Sciences, University of Kashmir, Srinagar, India
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So D, Tuck C. Innovative concepts in diet therapies in disorders of gut-brain interaction. JGH Open 2024; 8:e70001. [PMID: 39027160 PMCID: PMC11255864 DOI: 10.1002/jgh3.70001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/29/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024]
Abstract
Diet therapy in disorders of gut-brain interaction (DGBI) is rapidly advancing, with accumulating evidence to support two innovative therapies-manipulation of dietary fibers and enzyme supplementation-that target specific DGBI pathophysiology and modulate digestion. Dietary fibers escape digestion in the upper gastrointestinal tract and can influence gut function by impacting digestion, improving laxation, and interacting with the microbiota. A more nuanced understanding of different fiber types and their ability to impact gut function in highly specific ways has shown that fibers can impact distinct gut symptoms and pathophysiology. By considering their functional characteristics of bulking, gel-forming, and fermentability, restriction or supplementation of specific fibers can offer clinical value in DGBI. Similarly to fiber specificity, emerging evidence suggests that supplemental digestive enzymes may be targeted to known food triggers with consideration that enzymes are substrate specific. Limited evidence supports use of lactase to target lactose, and α-galactosidase to target galacto-oligosaccharides. Application of enzymes during manufacturing of food products may prove to be an additional strategy, although evidence is scant. Both innovative therapies may be utilized in isolation or in combination with other diet and nondiet therapies. Implementation can be guided by the principles that fiber modulation can be targeted to specific symptomology or requirement for alterations to gut function, and digestive enzymes can be targeted to known food triggers. This review aims to summarize recent literature of these two innovative concepts and provide practical suggestions for their implementation in clinical practice.
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Affiliation(s)
- Daniel So
- Department of GastroenterologyMonash University and Alfred HealthMelbourneAustralia
| | - Caroline Tuck
- Department of Nursing and Allied HealthSwinburne UniversityHawthornAustralia
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Xu C, Song Z, Hu JY, Li CC, Shen H. Global research trend and hotspot in the low FODMAP diet: a bibliometric analysis. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:63. [PMID: 38741213 PMCID: PMC11092139 DOI: 10.1186/s41043-024-00567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND According to national guidelines, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is a second-line therapy option for irritable bowel syndrome (IBS) and improves functional intestinal symptoms. Numerous noteworthy results have been published in this field over the past fifteen years. This study aims to analyze the global research trend and hotspot of the low FODMAP diet research, and provide a comprehensive perspective and direction for researchers. METHODS The Science Citation Index-Expanded of the Web of Science Core Collection (WoSCC) was used to identify low FODMAP diet-related articles and reviews. Three bibliometric programs (CiteSpace, VOSviewer, Scimago Graphic) were utilized to analyze and visualize the annual publications, authors, countries, institutions, journals, citations, and keywords. RESULTS In total, 843 documents related to the low FODMAP diet research were published in 227 journals by 3,343 authors in 1,233 institutions from 59 countries. The United States, which was the most engaged nation in international collaboration, had the largest annual production and the fastest growth. The most productive organization was Monash University, and the most fruitful researcher was Gibson PR. Nutrients ranked first in terms of the number of published documents. The article "A diet low in FODMAPs reduces symptoms of irritable bowel syndrome" (Halmos EP, 2014) received the most co-citations. Keywords that appear frequently in the literature mainly involve two main aspects: the clinical efficacy evaluation and mechanism exploration of the low FODMAP diet. The term "gut microbiota" stands out as the most prominent keyword among the burst keywords that have remained prevalent till date. CONCLUSION The restriction stage of the low FODMAP diet is superior to other dietary therapies for IBS in terms of symptom response, but it has a negative impact on the abundance of gut Bifidobacteria and diet quality. Identification of biomarkers to predict response to the low FODMAP diet is of great interest and has become the current research hotspot.
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Affiliation(s)
- Cheng Xu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhen Song
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing-Yi Hu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chong-Chao Li
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Hong Shen
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
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El Ezaby SA, Manzour AF, Eldeeb M, El Gendy YG, Abdel Hamid DM. Effect of the Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) Diet on Control of Pediatric Irritable Bowel Syndrome and Quality of Life Among a Sample of Egyptian Children: A Randomized Controlled Clinical Trial. Cureus 2024; 16:e61017. [PMID: 38910620 PMCID: PMC11194040 DOI: 10.7759/cureus.61017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a pediatric pain-dominant functional gastrointestinal disorder that has a negative impact on all children's dimensions of quality of life. A dietary approach that focuses on limiting food elements with high fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) can be used to decrease symptoms of IBS. This study aims to evaluate the effect of low FODMAP dietary intervention on health-related quality of life among a sample of Egyptian children. METHODS Eighty-four children aged 5-15 years old were randomly assigned to two groups, 42 patients in the low FODMAP diet group and 42 patients in the standard diet group. They received the diet for six weeks and were followed up weekly using a visual analog scale (VAS) for pain severity assessment, the Pediatric Quality of Life (PedsQL) Inventory Gastrointestinal (GI) Symptoms Module Scale, and the PedsQL Inventory Generic Core Scale to assess the physical and psychosocial functioning of the patients. RESULTS The VAS score decreased more in the low FODMAP group, which caused a significant difference between the two groups (p<0.001). The PedsQL Inventory GI Symptoms Module score increased more among the low FODMAP group, and this caused a significant difference between the two groups (p<0.001). PedsQL Inventory Generic Core score increased more among the low FODMAPs group, and this caused a significant difference between the two groups (p<0.001). CONCLUSION Low FODMAP dietary intervention in pediatrics for six weeks decreased abdominal pain severity, improved gastrointestinal symptoms, and improved the health-related quality of life of the affected children.
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Affiliation(s)
- Sarah A El Ezaby
- Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, EGY
| | - Ayat F Manzour
- Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, EGY
| | - Marwa Eldeeb
- Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, EGY
| | - Yasmin G El Gendy
- Pediatric Nutrition, Faculty of Medicine, Ain Shams University, Cairo, EGY
| | - Diaa M Abdel Hamid
- Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, EGY
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Mansour S, Alkhaaldi SMI, Sammanasunathan AF, Ibrahim S, Farhat J, Al-Omari B. Precision Nutrition Unveiled: Gene-Nutrient Interactions, Microbiota Dynamics, and Lifestyle Factors in Obesity Management. Nutrients 2024; 16:581. [PMID: 38474710 PMCID: PMC10935146 DOI: 10.3390/nu16050581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/05/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Obesity is a complex metabolic disorder that is associated with several diseases. Recently, precision nutrition (PN) has emerged as a tailored approach to provide individualised dietary recommendations. AIM This review discusses the major intrinsic and extrinsic components considered when applying PN during the management of obesity and common associated chronic conditions. RESULTS The review identified three main PN components: gene-nutrient interactions, intestinal microbiota, and lifestyle factors. Genetic makeup significantly contributes to inter-individual variations in dietary behaviours, with advanced genome sequencing and population genetics aiding in detecting gene variants associated with obesity. Additionally, PN-based host-microbiota evaluation emerges as an advanced therapeutic tool, impacting disease control and prevention. The gut microbiome's composition regulates diverse responses to nutritional recommendations. Several studies highlight PN's effectiveness in improving diet quality and enhancing adherence to physical activity among obese patients. PN is a key strategy for addressing obesity-related risk factors, encompassing dietary patterns, body weight, fat, blood lipids, glucose levels, and insulin resistance. CONCLUSION PN stands out as a feasible tool for effectively managing obesity, considering its ability to integrate genetic and lifestyle factors. The application of PN-based approaches not only improves current obesity conditions but also holds promise for preventing obesity and its associated complications in the long term.
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Affiliation(s)
- Samy Mansour
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates; (S.M.); (A.F.S.)
| | - Saif M. I. Alkhaaldi
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates; (S.M.); (A.F.S.)
| | - Ashwin F. Sammanasunathan
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates; (S.M.); (A.F.S.)
| | - Saleh Ibrahim
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates; (S.M.); (A.F.S.)
- Institute of Experimental Dermatology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Joviana Farhat
- Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
| | - Basem Al-Omari
- Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
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Iacovou M, Lewis JD. Commentary: When applying dietary therapies for gastrointestinal conditions, family values, culture, and social challenges matter. Nutr Rev 2023; 81:1490-1494. [PMID: 36809548 DOI: 10.1093/nutrit/nuad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Some gastrointestinal conditions now have diet as a cornerstone to therapy. Three examples include the low-fermentable, oligosaccharide, disaccharide, monosaccharide, and polyol diet for irritable bowel syndrome, a gluten-free diet for celiac disease, and a hypoallergenic diet for eosinophilic esophagitis. All have been shown to be effective in Western or highly industrialized countries. However, these gastrointestinal conditions occur worldwide. Less is known regarding the effectiveness of dietary therapies in cultures and regions of dense religious and traditional practices where food is a central focus. This includes South Asia, the Mediterranean region, Africa, the Middle East, South America, and within Indigenous communities. Hence, there is a need to reproduce dietary intervention studies within cultures of dense traditional dietary practices to understand the applicability and acceptability of dietary therapy to establish generalizability. Furthermore, there is a need for nutrition experts to have a deep understanding of various cultural cuisines, practices, values, and customs. To achieve this, increasing the diversity of students in the sciences and having a diverse workforce of nutrition experts and health professionals that reflects the patient population will allow for more personalized care. In addition, there are social challenges, including a lack of medical insurance coverage, the cost of dietary interventions, and inconsistent nutrition messaging. Although there are many cultural considerations and social challenges to implementing effective dietary interventions around the world, these barriers are addressable through research methodologies that address culture and society challenges, and enhanced training of dietitians.
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Affiliation(s)
- Marina Iacovou
- is with the Centre of Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, and the Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - James D Lewis
- is with the Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Saeed S, Ekhator C, Abdelaziz AM, Naveed H, Karski A, Cook DE, Reddy SM, Affaf M, Khan SJ, Bellegarde SB, Rehman A, Hasan AH, Shehryar A. Revolutionizing Inflammatory Bowel Disease Management: A Comprehensive Narrative Review of Innovative Dietary Strategies and Future Directions. Cureus 2023; 15:e44304. [PMID: 37664362 PMCID: PMC10470660 DOI: 10.7759/cureus.44304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/05/2023] Open
Abstract
This comprehensive narrative review delves into the intricate interplay between diet and inflammatory bowel disease (IBD), shedding light on the potential impact of dietary interventions in disease management. By analyzing nutritional interventions, risks, challenges, and future perspectives, this review serves as a vital resource for clinicians, researchers, and patients alike. The amalgamation of evidence underscores the significance of customizing dietary strategies for individual patients, considering disease phenotype and cultural factors. Through an exploration of dietary components' effects on IBD, including exclusive enteral nutrition and omega-3 fatty acids, this review offers pragmatic implementation advice and outlines avenues for further research. Bridging the gap between research findings and clinical applications, the review facilitates informed decision-making and patient-centric care. In the face of escalating IBD prevalence, this review emerges as an indispensable guide for healthcare professionals, empowering them to navigate the complexities of dietary management while enabling patients to actively participate in their care trajectory. Ultimately, this narrative review advances the understanding of diet's pivotal role in IBD management, fostering a more integrated approach to patient care and paving the way for improved research and policy initiatives in the field of inflammatory bowel diseases.
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Affiliation(s)
- Shahzeb Saeed
- Internal Medicine, Army Medical College, Rawalpindi, PAK
| | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
| | - Ali M Abdelaziz
- Internal Medicine, Alexandria University Faculty of Medicine, Alexandria, EGY
| | - Husnain Naveed
- Internal Medicine, Shifa Tameer-E-Millat University Shifa College of Medicine, Islamabad, PAK
| | - Amanda Karski
- Emergency Medicine, American University of Antigua, Miami, USA
| | - Daniel E Cook
- Medicine, Avalon University School of Medicine, Youngstown, USA
| | - Shivani M Reddy
- Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, IND
| | - Maryam Affaf
- Internal Medicine, Women's Medical and Dental College, Abbotabad, PAK
| | - Salman J Khan
- Hematology & Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Sophia B Bellegarde
- Pathology and Laboratory Medicine, American University of Antigua, St. John's, ATG
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12
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Gayoso L, Garcia-Etxebarria K, Arzallus T, Montalvo I, Lizasoain J, D’Amato M, Etxeberria U, Bujanda L. The effect of starch- and sucrose-reduced diet accompanied by nutritional and culinary recommendations on the symptoms of irritable bowel syndrome patients with diarrhoea. Therap Adv Gastroenterol 2023; 16:17562848231156682. [PMID: 37153501 PMCID: PMC10155021 DOI: 10.1177/17562848231156682] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/25/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common gastrointestinal condition which entails a high burden in the quality of life (QoL) of patients. Nutritional interventions have been proposed to alleviate symptoms, since still no effective treatments exist for IBS. OBJECTIVES Our aim is to analyse the feasibility of the use of starch- and sucrose-reduced diet (SSRD). DESIGN In this study, we used a SSRD accompanied by nutritional and culinary recommendations to measure the effects in IBS patients with diarrhoea. METHODS In all, 34 participants completed a 4-week nutritional intervention based on SSRD. Symptoms, QoL and dietary habits were assessed by several questionnaires that were completed at the beginning, daily, after 2 weeks, at the end, and after 2 months. RESULTS 85.29% of the participants reached the primary endpoint [reduction of 50 points or more in IBS-symptom severity scale (SSS)], and 58.82% the secondary endpoint (reduction of 50% or more in IBS-SSS). The relief of symptoms and improvement of the QoL were significant after 2 weeks of intervention, at the end and after 2 months. Dietary habits were consistent with the diet and high adherence was achieved. CONCLUSIONS SSRD and individualized nutritional and culinary guidance improved symptoms and QoL of IBS patients with diarrhoea, with a high adherence.
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Affiliation(s)
- Lucia Gayoso
- Technology Center in Gastronomy, Basque
Culinary Center, BCC Innovation, Donostia-San Sebastián, Spain
- Basque Culinary Center, Faculty of Gastronomic
Sciences, Mondragon Unibertsitatea, Donostia-San Sebastián, Spain
| | - Koldo Garcia-Etxebarria
- Gastrointestinal Genetics Group, Biodonostia,
Dr Beguiristain S/N, San Sebastian 20014, Spain
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, 08036,
Spain
| | - Teresa Arzallus
- Gastrointestinal Diseases Group, Universidad
del País Vasco (UPV/EHU), Biodonostia, San Sebastián, Spain
| | - Isabel Montalvo
- Gastrointestinal Diseases Group, Universidad
del País Vasco (UPV/EHU), Biodonostia, San Sebastián, Spain
| | - Jacobo Lizasoain
- Gastrointestinal Diseases Group, Universidad
del País Vasco (UPV/EHU), Biodonostia, San Sebastián, Spain
| | - Mauro D’Amato
- Gastrointestinal Genetics Lab, Basque Research
and Technology Alliance, CIC bioGUNE, Derio, Spain
- Ikerbasque, Basque Foundation for Sciences,
Bilbao, Spain
- Department of Medicine and Surgery, LUM
University, Casamassima, Italy
| | - Usune Etxeberria
- Technology Center in Gastronomy, Basque
Culinary Center, BCC Innovation, Donostia-San Sebastián, Spain
- Basque Culinary Center, Faculty of Gastronomic
Sciences, Mondragon Unibertsitatea, Donostia-San Sebastián, Spain
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de
Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Gastrointestinal Diseases Group, Universidad
del País Vasco (UPV/EHU), Biodonostia, San Sebastián, Spain
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Rej A, Sanders DS, Aziz I. Reply. Clin Gastroenterol Hepatol 2023; 21:1120-1121. [PMID: 35850411 DOI: 10.1016/j.cgh.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Anupam Rej
- Academic Unit of Gastroenterology, Sheffield Teaching Hospital, NHS Foundation Trust, Sheffield, UK
| | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospital, NHS Foundation Trust, Sheffield, UK; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Imran Aziz
- Academic Unit of Gastroenterology, Sheffield Teaching Hospital, NHS Foundation Trust, Sheffield, UK; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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14
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MacIntosh A, Heenan PE, Wright-McNaughton M, Frampton C, Skidmore P, Wall CL, Muir J, Talley NJ, Roy NC, Gearry RB. The relationship between fermentable carbohydrates and post-prandial bowel symptoms in patients with functional bowel disorders. Front Nutr 2023; 10:1060928. [PMID: 36819701 PMCID: PMC9932028 DOI: 10.3389/fnut.2023.1060928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
Background and aims A low fermentable oligosaccharide, disaccharide, monosaccharide, and polyols (FODMAP) diet alleviates symptoms of irritable bowel syndrome (IBS). We aimed to investigate the relationship between habitual FODMAP intake and post-prandial bowel symptoms in adults with IBS, functional diarrhoea (FD), or constipation (FD) (functional bowel disorders), and in healthy adults (controls). Methods 292 participants (173 with functional bowel disorders and 119 controls) completed a food and symptom times diary. Estimated meal portion sizes were entered into the Monash FODMAP Calculator to analyse FODMAP content. Wilcoxon and ANOVA tests were used to investigate the relationship between FODMAP intake and post-prandial bowel symptoms. Results IBS participants experienced more post-prandial bowel symptoms compared to participants with other functional bowel disorders or controls. Meals associated with abdominal pain contained on average increased excess fructose (0.31 g vs. 0.18 g, p < 0.05), sorbitol (0.27 g vs. 0.10 g, p < 0.01), and total FODMAP (3.46 g vs. 2.96 g, p < 0.05) compared to meals not associated with pain. Abdominal swelling was associated with increased sorbitol (0.33 g vs. 0.11 g, p < 0.01), and total FODMAP (3.26 g vs. 3.02 g, p < 0.05) consumption. Abdominal bloating was associated with increased galacto oligosaccharide consumption (0.18 g vs. 0.14 g, p < 0.05). Conclusion These findings support the role of FODMAP in post-prandial bowel symptom onset, however, the amount and type of FODMAP triggering symptoms vary between individuals. Future research should investigate the relationship between the effect of individual FODMAP consumption on post-prandial bowel symptoms for each subtype, the interaction of FODMAP with differing functional bowel disorders and whether longitudinally symptoms and dietary intake are stable.
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Affiliation(s)
- Alice MacIntosh
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Phoebe E. Heenan
- Department of Medicine, University of Otago, Christchurch, New Zealand
- High-Value Nutrition National Science Challenge, Liggins Institute at the University of Auckland, Auckland, New Zealand
| | | | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Paula Skidmore
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Catherine L. Wall
- Department of Medicine, University of Otago, Christchurch, New Zealand
- High-Value Nutrition National Science Challenge, Liggins Institute at the University of Auckland, Auckland, New Zealand
| | - Jane Muir
- Department of Gastroenterology, Monash University, Melbourne, VIC, Australia
| | - Nicholas Joseph Talley
- School of Medicine, University of Newcastle, Newcastle, NSW, Australia
- NHMRC Centre of Research Excellence in Digestive Health, University of Newcastle, Newcastle, NSW, Australia
| | - Nicole Clemence Roy
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- High-Value Nutrition National Science Challenge, Liggins Institute at the University of Auckland, Auckland, New Zealand
- Riddet Institute, Palmerston North, New Zealand
| | - Richard B. Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
- High-Value Nutrition National Science Challenge, Liggins Institute at the University of Auckland, Auckland, New Zealand
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15
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Rej A, Sanders DS, Shaw CC, Buckle R, Trott N, Agrawal A, Aziz I. Efficacy and Acceptability of Dietary Therapies in Non-Constipated Irritable Bowel Syndrome: A Randomized Trial of Traditional Dietary Advice, the Low FODMAP Diet, and the Gluten-Free Diet. Clin Gastroenterol Hepatol 2022; 20:2876-2887.e15. [PMID: 35240330 DOI: 10.1016/j.cgh.2022.02.045] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Various diets are proposed as first-line therapies for non-constipated irritable bowel syndrome (IBS) despite insufficient or low-quality evidence. We performed a randomized trial comparing traditional dietary advice (TDA) against the low FODMAP diet (LFD) and gluten-free diet (GFD). METHODS Patients with Rome IV-defined non-constipated IBS were randomized to TDA, LFD, or GFD (the latter allowing for minute gluten cross-contamination). The primary end point was clinical response after 4 weeks of dietary intervention, as defined by ≥50-point reduction in IBS symptom severity score (IBS-SSS). Secondary end points included (1) changes in individual IBS-SSS items within clinical responders, (2) acceptability and food-related quality of life with dietary therapy, (3) changes in nutritional intake, (4) alterations in stool dysbiosis index, and (5) baseline factors associated with clinical response. RESULTS The primary end point of ≥50-point reduction in IBS-SSS was met by 42% (n = 14/33) undertaking TDA, 55% (n = 18/33) for LFD, and 58% (n = 19/33) for GFD (P = .43). Responders had similar improvements in IBS-SSS items regardless of their allocated diet. Individuals found TDA cheaper (P < .01), less time-consuming to shop (P < .01), and easier to follow when eating out (P = .03) than the GFD and LFD. TDA was also easier to incorporate into daily life than the LFD (P = .02). Overall reductions in micronutrient and macronutrient intake did not significantly differ across the diets. However, the LFD group had the greatest reduction in total FODMAP content (27.7 g/day before intervention to 7.6 g/day at week 4) compared with the GFD (27.4 g/day to 22.4 g/day) and TDA (24.9 g/day to 15.2 g/day) (P < .01). Alterations in stool dysbiosis index were similar across the diets, with 22%-29% showing reduced dysbiosis, 35%-39% no change, and 35%-40% increased dysbiosis (P = .99). Baseline clinical characteristics and stool dysbiosis index did not predict response to dietary therapy. CONCLUSIONS TDA, LFD, and GFD are effective approaches in non-constipated IBS, but TDA is the most patient-friendly in terms of cost and convenience. We recommend TDA as the first-choice dietary therapy in non-constipated IBS, with LFD and GFD reserved according to specific patient preferences and specialist dietetic input. CLINICALTRIALS gov: NCT04072991.
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Affiliation(s)
- Anupam Rej
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Christian C Shaw
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Rachel Buckle
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Nick Trott
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Anurag Agrawal
- Doncaster and Bassetlaw Hospitals NHS Trust, Doncaster, United Kingdom
| | - Imran Aziz
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
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16
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Scrivin R, Costa RJS, Pelly F, Lis D, Slater G. An exploratory study of the management strategies reported by endurance athletes with exercise-associated gastrointestinal symptoms. Front Nutr 2022; 9:1003445. [PMID: 36438762 PMCID: PMC9691682 DOI: 10.3389/fnut.2022.1003445] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
This exploratory study investigated endurance athletes self-reported exercise-associated gastrointestinal symptoms (Ex-GIS) and associated strategies to manage symptomology. Adult endurance athletes with a history of Ex-GIS (n = 137) participating in events ≥ 60 min completed an online validated questionnaire. Respondents included runners (55%, n = 75), triathletes (22%, n = 30), and non-running sports (23%, n = 32), participating at a recreationally competitive (37%, n = 51), recreationally non-competitive (32%, n = 44), and competitive regional/national/international (31%, n = 42) levels. Athletes identified when Ex-GIS developed most frequently either around training (AT), around competitions (AC), or equally around both training (ET) and competitions (EC). Athletes reported the severity of each symptom before, during, and after exercise. Athletes predominantly categorized Ex-GIS severity as mild (< 5/10) on a 0 (no symptoms) to 10 (extremely severe symptoms) visual analog symptomology scale. The Friedman test and post hoc analysis with Wilcoxon signed rank test was conducted with a Bonferroni correction applied to determine differences between repeated measures. The only severe symptom of significance was the urge to defecate during training in the ET group (Z = –0.536, p = 0.01). Ex-GIS incidence was significantly higher during training and competitions in all categories. A content review of self-reported strategies (n = 277) to reduce Ex-GIS indicated popular dietary strategies were dietary fiber reduction (15.2%, n = 42), dairy avoidance (5.8%, n = 16), and a low fermentable oligosaccharides, monosaccharides, and polyols (FODMAP) diet (5.4%, n = 15). In contrast, non-dietary strategies included the use of medications (4.7%, n = 13) and relaxation/meditation (4.0%, n = 11). On a Likert scale of 1–5, the most successful dietary strategies implemented were dietary fiber reduction (median = 4, IQR = 4, 5), low FODMAP diets (median = 4, IQR = 4, 5), dairy-free diets (median = 4, IQR = 4, 5), and increasing carbohydrates (median = 4, IQR = 3, 4). Accredited practicing dietitians were rated as the most important sources of information for Ex-GIS management (n = 29). Endurance athletes use a variety of strategies to manage their Ex-GIS, with dietary manipulation being the most common.
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Affiliation(s)
- Rachel Scrivin
- School of Health and Behavioral Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
- Faculty of Health, Education and Environment, Toi Ohomai Institute of Technology, Tauranga, New Zealand
- *Correspondence: Rachel Scrivin,
| | - Ricardo J. S. Costa
- Department of Nutrition Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Fiona Pelly
- School of Health and Behavioral Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Dana Lis
- Department of Neurobiology, Physiology and Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Gary Slater
- School of Health and Behavioral Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
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17
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El Gendy YGA, Abdel Wahed MA, Ragab MHH, Awad YMM. Effects of a Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyol Diet on Symptoms of Functional Abdominal Pain in Pediatric Patients. Pediatr Gastroenterol Hepatol Nutr 2022; 25:510-518. [PMID: 36451691 PMCID: PMC9679304 DOI: 10.5223/pghn.2022.25.6.510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/02/2022] [Accepted: 09/18/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Recently, great interest has been focused on dietary fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) for the treatment of functional abdominal pain (FAP). Several meta-analyses, including those on the adult population, have been published, potentiating its role. However, pediatric studies are scarce. We aimed to evaluate the effect of a low-FODMAP diet on the severity of FAP in children. METHODS This clinical trial included 50 patients aged 3-18 years with irritable bowel syndrome and FAP that were not otherwise specified. The patients were instructed to receive a low FODMAP diet guided by a dietitian. The primary outcome was the percentage of responders after 2 months of dietary intervention compared with baseline. Other outcomes included changes in stool consistency and quality of life (QoL) scores using the KIDSCREEN-10 questionnaire, and weight-for-age z-scores. RESULTS After the dietary intervention, 74% of patients showed more than 30% lower pain intensity, as examined using the Wong-Baker Faces pain rating scale. Their QoL significantly improved, and patients have gained weight. CONCLUSION A low FODMAP diet can improve pain intensity and QoL among children with functional abdominal pain, with no detrimental effects on body weight.
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18
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Elma Ö, Brain K, Dong HJ. The Importance of Nutrition as a Lifestyle Factor in Chronic Pain Management: A Narrative Review. J Clin Med 2022; 11:5950. [PMID: 36233817 PMCID: PMC9571356 DOI: 10.3390/jcm11195950] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
In everyday clinical practice, healthcare professionals often meet chronic pain patients with a poor nutritional status. A poor nutritional status such as malnutrition, unhealthy dietary behaviors, and a suboptimal dietary intake can play a significant role in the occurrence, development, and prognosis of chronic pain. The relationship between nutrition and chronic pain is complex and may involve many underlying mechanisms such as oxidative stress, inflammation, and glucose metabolism. As such, pain management requires a comprehensive and interdisciplinary approach that includes nutrition. Nutrition is the top modifiable lifestyle factor for chronic non-communicable diseases including chronic pain. Optimizing one's dietary intake and behavior needs to be considered in pain management. Thus, this narrative review reports and summarizes the existing evidence regarding (1) the nutrition-related health of people experiencing pain (2) the underlying potential mechanisms that explain the interaction between nutrition and chronic pain, and (3) the role of nutrition screening, assessment and evaluation for people experiencing pain and the scope of nutrition practice in pain management. Future directions in the nutrition and chronic pain field are also discussed.
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Affiliation(s)
- Ömer Elma
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| | - Katherine Brain
- School of Health Science, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Integrated Pain Service, Newcastle, NSW 2300, Australia
| | - Huan-Ji Dong
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden
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19
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Gut microbiome dysbiosis in inflammatory bowel disease. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2022; 192:179-204. [DOI: 10.1016/bs.pmbts.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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So D, Gibson PR, Muir JG, Yao CK. Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine. Gut 2021; 70:2383-2394. [PMID: 34417199 DOI: 10.1136/gutjnl-2021-324891] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/04/2021] [Indexed: 12/16/2022]
Abstract
Clinical guidelines in the use of fibre supplementation for patients with IBS provide one-size-fits-all advice, which has limited value. This narrative review addresses data and concepts around the functional characteristics of fibre and subsequent physiological responses induced in patients with IBS with a view to exploring the application of such knowledge to the precision use of fibre supplements. The key findings are that first, individual fibres elicit highly distinct physiological responses that are associated with their functional characteristics rather than solubility. Second, the current evidence has focused on the use of fibres as a monotherapy for IBS symptoms overall without attempting to exploit these functional characteristics to elicit specific, symptom-targeted effects, or to use fibre types as adjunctive therapies. Personalisation of fibre therapies can therefore target several therapeutic goals. Proposed goals include achieving normalisation of bowel habit, modulation of gut microbiota function towards health and correction of microbial effects of other dietary therapies. To put into perspective, bulking fibres that are minimally fermented can offer utility in modulating indices of bowel habit; slowly fermented fibres may enhance the activities of the gut microbiota; and the combination of both fibres may potentially offer both benefits while optimising the activities of the microbiota throughout the different regions of the colon. In conclusion, understanding the GI responses to specific fibres, particularly in relation to the physiology of the individual, will be the future for personalising fibre therapy for enhancing the personalised management of patients with IBS.
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Affiliation(s)
- Daniel So
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Jane G Muir
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Chu K Yao
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
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21
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The low FODMAP diet for IBS; A multicentre UK study assessing long term follow up. Dig Liver Dis 2021; 53:1404-1411. [PMID: 34083153 DOI: 10.1016/j.dld.2021.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/11/2021] [Accepted: 05/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The low FODMAP diet (LFD) is effective in managing irritable bowel syndrome (IBS) in the short term. This study assessed the long-term effect of the LFD on symptoms, nutritional composition and socialising. METHODS Patients with IBS who received dietetic-led LFD advice were approached at long term follow up (>6 months post LFD advice) from six centres across the United Kingdom. Participants completed questionnaires assessing gastrointestinal symptoms, adherence, nutritional intake, dietary acceptability and food related quality of life (QOL). RESULTS 205 participants completed the study, with a mean follow up of 44 months (3.7 years). Adequate symptom relief was noted in 60% of individuals at long term follow up, with 76% being on the personalisation phase of the LFD (pLFD). Mean nutritional intake did not differ between individuals on the pLFD versus habitual diet, with no difference in fructan intake (2.9 g/d vs 2.9 g/d, p = 0.96). The majority (80%) of individuals on the pLFD consumed specific 'free-from' products at the long term, with the purchase of gluten or wheat free products being the commonest (68%). CONCLUSION The majority of patients follow the pLFD in the long term, with a large proportion purchasing gluten or wheat free products to manage their symptoms.
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22
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So D, Yao CK, Gill PA, Pillai N, Gibson PR, Muir JG. Screening dietary fibres for fermentation characteristics and metabolic profiles using a rapid in vitro approach: implications for irritable bowel syndrome. Br J Nutr 2021; 126:208-218. [PMID: 33028442 DOI: 10.1017/s0007114520003943] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The therapeutic value of specific fibres is partly dependent on their fermentation characteristics. Some fibres are rapidly degraded with the generation of gases that induce symptoms in patients with irritable bowel syndrome (IBS), while more slowly or non-fermentable fibres may be more suitable. More work is needed to profile a comprehensive range of fibres to determine suitability for IBS. Using a rapid in vitro fermentation model, gas production and metabolite profiles of a range of established and novel fibres were compared. Fibre substrates (n 15) were added to faecal slurries from three healthy donors for 4 h with gas production measured using real-time headspace sampling. Concentrations of SCFA and ammonia were analysed using GC and enzymatic assay, respectively. Gas production followed three patterns: rapid (≥60 ml/g over 4 h) for fructans, carrot fibre and maize-derived xylo-oligosaccharide (XOS); mild (30-60 ml/g) for partially hydrolysed guar gum, almond shell-derived XOS and one type of high-amylose resistant starch 2 (RS2) and minimal (no differences with blank controls) for methylcellulose, another high-amylose RS2, acetylated or butyrylated RS2, RS4, acacia gum and sugarcane bagasse. Gas production correlated positively with total SCFA (r 0·80, P < 0·001) and negatively with ammonia concentrations (r -0·68, P < 0·001). Proportions of specific SCFA varied: fermentation of carrot fibre, XOS and acetylated RS2 favoured acetate, while fructans favoured butyrate. Gas production and metabolite profiles differed between fibre types and within fibre classes over a physiologically relevant 4-h time course. Several fibres resisted rapid fermentation and may be candidates for clinical trials in IBS patients.
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Affiliation(s)
- Daniel So
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, VIC3004, Australia
| | - Chu K Yao
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, VIC3004, Australia
| | - Paul A Gill
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, VIC3004, Australia
- Department of Immunology and Pathology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, VIC3004, Australia
| | - Naresh Pillai
- School of Engineering, RMIT University, Melbourne, VIC3000, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, VIC3004, Australia
| | - Jane G Muir
- Department of Gastroenterology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, VIC3004, Australia
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The Potential of Kluyveromyces marxianus to Produce Low-FODMAP Straight-Dough and Sourdough Bread: a Pilot-Scale Study. FOOD BIOPROCESS TECH 2021. [DOI: 10.1007/s11947-021-02681-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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24
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Manning LP, Yao CK, Biesiekierski JR. Therapy of IBS: Is a Low FODMAP Diet the Answer? Front Psychiatry 2020; 11:865. [PMID: 33110411 PMCID: PMC7488954 DOI: 10.3389/fpsyt.2020.00865] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 08/08/2020] [Indexed: 12/12/2022] Open
Abstract
Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder with a worldwide prevalence of 11%. It is characterized by abdominal pain and altered bowel habits in the absence of underlying unique pathology. The condition is associated with poor quality of life and high use of healthcare resources required for management. The low FODMAP diet (LFD) is a recognized treatment for symptom management of IBS; however, approximately 30% of patients do not respond. The aim of this review was to understand the effectiveness and application of the LFD compared with other dietary and non-dietary interventions. Ten studies were included, eight of which assessed the LFD against other dietary interventions including traditional dietary advice, modified National Institute for Health and Care Excellence guidelines, a high FODMAP diet, gluten-free diet and Mediterranean diet, generalized dietary advice, probiotics, and a sham diet. Two studies compared a LFD to non-diet interventions of gut directed hypnotherapy or yoga. The findings clearly support the LFD as an effective treatment in IBS, and although it highlights the role for microbiota and current psychosocial state, it remains challenging to identify what combination of treatments may be best to ensure a personalized approach and overall higher response rates to IBS therapy.
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Affiliation(s)
- Lauren P. Manning
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia
| | - C. K. Yao
- Department of Gastroenterology, Central Clinical School, Monash University & Alfred Health, Melbourne, VIC, Australia
| | - Jessica R. Biesiekierski
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia
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25
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Ireton-Jones C, Weisberg MF. Management of Irritable Bowel Syndrome: Physician-Dietitian Collaboration. Nutr Clin Pract 2020; 35:826-834. [PMID: 32786046 DOI: 10.1002/ncp.10567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Irritable bowel syndrome (IBS) affects 10%-15% of adults in the United States and 12% of the worldwide population. Gastroenterologists as well as primary care practitioners are likely to be the first resource for patients with gastrointestinal (GI) symptoms. IBS is difficult to diagnose, as it is a functional GI disorder, determined after ruling out a myriad of other diagnoses. The 2016 Rome IV criteria define IBS as "a functional bowel disorder in which recurrent abdominal pain is associated with defecation or a change in bowel habits. Disordered bowel habits are typically present (ie, constipation, diarrhea, or a mix of constipation and diarrhea), as are symptoms of abdominal bloating/distension occurring over at least 6 months and not less than 3 months." Treatment of IBS historically has been through medical management; however, nutrition management of IBS using the FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) elimination diet is now a recommended, first-line therapy. FODMAPs are short-chain, poorly absorbed carbohydrates that are associated with symptoms in people with IBS. This diet intervention can be quite challenging, and therefore, patients should meet with a qualified dietitian who can provide the complex diet information in a practicable form. Physician-dietitian collaboration is invaluable for IBS patients to achieve a successful outcome.
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26
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Bajinka O, Tan Y, Abdelhalim KA, Özdemir G, Qiu X. Extrinsic factors influencing gut microbes, the immediate consequences and restoring eubiosis. AMB Express 2020; 10:130. [PMID: 32710186 PMCID: PMC7381537 DOI: 10.1186/s13568-020-01066-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/18/2020] [Indexed: 02/07/2023] Open
Abstract
From the emerging studies, the more diverse the microbial population in the gut, the healthier the gut. Health benefits are associated with the functional characteristics of these diverse microbial genes. Extrinsic factors causing dysbiosis are extensively studied however, linking the varying degree of consequences to the respective factors and therapeutic possibilities are not explored at length. This review aims to examine from previous studies and put forward the types of dysbiosis, the immediate consequences and the scientific approaches to restore disrupted microbiota. Dietary supplements are found to be one of the factors contributing profoundly to the alteration of gut microbiota. While diet rich in fibre and fermented food established a diverse microbiome and produce vital metabolites, high fat, animal proteins and high caloric carbohydrate are as well relative to dysbiosis among infants, adult or diseases individuals. The intermittent fasting, feeding methods, the pH and water quality are among the factors associated with dysbiosis. Prebiotics and Probiotics maintain and restore gut homeostasis. Antibiotic-induced dysbiosis are relatively on the spectrum of activity, the pharmacokinetics properties, the dose taken during the treatment route of administration and the duration of drug therapy. The higher the altitude, the lesser the diversity. Extreme temperatures as well are related to reduced microbial activity and metabolism. Delivery through caserium-section deprived the newborn from restoring valuable vaginal bacterial species and the baby will instead assumed intestinal microbiota-like. While exercise and oxidative stress contribute even though moderately, fecal microbial transfer (FMT) also influence gut microbiota.
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Literature Review: Dietary Intervention Adherence and Adherence Barriers in Functional Gastrointestinal Disorder Studies. J Clin Gastroenterol 2020; 54:203-211. [PMID: 31714332 DOI: 10.1097/mcg.0000000000001280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Dietary management is key in controlling functional gastrointestinal disorders (FGIDs) symptoms. However, the degree to which patients with FGIDs in clinical studies adhere to dietary recommendations is unknown. Our aim was to evaluate adherence, dietary education, and adherence-related factors in FGIDs dietary intervention trials. A literature search was performed using MEDLINE, Google Scholar, and SCOPUS for clinical trials evaluating dietary management of FGIDs. Full manuscripts published from January 2000 through August 2018 were reviewed. Data including definitions of adherence and rates, study design, dietary education, use of a dietitian, provision of study foods, potential adherence barriers, and dropouts were captured. A total of 21 publications were included. Fifteen (67%) focused on the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, 5 (24%) on fiber supplementation, and 1 (9%) on a low carbohydrate diet. Fifteen (71%) were randomized controlled trials. Meals/supplements were provided to the study participants in 27%, 80%, and 100%, of the low FODMAP, fiber, and low carbohydrate studies, respectively, which appeared to significantly enhance adherence (P<0.03). Eighteen studies (81%) provided either written or oral diet information to study participants. Overall, only 10 publications (48%) provided adherence data. Nine (60%) of the low FODMAP studies provided adherence data (range, 30% to 100%); ranges could not be calculated for the other dietary trials. The most common method to measure adherence was via food diaries. Therefore, adherence is not often measured in FGIDs dietary intervention clinical trials; when reported, rates of adherence range widely. Studies providing food had the highest adherence rates.
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28
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Abstract
The purpose of the present review is to describe how human physiology at very low carbohydrate intakes relates to the criteria for nutritional essentiality. Although we did not limit ourselves to one particular type or function of carbohydrates, we did primarily focus on glucose utilisation as that function was used to determine the recommended daily allowance. In the general population, the human body is able to endogenously synthesise carbohydrates, and does not show signs of deficiency in the absence of dietary carbohydrates. However, in certain genetic defects, such as glycogen storage disease type I, absence of dietary carbohydrates causes abnormalities that are resolved with dietary supplementation of carbohydrates. Therefore, dietary carbohydrates may be defined as conditionally essential nutrients because they are nutrients that are not required in the diet for the general population but are required for specific subpopulations. Ketosis may be considered a physiological normal state due to its occurrence in infants in addition to at very low carbohydrate intakes. Although sources of dietary carbohydrates can provide beneficial micronutrients, no signs of micronutrient deficiencies have been reported in clinical trials of low-carbohydrate ketogenic diets. Nonetheless, more research is needed on how micronutrient requirements can change depending on the dietary and metabolic context. More research is also needed on the role of dietary fibre during a low-carbohydrate ketogenic diet as the beneficial effects of dietary fibre were determined on a standard diet and several studies have shown beneficial effects of decreasing non-digestible carbohydrates.
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29
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Pesce M, Cargiolli M, Cassarano S, Polese B, De Conno B, Aurino L, Mancino N, Sarnelli G. Diet and functional dyspepsia: Clinical correlates and therapeutic perspectives. World J Gastroenterol 2020; 26:456-465. [PMID: 32089623 PMCID: PMC7015717 DOI: 10.3748/wjg.v26.i5.456] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/24/2019] [Accepted: 01/18/2020] [Indexed: 02/06/2023] Open
Abstract
Hypervigilance and symptoms anticipation, visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia (FD) patients. Many patients recognize meals as the main triggering factor; thus, dietary manipulations often represent the first-line management strategy in this cohort of patients. Nonetheless, scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms, resulting in non-standardized nutritional approaches. Most dietary advises are indeed empirical and often lead to exclusion diets, reinforcing in patients the perception of “being intolerant” to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology (i.e., hypervigilance and symptom anticipation). Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals (i.e., dietitians) are only available in tertiary referral settings. This in turn, can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia. In this review, we aim at evaluating the relationship between dietary habits, macronutrients and specific foods in determining FD symptoms. We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients, providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.
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Affiliation(s)
- Marcella Pesce
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples 80131, Italy
- GI Physiology Unit, University College London Hospital, London NW1 2BU, United Kingdom
| | - Martina Cargiolli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples 80131, Italy
| | - Sara Cassarano
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples 80131, Italy
| | - Barbara Polese
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples 80131, Italy
| | - Barbara De Conno
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples 80131, Italy
| | - Laura Aurino
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples 80131, Italy
| | - Nicola Mancino
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples 80131, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples 80131, Italy
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30
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Rej A, Aziz I, Tornblom H, Sanders DS, Simrén M. The role of diet in irritable bowel syndrome: implications for dietary advice. J Intern Med 2019; 286:490-502. [PMID: 31468640 DOI: 10.1111/joim.12966] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects approximately 10% of the population. Diet triggers symptoms in the vast majority of individuals with IBS. In view of this, there has been a focus on the role of diet in IBS. The diets currently being headlined for IBS include (i) traditional dietary advice, (ii) the low fermentable oligo-, di-, mono- saccharides and polyols (FODMAPs) diet and (iii) the gluten-free diet (GFD). Although traditional dietary advice is considered as the first-line dietary therapy, its evidence base is variable, with a few randomized controlled trials (RCTs) exploring the efficacy of this approach, other than for fibre. There are now a growing number of RCTs demonstrating the efficacy of the low FODMAP diet in the short-term, with some emerging data on the long-term 'adapted' low FODMAP diet. There are also several RCTs showing the benefits of a GFD in IBS; however, this concept is hampered with uncertainty as to the mechanism of action. Nevertheless, all of these dietary therapies are viable options for individuals with IBS, with the dietitian and patient engagement at the forefront of achieving success. However, future pragmatic studies are needed to clarify the comparative efficacy and convenience of implementing these various diets into routine life. Moreover, it is imperative to better delineate the concern that restrictive diets - such as the low FODMAP and GFD - may promote nutritional inadequacies, disordered eating behaviours, and lead to detrimental alterations to the gut microbiota.
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Affiliation(s)
- A Rej
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - I Aziz
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK
| | - H Tornblom
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK
| | - M Simrén
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA
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31
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Fodor I, Man SC, Dumitrascu DL. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet in children. World J Clin Cases 2019; 7:2666-2674. [PMID: 31616683 PMCID: PMC6789397 DOI: 10.12998/wjcc.v7.i18.2666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/26/2019] [Accepted: 08/27/2019] [Indexed: 02/05/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a lifelong condition with a high prevalence among children and adults. As the diet is a frequent factor that triggers the symptoms, it has been assumed that by avoiding the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP), the symptoms might be improved. Therefore, in the past decade, low FODMAP diet has been intensively investigated in the management of IBS. The capacity of FODMAPs to trigger the symptoms in patients with IBS was related to the stimulation of mechanoreceptors in the small and large intestine. This stimulation appears as a response to a combination of increased luminal water (the osmotic effect) and the release of gases (carbon dioxide and hydrogen) due to the fermentation of oligosaccharides and malabsorption of fructose, lactose and polyols. Numerous studies have been published regarding the efficacy of a low FODMAP diet compared to a traditional diet in releasing the IBS symptoms in adults, but there are only a few studies in the juvenile population. The aim of this review is to analyze the current data on both low FODMAP diet in children with IBS and the effects on their nutritional status and physiological development, given the fact that it is a restrictive diet.
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Affiliation(s)
- Ioana Fodor
- 3rd Pediatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Sorin Claudiu Man
- 3rd Pediatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Dan L Dumitrascu
- 2nd Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
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32
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Lee HJ, Kim HJ, Kang EH, Jung KW, Myung SJ, Min YW, Choi CH, Ryu HS, Choi JK, Kwon JG, Hong KS, Park KS. Self-reported Food Intolerance in Korean Patients With Irritable Bowel Syndrome. J Neurogastroenterol Motil 2019; 25:222-232. [PMID: 30827068 PMCID: PMC6474711 DOI: 10.5056/jnm18125] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/08/2018] [Accepted: 11/27/2018] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Various foods trigger and/or worsen the symptoms of irritable bowel syndrome (IBS). However, Korean food-related gastrointestinal (GI) symptoms in IBS patients have not yet been investigated. This study aims to evaluate the prevalence of self-reported food intolerance in Korean IBS patients and determine the Korean food items and food groups perceived by patients to worsen their GI symptoms. Methods We recruited 393 study subjects, comprising 101 IBS patients, 167 symptomatic non-IBS subjects, and 125 control subjects. All participants completed a questionnaire to identify the most problematic foods and assess the occurrence of GI symptoms caused by 119 Korean food items. They also completed the validated Rome III questionnaire for IBS. Results The prevalence of self-reported food intolerance in Korean IBS patients was 79.2%, which was significantly higher than that in control subjects (44.8%, P < 0.001). The most problematic foods reported by IBS patients who experienced food intolerance were high-fat foods (25.0%), gluten foods (23.8%), spicy foods (15.0%), and dairy products (15.0%). A total of 63.4% of IBS patients reported GI symptoms related to the consumption of foods high in fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP), while 48.5% of IBS patients reported symptoms associated with high-fat foods. Gas problems and loose stools were the most frequently reported symptoms. Conclusions A large proportion of Korean IBS patients complained of intolerance to certain food items, with high-fat and high-FODMAP foods being the main triggers. This study provides a basis for planning food intervention studies for Korean IBS patients.
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Affiliation(s)
- Hyo Jeong Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Eun Hee Kang
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Hwan Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han Seung Ryu
- Department of Internal Medicine, Wonkwang University College of Medicine and Digestive Disease Research Institute, Iksan, Jeollabuk-do, Korea
| | - Jong Kyoung Choi
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Joong Goo Kwon
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Kyoung Sup Hong
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Gastroenterology, Mediplex Sejong Hospital, Incheon, Korea (Current address)
| | - Kyung Sik Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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33
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Baranguán Castro ML, Ros Arnal I, García Romero R, Rodríguez Martínez G, Ubalde Sainz E. Implementation of a low FODMAP diet for functional abdominal pain. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2018.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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34
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Fragkos KC, Keetarut K, Cox A, Eady J, Emmanuel AV, Zarate-Lopez N. Joint Hypermobility Syndrome Affects Response to a Low Fermentable Oligosaccharide, Disaccharide, Monosaccharide and Polyol Diet in Irritable Bowel Syndrome Patients: A Retrospective Study. Gastroenterology Res 2019; 12:27-36. [PMID: 30834032 PMCID: PMC6396789 DOI: 10.14740/gr1133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/16/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet causes significant clinical improvement in patients with irritable bowel syndrome (IBS). Joint hypermobility syndrome (JHS), defined as musculoskeletal symptoms in a hypermobile individual in the absence of systemic rheumatological disease, may be associated with functional gastrointestinal symptoms, including IBS. The aim of this study is to examine whether JHS can affect the response to the low FODMAP diet in patients with IBS. METHODS In this retrospective study, we included patients with IBS according to Rome III criteria who had followed a low FODMAP diet. Symptoms scores were measured before and after the low FODMAP diet. RESULTS A total of 165 patients (130 females, age 44 ± 14 years) were included. Diarrhea predominant IBS (IBS-D) was present in 40.6% of our patients while JHS was present in 21.2%. The score for abdominal pain was higher for JHS compared to non-JHS prior to intervention (P = 0.011). Symptoms improved in both groups of patients after a low FODMAP diet (P < 0.0001). The largest effects were shown with significant decreases of the average score and bloating. When broken down by JHS and IBS type, a low FODMAP diet significantly improved pain, bloating, diarrhea, constipation, and the average score with the largest effect in JHS/constipation predominant IBS (IBS-C), JHS/mixed IBS and unclassified IBS (IBS-M), JHS/IBS-D, non-JHS/IBS-C and JHS/IBS-M, respectively. CONCLUSIONS Our study suggests that a low FODMAP diet has a greater effect on IBS symptoms in JHS than non-JHS patients.
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Affiliation(s)
- Konstantinos C. Fragkos
- GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Katie Keetarut
- Dietetics Department, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Anna Cox
- GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Johanna Eady
- Dietetics Department, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Anton V. Emmanuel
- GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Natalia Zarate-Lopez
- GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
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35
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Mitchell H, Porter J, Gibson PR, Barrett J, Garg M. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49:124-139. [PMID: 30589971 DOI: 10.1111/apt.15079] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 10/27/2018] [Accepted: 11/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the efficacy of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) for patients with irritable bowel syndrome, many questions remain unanswered with respect to its clinical implementation. AIM To review literature to identify, synthesise, and provide direction for future research in the implementation and evaluation of the low FODMAP diet. METHODS Bibliographical searches were performed in Ovid Medline, CINAHL, Scopus and PubMed from database commencement until September 2018, with search terms focused on the population (irritable bowel syndrome) and intervention of interest (FODMAP). RESULTS Predictors of response to a low FODMAP diet remain under investigation, with preliminary data supporting faecal microbiota or faecal volatile organic compound profiling. Training of clinicians, and standards for the education of patients about the phases of a low FODMAP diet, as well as the role of Apps, require formal evaluation. There are limited data on the longer term efficacy and safety of the low FODMAP diet with respect to sustained symptom control, effect on quality of life and healthcare utilisation, nutritional adequacy, precipitation of disordered eating behaviours, effects on faecal microbiota and metabolomic markers, and subsequent translation to clinical effects. CONCLUSIONS Many gaps in implementation of the low FODMAP diet in clinical practice, as well as long-term safety and efficacy, remain for further investigation.
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Affiliation(s)
- Hannah Mitchell
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia.,Allied Health, Eastern Health, Melbourne, Victoria, Australia
| | - Judi Porter
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Allied Health, Eastern Health, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Victoria, Australia
| | - Jacqueline Barrett
- Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Victoria, Australia
| | - Mayur Garg
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia
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Bile acids and FXR in functional gastrointestinal disorders. Dig Liver Dis 2018; 50:795-803. [PMID: 29908754 DOI: 10.1016/j.dld.2018.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 12/11/2022]
Abstract
Functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome (IBS) and chronic constipation (CC), are commonly diagnosed conditions in clinical practice which create a substantial global burden. Since the farnesoid X receptor (FXR) and bile acids (BAs) are responsible for maintaining homeostasis in the GI tract, any disturbances in the expression of FXR or the composition of BAs may contribute to the development of the GI symptoms. Alterations in the mechanism of action of FXR directly affect the BAs pool and account for increased intestinal permeability and changes in abundance and diversity of gut microbiota leading to intestinal dysmotility. Current review focuses on the correlation between the FXR, BAs and the composition of gut microbiota and its influence on the occurrence of GI symptoms in FGIDs.
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Abstract
Ana M Valdes and colleagues discuss strategies for modulating the gut microbiota through diet and probiotics
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Affiliation(s)
- Ana M Valdes
- School of Medicine, University of Nottingham, City Hospital, Nottingham NG5 1PB, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Jens Walter
- Department of Agricultural, Food, and Nutritional Science and Department of Biological Sciences, University of Alberta, Edmonton, Canada
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
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38
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[Implementation of a low FODMAP diet for functional abdominal pain]. An Pediatr (Barc) 2018; 90:180-186. [PMID: 29685830 DOI: 10.1016/j.anpedi.2018.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. MATERIAL AND METHODS A table was designed in which foods were classified according to their FODMAP content, as well as a 'Symptoms and Stools Diary'. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. RESULTS A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41-3.33] versus 2 [IQR: 1.33-6.33] daily episodes, P=.024), less pain severity compared to baseline (1.41cm [IQR: 0.32-5.23] versus 4.63cm [IQR: 2.51-6.39] measured by 10-cm Visual Analogue Scale, P=.035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. CONCLUSIONS The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods.
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Henriksen M, Høivik ML, Jelsness-Jørgensen LP, Moum B. Irritable Bowel-like Symptoms in Ulcerative Colitis are as Common in Patients in Deep Remission as in Inflammation: Results From a Population-based Study [the IBSEN Study]. J Crohns Colitis 2018; 12:389-393. [PMID: 29186372 DOI: 10.1093/ecco-jcc/jjx152] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS An increased prevalence of irritable bowel syndrome [IBS]-like symptoms has been reported in patients with ulcerative colitis [UC]. Whether ongoing inflammation increases the prevalence of such symptoms is unknown. The aims of this study were to determine the prevalence of IBS-like symptoms in a population-based cohort of UC patients 20 years after diagnosis, and to assess the possible association between such symptoms and ongoing inflammation. METHODS Patients diagnosed with UC between 1990 and 1994, in a geographically well-defined area, were included in a prospective follow-up study, and IBS symptoms according to Rome III criteria were recorded 20 years after diagnosis. The patients underwent colonoscopy with biopsies and/or the level of faecal calprotectin was analysed. RESULTS A total of 260 patients answered the Rome III questionnaire. The overall prevalence of IBS-like symptoms was 27%. In patients who had no signs of inflammation in colonic biopsies [n = 96] [deep remission], the prevalence was 29%. No difference in prevalence of IBS-like symptoms was found between patients with ongoing inflammation and patients in deep remission. CONCLUSIONS IBS-like symptoms in UC patients are frequent after 20 years of disease. Deep remission did not change the frequency of IBS-like symptoms.
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Affiliation(s)
- Magne Henriksen
- Østfold Hospital Trust, Department of Gastroenterology, Grålum, Norway
| | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Østfold Hospital Trust, Department of Gastroenterology, Grålum, Norway.,Østfold University College, Department of Health Science, Halden, Norway
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hewawasam SP, Iacovou M, Muir JG, Gibson PR. Dietary practices and FODMAPs in South Asia: Applicability of the low FODMAP diet to patients with irritable bowel syndrome. J Gastroenterol Hepatol 2018; 33:365-374. [PMID: 28700090 DOI: 10.1111/jgh.13885] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022]
Abstract
The low Fermentable Oligosaccharides, Disaccharides, and Monosaccharides And Polyols (FODMAP) diet has been described, evaluated, and found efficacious for the treatment of patients with irritable bowel syndrome primarily in Western countries. The aim of this review was to address the applicability of this diet to South Asia. The high prevalence of irritable bowel syndrome in South Asia and its associated effects of quality of life and economics warrant the introduction of efficacious therapies. The considerable heterogeneity of dietary patterns and methods of food preparation across South Asian countries and a paucity of food analysis limit precision in defining foods that are high or low in FODMAPs. Spices and condiments are commonly consumed and mostly have a low FODMAP content. However, major high FODMAP sources are frequently used and include onion, garlic, shallots, legumes/pulses, and wheat-based products, as well as coconut and milk products, offering an opportunity for dietary management to reduce the symptom load. The feasibility of instituting a restrictive diet in which foods with a high FODMAP content are replaced by foods low in FODMAPs must be addressed as a substantial proportion of the nutritional intake including energy, proteins, and micronutrients, is often obtained from FODMAP-rich food. Furthermore, limited knowledge of health professionals together with a paucity of dietitians further challenge the practicality of introducing the diet. Thus, while the use of the low FODMAP diet in South Asia may be more limited than in westernized countries, it does offer potential therapeutic opportunities, the efficacy, and impact of which require further investigation.
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Affiliation(s)
- Samapriya P Hewawasam
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Marina Iacovou
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Jane G Muir
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
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Tuck CJ, Vanner SJ. Dietary therapies for functional bowel symptoms: Recent advances, challenges, and future directions. Neurogastroenterol Motil 2018; 30. [PMID: 29094792 DOI: 10.1111/nmo.13238] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Functional gastrointestinal symptoms in irritable bowel syndrome (IBS) and quiescent inflammatory bowel disease (IBD) cause significant morbidity and a reduction in quality of life. Multiple dietary therapies are now available to treat these symptoms, but supporting evidence for many is limited. In addition to a further need for studies demonstrating efficacy and mechanism of action of dietary therapies, the risk of nutritional inadequacy, alterations to the microbiome and changes in quality of life are key concerns requiring elucidation. Identifying predictors of response to dietary therapy is an important goal as management could be tailored to the individual to target specific dietary components, and thereby reduce the level of dietary restriction necessary. PURPOSE This review discusses the available dietary therapies to treat symptoms in patients with IBS and patients with quiescent IBD suffering from IBS symptoms, with the aim to understand where current dietary evidence lies and how to move forward in dietary research in this field.
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Affiliation(s)
- C J Tuck
- Gastrointestinal Diseases Research Unit, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - S J Vanner
- Gastrointestinal Diseases Research Unit, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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Verspreet J, Hansen AH, Harrison SJ, Vergauwen R, Van den Ende W, Courtin CM. Building a fructan LC–MS2 library and its application to reveal the fine structure of cereal grain fructans. Carbohydr Polym 2017; 174:343-351. [DOI: 10.1016/j.carbpol.2017.06.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 02/06/2023]
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Ireton-Jones C. The low FODMAP diet: fundamental therapy in the management of irritable bowel syndrome. Curr Opin Clin Nutr Metab Care 2017; 20:414-419. [PMID: 28617710 DOI: 10.1097/mco.0000000000000398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The low FODMAP diet is now recognized as first-line therapy for treatment of irritable bowel syndrome (IBS) symptoms including abdominal pain, gas, bloating, diarrhea and or constipation. This information must be disseminated for application to clinical practice. RECENT FINDINGS There are many people with IBS worldwide who can benefit from following the low FODMAP diet to alleviate or minimize symptoms. Clinical studies and trials demonstrating the positive outcomes of the low FODMAP diet have been based on diet education provided by dietitians. Understanding the types of carbohydrates that are high in FODMAPs and the associated symptoms, nutrition intervention can be targeted using the low FODMAP diet. The nutrition intervention is relatively in expensive, noninvasive and basically without side-effects if monitored by a dietitian and clinical team. SUMMARY Applying the low FODMAP diet in IBS can greatly improve health and quality of life outcomes by alleviating or significantly improves symptoms.
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Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients 2017; 9:nu9090940. [PMID: 28846594 PMCID: PMC5622700 DOI: 10.3390/nu9090940] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) affects 7–15% of the general population. A recently devised dietary approach consists of restricting foods with highly fermentable oligo-, di-, and monosaccharides, and polyols (FODMAPs), which can trigger and/or exacerbate IBS symptoms. The aim of this study is to use meta-analysis to provide an update on the randomised control trials (RCTs) and cohort studies, and examine them separately in relation to diet type. Papers were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. Cohen’s d and odds ratios were used as a measure of effect size for RCTs. A random effects model was used to account for different sources of variation among studies. Heterogeneity was assessed using Q statistics, I2, Tau, and Tau2. Publication bias was analysed and represented by a funnel plot, and funnel plot symmetry was assessed with Egger’s test. The results showed that in the RCTs, the patients receiving a low-FODMAP diet experienced a statistically significant pain and bloating reduction compared with those receiving a traditional diet; as regards to stool consistency, there was no significant difference between treatments. A significant reduction in abdominal pain and bloating were described by patients receiving a low-FODMAP diet compared with those receiving a high-FODMAP diet. In cohort studies, pain and bloating were significantly reduced after treatment compared with the baseline diet. We conclude that there is evidence that a low-FODMAP diet could have a favourable impact on IBS symptoms, especially abdominal pain and bloating. However, it remains to be demonstrated whether a low-FODMAP diet is superior to conventional IBS diets, especially in the long term.
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45
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Close association between intestinal microbiota and irritable bowel syndrome. Eur J Clin Microbiol Infect Dis 2017; 36:2303-2317. [DOI: 10.1007/s10096-017-3060-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/04/2017] [Indexed: 12/13/2022]
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Costa RJS, Snipe RMJ, Kitic CM, Gibson PR. Systematic review: exercise-induced gastrointestinal syndrome-implications for health and intestinal disease. Aliment Pharmacol Ther 2017; 46:246-265. [PMID: 28589631 DOI: 10.1111/apt.14157] [Citation(s) in RCA: 254] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/03/2017] [Accepted: 05/01/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND "Exercise-induced gastrointestinal syndrome" refers to disturbances of gastrointestinal integrity and function that are common features of strenuous exercise. AIM To systematically review the literature to establish the impact of acute exercise on markers of gastrointestinal integrity and function in healthy populations and those with chronic gastrointestinal conditions. METHODS Search literature using five databases (PubMed, EBSCO, Web of Science, SPORTSdiscus, and Ovid Medline) to review publications that focused on the impact of acute exercise on markers of gastrointestinal injury, permeability, endotoxaemia, motility and malabsorption in healthy populations and populations with gastrointestinal diseases/disorders. RESULTS As exercise intensity and duration increases, there is considerable evidence for increases in indices of intestinal injury, permeability and endotoxaemia, together with impairment of gastric emptying, slowing of small intestinal transit and malabsorption. The addition of heat stress and running mode appears to exacerbate these markers of gastrointestinal disturbance. Exercise stress of ≥2 hours at 60% VO2max appears to be the threshold whereby significant gastrointestinal perturbations manifest, irrespective of fitness status. Gastrointestinal symptoms, referable to upper- and lower-gastrointestinal tract, are common and a limiting factor in prolonged strenuous exercise. While there is evidence for health benefits of moderate exercise in patients with inflammatory bowel disease or functional gastrointestinal disorders, the safety of more strenuous exercise has not been established. CONCLUSIONS Strenuous exercise has a major reversible impact on gastrointestinal integrity and function of healthy populations. The safety and health implications of prolonged strenuous exercise in patients with chronic gastrointestinal diseases/disorders, while hypothetically worrying, has not been elucidated and requires further investigation.
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Affiliation(s)
- R J S Costa
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | - R M J Snipe
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | - C M Kitic
- Sport Performance Optimisation Research Team, School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - P R Gibson
- Department of Gastroenterology- The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
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47
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Zweig A, Pohl D. [Not Available]. PRAXIS 2017; 106:1229-1235. [PMID: 29088970 DOI: 10.1024/1661-8157/a002856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Funktionelle Magen-Darm-Beschwerden sind in der Allgemeinbevölkerung weit verbreitet, und das Reizdarmsyndrom (Irritable Bowel Syndrome, IBS) ist eines der häufigsten gastroenterologischen Krankheitsbilder. Trotz individuell sehr unterschiedlicher klinischer Präsentation berichtet ein Grossteil der Patienten über eine Abhängigkeit ihrer Beschwerden von der Nahrungsaufnahme bzw. von bestimmten Nahrungsmitteln. Die FODMAP-arme Diät, durch eine spezialisierte Ernährungsberatung instruiert, zeigt sich sehr wirksam zur Symptomreduktion bei IBS-Patienten. Sie basiert auf einer Reduktion fermentierbarer Kohlenhydrate. Ziel der Diät ist es, potenzielle nutritive Auslöser abdominaler Symptome zu identifizieren und diese in der täglichen Ernährung zu meiden.
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Affiliation(s)
- Annina Zweig
- 1 Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich
| | - Daniel Pohl
- 1 Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich
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