Ibs and short_chain_carbohydrates_ong

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Ibs and short_chain_carbohydrates_ong

  1. 1. www.pronutritionist.net Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome Ong D et al J Gastroenterol Hepatol 2010;25:1366-1373 Page 1 Reijo Laatikainen, Authorized Nutritionist, MBA http://twitter.com/pronutritionist http://www.facebook.com/pronutritionist Http://www.slideshare.net/pronutritionist
  2. 2. Page 2 Pronutritionist’s background (1/2) • Irritable bowel syndrome (IBS) is very common disorder – affecting approximately 15% of population – In Finland c. 5-16 % of population is affected (Hillilä M et al. 2008) – IBS causes significant worsening of quality of life (comparable to type 2 diabetes or migraine) and lead to substantial health care costs • IBS is characterized by – Key symtomps: abdominal pain, altered bowel habit (diarrhoea/constipation) and bloating – Additional symptoms may include wind, distension – IBS is often accompanied with heartburn and/or dyspepsia • Some dietary factors may have an effect to symptoms – Probiotics, soluble fiber and avoidance of caffeine is often recommended – Role carbohydrates is under research, for example restriction of carbohydrates is emerging as an alternative therapy ( Austin et al. 2009) Ong D et al. J Gastroenterol Hepatol 2010;25:1366- 1373 www.pronutritionist.net
  3. 3. Pronutritionist’s background (2/2) • Recent studies have identified a collection of short-chain carbohydrates that are poorly absorbed in the small intestine – FODMAPs = Fermentable Oligo- Di- and Mono-saccharides And Polyols (incl. Fructans, galactans, lactose, fructose, xylitol, sorbitol) – FODMAPs may be important triggers of functional gut symptoms (Gibson PR et al. 2007) • Also psyllium fiber and probiotics have shown some promise in the treatment of IBS (Bijkerk CJ et al. 2009 & Moayyedi PT et al. 2008) www.pronutritionist.netOng D et al. J Gastroenterol Hepatol 2010;25:1366-1373 3
  4. 4. Methods • Single-blind, crossover intervention trial • n = 30 – 15 healthy and 15 with IBS • Diets: – low (9 g/day) in FODMAPs (LFD) (included sucrose sweetened drinks, chewing gum!) – high (50 g/day) in FODMAPs (HFD) – each diet lasted 2 days, all meals were provided to participants – there was a 7-day washout period between the diets • Food and gastrointestinal symptom diaries were kept during the study • Breath samples were collected hourly over 14 h on day 2 in order to estimate the effects of different FODMAP diets on gas production Page 4 Ong D et al. J Gastroenterol Hepatol 2010;25:1366- 1373 www.pronutritionist.net
  5. 5. Results 1/3 • In patients with IBS all symptoms were significantly worse with the HFD when considered individually • A composite IBS symptom score (including the most commonly reported IBS gastrointestinal symptoms) was significantly higher for IBS patients during the HFD than during the LFD • In the IBS group, upper gastrointestinal symptoms as heartburn and nausea, and lethargy increased during the HFD • HFD increased gas production measured by breath tests in both healthy and IBS patients. In addition, IBS patients produced more gas • However, in the healthy subjects, the only symptom to change significantly was an increase in flatus during the HFD Page 5 Ong D et al. J Gastroenterol Hepatol 2010;25:1366- 1373 www.pronutritionist.net
  6. 6. Results (2/3) www.pronutritionist.netOng D et al. J Gastroenterol Hepatol 2010;25:1366-1373 6 14 1 Pain during LOW FODMAP (9g/d.) none/mild moderate/s evere 6 9 Pain during HIGH FODMAP (50 g/d.) none/mild moderate/sever e Abdominal pain/discomfort (# of IBS patients) Only one out of the healthy participant (controls) developed moderate/ severe bloating on HIGH FODMAP diet
  7. 7. Results (3/3) www.pronutritionist.netOng D et al. J Gastroenterol Hepatol 2010;25:1366-1373 7 Abdominal bloating (# of IBS patients) 12 3 Bloating during LOW FODMAP (9g/d.) none/mild moderate/sever e 4 11 Bloating during HIGH FODMAP (50 g/d.) none/mild moderate/sev ere None of the healthy participants (controls) developed moderate/ severe bloating on HIGH FODMAP diet
  8. 8. Pronutritionist’s discussion (1/2) • Fructans, galactans, di-, monosaccharides, polyols (FODMAPs) caused significant symptoms among IBS patients when daily dose was increased from 9 to 50 grams • The symptoms of IBS developed quickly being evident over the first day of the HFD in patients with IBS – Since they were blinded to the nature of the diet, this finding supports the concept that FODMAPs presented in a food matrix are a trigger for gastrointestinal symptoms • Both diets were similar for total energy, protein and starch intake, but fat intake was significantly lower during the HFD dietary period for both healthy and IBS – it’s unlikely that the difference in fat contributed to the observed increase in gas or symptoms • Also potentially fermentable indigestible long-chain carbohydrate intake was similar in both diets www.pronutritionist.netOng D et al. J Gastroenterol Hepatol 2010;25:1366-1373 8
  9. 9. Pronutritionist’s discussion (2/2) • Based on this study, it seems that ingestion of FODMAPs in the diet – leads to prolonged gas production in the intestine in healthy volunteers and patients with IBS – induces gastrointestinal and systemic symptoms in patients with IBS • Avoidance of xylitol, sorbitol, fructose, inulin, and food items rich in fructans (wheat, white bread, pasta, onion, asparagus, leeks etc.) is worth testing in IBS • This study supports previous findings in which 75 % of IBS patients have received rather good relief from FODMAP diet (Gibson PR and Sheppard SJ 2009) • However, avoidance of chilis and introduction of psyllium fiber and probiotic is also warranted www.pronutritionist.netOng D et al. J Gastroenterol Hepatol 2010;25:1366-1373 9
  10. 10. 7/05/201410 http://twitter.com/pronutritionist Reijo Laatikainen, Authorized Nutritionist, Dietitian, M.Sc, MBA http://twitter.com/pronutritionist http://www.facebook.com/pronutritionist Http://www.slideshare.net/pronutritionist

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