ibs and short_chain_carbohydrates_ong

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Manipulation of dietary short chain carbohydrates alters the

pattern of gas production and genesis of symptoms inirritable bowel syndrome

Ong D et al

J Gastroenterol Hepatol 2010;25:1366-1373

Reijo Laatikainen, Authorized Nutritionist, MBA

http://twitter.com/pronutritionisthttp://www.facebook.com/pronutritionist

Http://www.slideshare.net/pronutritionist

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


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

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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



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



Results (2/3)


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Abdominal pain/discomfort (# of IBS patients)

Only one out of the healthy participant (controls) developed moderate/ severe bloating on HIGH FODMAP diet

Results (3/3)


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Abdominal bloating (# of IBS patients)

None of the healthy participants (controls) developed moderate/ severe bloating on HIGH FODMAP diet

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


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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


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11/04/2310http://twitter.com/pronutritionist

Reijo Laatikainen, Authorized Nutritionist, MBA

http://twitter.com/pronutritionisthttp://www.facebook.com/pronutritionist

Http://www.slideshare.net/pronutritionist

ibs and short_chain_carbohydrates_ong

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