Consumption of Lactose, Other FODMAPs and Diarrhoea during Adjuvant 5-Fluorouracil Chemotherapy for Colorectal Cancer

Reetta Holma,Heikki Joensuu,Riitta Korpela,Pia Österlund,Reijo Laatikainen,Helena Orell,Tuija Poussa,Katri Peuhkuri

doi:10.3390/nu12020407

Abstract

Chemotherapy-induced mucosal injury of the small intestine may interfere with the enzymes and transporters responsible for the hydrolysis and absorption of dietary carbohydrates causing diarrhoea, abdominal discomfort and pain. The aim of this study was to investigate the association between the consumption of foods rich in FODMAPs (fermentable oligo-, di- and monosaccharides and polyols) and gastrointestinal symptoms in patients receiving adjuvant therapy for colorectal cancer. The patients (n = 52) filled in a 4-day food diary at baseline and during therapy and kept a symptom diary. The intakes of FODMAP-rich foods were calculated as portions and the intakes were divided into two consumption categories. Patients with high consumption of FODMAP-rich foods had diarrhoea more frequently than those with low consumption (for lactose-rich foods the odds ratio (OR) was 2.63, P = 0.03; and for other FODMAP-rich foods 1.82, P = 0.20). Patients with high consumption of both lactose-rich and other FODMAP-rich foods had an over 4-fold risk of developing diarrhoea as compared to those with low consumption of both (OR, 4.18; P = 0.02). These results were confirmed in multivariate models. Conclusion: Consumption of lactose-rich foods results in an increased risk of diarrhoea during adjuvant therapy for colorectal cancer, especially when the consumption of other FODMAP-rich foods is also high.

Highlights

Cytotoxic chemotherapy may damage the gastrointestinal tract mucosa and cause mucosal inflammation, oedema, ulceration and tissue atrophy
The objective of this study was to investigate whether the consumption of foods rich in FODMAPs would be associated with gastrointestinal symptoms during adjuvant therapy for colorectal cancer
The LIPSYT study focused on adverse events of chemotherapy regimens that were given after surgery for colorectal cancer, chemotherapy-related secondary lactose intolerance and involving a Lactobacillus rhamnosus GG intervention in an attempt to reduce chemotherapy-associated adverse effects [6,12]

Summary

Introduction

Cytotoxic chemotherapy may damage the gastrointestinal tract mucosa and cause mucosal inflammation, oedema, ulceration and tissue atrophy. Chemotherapy-associated gastrointestinal toxicity often manifests as diarrhoea, abdominal discomfort and pain; it may lead to treatment. A mucosal injury in the brush border of the small intestine can interfere with the function of the enzymes and transporters that are responsible for hydrolysis and absorption of dietary carbohydrates [3]. The effects of malabsorption of other carbohydrates, such as fructose, on the symptoms evoked by chemotherapy remain to be clarified. The fructose absorption capacity of the small intestinal epithelial cells is limited but can be considerably enhanced by co-ingestion of glucose or galactose [4,7]. Fructose is increasingly found in the Western diet [7]

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