Fermentable Oligo-, Di-, Monosaccharides And Polyols Research Articles

Barsak Hastalıklarında Güncel Diyet Yaklaşımı: Fermente Oligo-, Di- ve Mono-Sakkaritler ve Polyol (FODMAP) İçeriği Düşük Diyet

Yaşam kalitesini olumsuz etkileyen inflamatuar barsak hastalıkları (İBH) ve irritabl barsak sendromu (İBS), ülkemizde ve dünya genelinde yaygın görülen önemli sağlık sorunlarındandır ve bu hastalıkların patofizyolojisi tam olarak açıklanamamıştır. Diyet gibi çevresel etmenler semptomların gelişiminde etkili olabilmektedir. Barsak sağlığı ile ilgili çalışmalarda farklı diyet önerileri bulunmaktadır. Bunlardan biri de kısa zincirli, emilimi sınırlı/düşük karbonhidratlardan olan fermente oligo-, di- ve mono-sakkaritler ve polyollerin (FODMAP) sınırlandırıldığı diyettir. FODMAP içeren karbonhidratların sindirimi ile fermente substratların, suyun ince barsak ve kolondaki miktarı artmaktadır. Bu durum luminal distansiyon ve gaz oluşumuna neden olmaktadır. Literatürde diyette fermente karbonhidratların sınırlandırılmasının (düşük FODMAP içerikli diyet) gastrointestinal sistem (GİS) semptomları üzerine olumlu etkiler gösterebileceğini savunan çalışmalar bulunmaktadır. Son dönemlerde İBH ve İBS için güncel tedavi yaklaşımı olan FODMAP içeren karbonhidratlardan sınırlı tıbbi beslenme tedavisinin sağlık üzerine etkinliği konusunda çalışmalar yapılmaktadır. Literatüre her yeni eklenen tıbbi beslenme tedavisi için bireyin beslenme ve genel sağlık durumu üzerine olumlu/olumsuz etkilerinin değerlendirilmesi önemlidir. Ancak, literatürde yer alan randomize kontrol çalışmalarının sınırlı sayıda olduğu dikkat çekmektedir. İBH ve İBS tanısı alan bireylerde fermente karbonhidratların sınırlandırılmasının gastrointestinal sağlık üzerine etkilerinin incelendiği uzun dönemli yapılan daha çok sayıda çalışmaya gereksinimi olduğu düşünülmektedir. Bu derleme, FODMAP içeren karbonhidratlardan sınırlı tıbbi beslenme tedavisinin etkinliği konusunda bilgi verilmesi amacıyla yapılmıştır.

Differential Effects of FODMAPs (Fermentable Oligo-, Di-, Mono-Saccharides and Polyols) on Small and Large Intestinal Contents in Healthy Subjects Shown by MRI

OBJECTIVES:The objective of this study was to investigate whether ingestion of fructose and fructans (such as inulin) can exacerbate irritable bowel syndrome (IBS) symptoms. The aim was to better understand the origin of these symptoms by magnetic resonance imaging (MRI) of the gut. METHODS: A total of 16 healthy volunteers participated in a four-way, randomized, single-blind, crossover study in which they consumed 500 ml of water containing 40 g of either glucose, fructose, inulin, or a 1:1 mixture of 40 g glucose and 40 g fructose. MRI scans were performed hourly for 5 h, assessing the volume of gastric contents, small bowel water content (SBWC), and colonic gas. Breath hydrogen (H2) was measured and symptoms recorded after each scan.RESULTS:Data are reported as mean (s.d.) (95% CI) when normally distributed and median (range) when not. Fructose increased area under the curve (AUC) from 0–5 h of SBWC to 71 (23) l/min, significantly greater than for glucose at 36 (11–132) l/min (P<0.001), whereas AUC SBWC after inulin, 33 (17–106) l/min, was no different from that after glucose. Adding glucose to fructose decreased AUC SBWC to 55 (28) l/min (P=0.08) vs. fructose. Inulin substantially increased AUC colonic gas to 33 (20) l/min, significantly greater than glucose and glucose+fructose (both P<0.05). Breath H2 rose more with inulin than with fructose. Glucose when combined with fructose significantly reduced breath H2 by 7,700 (3,121–12,300) p.p.m./min relative to fructose alone (P<0.01, n=13).CONCLUSIONS:Fructose but not inulin distends the small bowel with water. Adding glucose to fructose reduces the effect of fructose on SBWC and breath hydrogen. Inulin distends the colon with gas more than fructose, but causes few symptoms in healthy volunteers.

Functional bowel symptoms and diet

It is well recognised that ingestion of food is a trigger for functional bowel symptoms, particularly those associated with irritable bowel syndrome (IBS). Patients often use manipulation of diet as a means of controlling symptoms. Despite description of multiple dietary methods, few have scientific backing or quality evidence of efficacy. One approach is to define how specific food components influence the pathophysiology of IBS and then rationally design dietary approaches. For example, short-chain poorly absorbed carbohydrates (fermentable oligo-, di- and mono-saccharides and polyols (FODMAP)) cause luminal distension, which is a major stimulus for the development of symptoms in patients with visceral hypersensitivity. By determining food content of FODMAP, a diet in which foods low in FODMAP are favoured over those high in FODMAP can be designed. Observational, comparative and randomised controlled treatment and rechallenge studies have shown that such an approach is efficacious in the majority of patients with IBS. The low FODMAP diet is now the primary dietary therapy for such patients. Similar approaches can be applied to other food components, including proteins (such as gluten), fats and natural bioactive food chemicals. Such approaches have suggestions of efficacy, but the evidence base remains underdeveloped. An additional and important consideration for any dietary therapy is its nutritional adequacy and potential adverse health effects. Dietary manipulation is now a key management strategy in patients with functional bowel symptoms. Future well-designed interventional studies will lead to refinement of dietary approaches taken and to a better understanding of their long-term safety.

The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study

Current treatment for irritable bowel syndrome (IBS) is suboptimal. Fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) may trigger gastrointestinal symptoms in IBS patients. Our aim was to determine whether a low FODMAP diet improves symptoms in IBS patients. Irritable bowel syndrome patients, who had performed hydrogen/methane breath testing for fructose and lactose malabsorption and had received dietary advice regarding the low FODMAP diet, were included. The effect of low FODMAP diet was prospectively evaluated using a symptom questionnaire. Furthermore, questions about adherence and satisfaction with symptom improvement, dietary advice and diet were assessed. Ninety patients with a mean follow up of 15.7 months were studied. Most symptoms including abdominal pain, bloating, flatulence and diarrhoea significantly improved (p < 0.001 for all). 75.6%, 37.8% and 13.3% of patients had fructose, lactose malabsorption or small intestinal bacterial overgrowth respectively. Fructose malabsorption was significantly associated with symptom improvement (abdominal pain odds ratio (OR) 7.09 [95% confidence interval (CI) 2.01-25.0], bloating OR 8.71 (95% CI 2.76-27.5), flatulence OR 7.64 (95% CI 2.53-23.0) and diarrhoea OR 3.39 (95% CI 1.17-9.78), p < 0.029 for all). Most patients (75.6%) were adherent to the diet, which was associated with symptom improvement (abdominal pain, bloating, flatulence and diarrhoea all significantly associated with adherence, r > 0.27, p < 0.011). Most patients (72.1%) were satisfied with their symptoms. The low FODMAP diet shows efficacy for IBS patients. The current strategy of breath testing and dietary advice provides a good basis to understand and adhere to the diet.

Su2076 Weight Regain After Roux-en-Y Gastric Bypass Surgery Is Associated With Dysphagia Symptoms but Not Manometric Findings

Background: It has been suggested that a diet low in fermentable short chain carbohydrates, FODMAPs (Fermentable Oligo-Di-Monosaccharides and Polyols) can reduce gastrointestinal symptoms in patients with irritable bowel syndrome (IBS) (Gibson & Shepherd Am J Gastroenterol 2012). However, the intake of FODMAPs in IBS patients compared to the general population has not been studied. Aim: To measure the intake of FODMAPs in patients with IBS in comparison with the general population, and to determine the major sources of FODMAPs in the diet of IBS patients. Method: We included 115 patients with IBS according to the Rome III criteria (39.1±13.0 (mean± SD) years; 88 females) referred to our outpatient clinic. They completed a 4-days food registration record, which was compared with 115 age-and gender matched control subjects from a nation-wide dietary survey. A database including content of fructose, fructan, lactose, galacto-oligosaccharides (GOS) and polyols in 1700 food items was developed specifically for this study to determine the intake of FODMAPs. Results:The IBS patients had significantly lower intake of FODMAPs than the control group from the general population (30.91±14.3 vs.34.56±12.67 g/day; p,0.05). The intake of lactose was lower in IBS patients compared to controls (10.47±8.22) vs.13.70±8.29 g/day; p, 0.001), while polyol intake was significantly higher in the IBS group (1.70±1.87 vs.1.25±1.64 g/day; p,0.05). However, there were no statistically significant differences regarding the intake of fructose (14.18±7.63 vs.15.28±6.93 g/day; p=0.24) fructan (3.91±1.73 vs.3.78±1.67g/day; p=0.55) or GOS (0.63±0.61vs. 0.53±0.56 g/day; p=0.16) between IBS patients and control subjects. The major food sources with naturally occurring fructan and contributing to the intake of fructan in both groups were onion, garlic, wheat and rye. Fruit drinks/-juices and apples were the main contributors to the fructose intake. The richest sources of polyols in the IBS group were pears and sugar-free sweets and in the controls pears, apples and sugar-free sweets. Legumes and wheat-products were the major contributors to intake of GOS in both groups. IBS patients ate less dairy products and replaced 15% of lactose containing products with lactose-free, soy or oat products. The patients ingested half the amount of fruit drinks in comparison to the control group, and their intake of wheat containing food items was also lower than for the control group. Intake of legumes and onions were equal in both groups except for garlic that was more frequently consumed in the IBS group. Conclusion: Intake of FODMAPs seems to be lower in IBS patients than in the general population, and this was mainly explained by a reduction of the intake of lactose containing food items. Further studies assessing the role of intake of FODMAPs for symptoms in IBS patients are needed.

PMO-031 An audit investigating the efficacy of the low FODMAP diet in improving symptoms in patients with functional gastro-intestinal symptoms

IntroductionThe low FODMAP (Fermentable Oligo-, Di-, Mono-saccharides and Polyols) diet is a diet low in fermentable carbohydrates. These types of carbohydrate are rapidly fermented but poorly absorbed in the small...

Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms

Recognition of food components that induce functional gut symptoms in patient's functional bowel disorders (FBD) has been challenging. Food directly or indirectly provides considerable afferent input into the enteric nervous system. There is an altered relationship between the afferent input and perception/efferent response in FBD. Defining the nature of food-related stimuli may provide a means of minimizing such an input and gut symptoms. Using this premise, reducing the intake of FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols)--poorly absorbed short-chain carbohydrates that, by virtue of their small molecular size and rapid fermentability, will distend the intestinal lumen with liquid and gas--improves symptoms in the majority of patients. Well-developed methodologies to deliver the diet via dietician-led education are available. Another abundant source of afferent input is natural and added food chemicals (such as salicylates, amines, and glutamates). Studies are needed to assess the efficacy of the low food chemical dietary approach. A recent placebo-controlled trial of FODMAP-poor gluten provided the first valid evidence that non-celiac gluten intolerance might actually exist, but its prevalence and underlying mechanisms require elucidation. Food choice via the low FODMAP and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for functional gut symptoms.

Diarrhoea during enteral nutrition is predicted by the poorly absorbed short‐chain carbohydrate (FODMAP) content of the formula

Although it is recognized that diarrhoea commonly complicates enteral nutrition, the causes remain unknown. To identify factors associated with diarrhoea in patients receiving enteral nutrition with specific attention to formula composition. Medical histories of in-patients receiving enteral nutrition were identified by ICD-10-AM coding and randomly selected from the year 2003 to 2008. Clinical and demographic data were extracted. Formulas were classified according to osmolality, fibre and FODMAP (fermentable oligo-, di- and mono-saccharides and polyols) content. Formula FODMAP levels ranged from 10.6 to 36.5 g/day. Of 160 patients receiving enteral nutrition, 61% had diarrhoea. Univariate analysis showed diarrhoea was associated with length of stay >21 days (OR 4.2), enteral nutrition duration >11 days (OR 4.0) and antibiotic use (OR 2.1). After adjusting for influencing variables through a logistic regression model, a greater than five-fold reduction in risk of developing diarrhoea was seen in patients initiated on Isosource 1.5 (P = 0.029; estimated OR 0.18). The only characteristic unique to this formula was its FODMAP content, being 47-71% lower than any other formula. Length of stay and enteral nutrition duration independently predicted diarrhoea development, while being initiated on a lower FODMAP formula reduced the likelihood of diarrhoea. As retrospective evaluation does not support a cause-effect relationship, an interventional study investigating FODMAPs in enteral formula is indicated.

PTH-064 Implementation of the low-fermentable oligo-, di-, mono-saccharides and polyols diet in the UK: how easy is it and does it work?: Abstract PTH-064

Introduction Avoidance of fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) is an effective treatment for irritable bowel syndrome (IBS) and is widely used in Australasia. The complexity of this strategy requires that dietitians undergo specialist training prior to successful implementation of the diet. Differences between Australian and UK food availability, composition and intake are such that it is not clear whether this dietary approach is effective outside Australasia. We aimed to develop and implement the low FODMAP diet in the UK and evaluate its efficacy in the management of IBS. Methods An Australian dietitian with 3 years9 experience in the low FODMAP diet joined a UK Consultant Gastroenterologist, also experienced in the diet, and a UK Consultant Dietitian with a special interest in IBS. Resources were developed and tailored to the UK context. Extensive review of food availability and FODMAP composition of processed foods was undertaken via supermarket research. Dietary intake and food choice was examined by patient consultation. Input from experienced UK dietitians ensured appropriate dietary language was used in the resources. Subsequently, the diet was implemented and service evaluation on 8-week symptom response was conducted. The evaluation consisted of Likert scale questions assessing change in severity of individual and global symptoms. This was compared with data collected from patients receiving standard dietary advice. Results Marked differences in the UK and Australian diets were noted, including greater availability of pre-prepared foods, frequent addition of high FODMAP ingredients (eg, oligofructose) to packaged foods and differences in the availability and consumption of fruit and vegetables. Accordingly, implementation of the diet in the UK required marked adaptation in its application and supporting materials. Early evaluation data indicate that although standard advice is effective, a low FODMAP approach offers additional benefit for bloating and flatulence (Abstract 064). Conclusion The low FODMAP diet appears to be a promising strategy for managing IBS in the UK. The success of this complex diet requires delivery by an experienced dietitian and the use of comprehensive and relevant education material.