Managing irritable bowel syndrome: The low-FODMAP diet

Chickpeas and gut microbiome: Functional food implications for health

Chickpea is considered a rich source of nutrients, especially protein and dietary fibre. Besides, chickpea has potential benefits for the maintenance of gut health by improving intestinal integrity and serving as a source of energy for the gut microbiota. Moreover, chickpea consumption has been found to possess anti-cancer, anti-inflammatory, and antioxidant activity. On undergoing certain treatments like soaking, dehulling, roasting, and germination, the anti-nutritional profile of chickpeas can be reduced. Observing these benefits, this review explores the impact of chickpea and its components on maintaining gut health, emphasizing various benefits. Besides, the paper comprehensively covers the nutritional composition of chickpeas and factors influencing the bioavailability of its components concerning gut health. Additionally, it outlines the mechanisms through which chickpeas influence gastrointestinal health, providing valuable insights into complex processes and potential therapeutic applications. Furthermore, the review identifies contributions that can guide future research, encouraging further exploration of chickpeas' role in gut health and the development of interventions. As a result of the presented review, chickpeas can be used as an affordable source of food, which is nutritionally stable and prevents gastrointestinal diseases.

Fructan content in most commonly consumed Slovenian foods and estimation of daily fructan consumption

Fructans can be considered as part of the group of fermentable oligo-, di- and monosaccharides and polyols (FODMAPs). Short-chain fructans have a rapid fermentation rate and can thus worsen symptoms in patients with irritable bowel syndrome. In this study, the fructan content in 40 of the most commonly consumed foods in Slovenia was measured. Overall, the fructan content was relatively low: 0.1-1.97 g/100 g fresh weight. The highest fructan content was found in onion (1.97 g/100 g), followed by wheat flour (0.75 g/100 g). A simple model for calculating fructan intake was developed based on the results of the SI. Menu 2017/2018 national survey, which collected data on the frequency of intake of different foods and food groups (expressed in g/day). After calculating the daily intake of the surveyed foods, we used our results on fructan content to estimate daily fructan consumption. Mean daily fructan intake reaches 1.6-1.7 g/day, with no differences between men and women. Our assessment of fructan intake at the national level represents the first step toward the creation of a database on FODMAP intake.

The low-FODMAP diet

In this article we present a protocol for the use of the low-FODMAP diet in paediatric patients and review of the current evidence on its efficacy. These short-chain carbohydrates, which can be fermented by the intestinal microbiota, are found in a wide variety of foods, mainly of plant origin. The low-FODMAP diet is a therapeutic tool used for the management of gastrointestinal disorders such as irritable bowel syndrome. The sources we used were PubMed, Web of Science, Google Scholar and institutional websites. Following consumption of FODMAP-rich foods, a series of end products are generated that are not absorbed, giving rise to symptoms. Before starting a low-FODMAP diet, it is important to carry out a diagnostic evaluation including any applicable tests. Treatment is structured in 3 phases: elimination, reintroduction and personalization phase. In the first phase, FODMAP-rich foods are eliminated for 2-3 weeks. In the second phase, lasting 8 weeks, FODMAP-rich foods are gradually reintroduced. The last phase consists in customizing the diet according to individual tolerance. This article details which foods contain FODMAPs and possible substitutes. In addition, specific food diary/intake tracking and educational materials are provided in a series of appendices to facilitate adherence to the diet. Although most studies have been conducted in adults, there is also some evidence on the beneficial effects in the paediatric age group, with a reduction of symptoms, especially in patients with functional gastrointestinal disorders. Nevertheless, more research is required on the subject.

Long-Term Effects of an Oligoantigenic Diet in Children with Attention-Deficit/Hyperactivity Disorder (ADHD) on Core Symptomatology

In the early 1920s, it was discovered that nutrition is associated with what is known today as Attention-Deficit/Hyperactivity Disorder (ADHD) and that certain foods can worsen the symptoms. In previous studies, approximately 60% of the participants experience at least a 40% reduction in ADHD symptoms after an oligoantigenic diet (OD). The purpose of this study was to evaluate ADHD symptoms in children approximately 3.5 years after completing a 4-week oligoantigenic diet. Among 28 participants who completed the 4-week diet, 21 were re-assessed for this study after 3.5 years. The severity of ADHD symptoms was assessed with the ADHD-Rating-Scale-IV (ARS). Of 21 participants, 14 fulfilled the responder criterion, whereas 7 did not. At follow-up, 28% of the participants were taking medication. The mean ARS total score improved significantly from T1: M = 29.62 (SD = 9.80) to T2: M = 15.86 (SD = 8.56) between the time points before and after the diet (d = -1.91). There was also a lower ARS total score at the follow-up T5: M = 16.00 (SD = 10.52) compared to before the diet (d = -1.17). This study shows that individually adjusted nutrition significantly improved the ADHD symptomatology of the participants long-term. This suggests that an oligoantigenic diet with subsequent individual nutritional recommendations could become an additional treatment option for children with ADHD.

An evaluation of dietary adequacy among patients with constipation-predominant irritable bowel syndrome in Malaysia

Background/Aims

Substantial proportions of patients with constipation-predominant irritable bowel syndrome (IBS-C) linked their symptoms with particular intake of foods. However, there is lack of current data regarding the intake among IBS-C patients before any dietary interventions. Thus, this study aimed to evaluate the dietary adequacy among IBS-C against the standard recommended nutrient intake (RNI) and healthy controls.

Methods

A retrospective case-control study was conducted involving IBS-C patients and healthy control subjects. A validated 126-food items frequency questionnaire was administered to all the subjects to assess their dietary intake, guided by dietitians. The calculated nutrients intake for IBS-C patients was then compared against the standard RNI and healthy controls.

Results

A total of 306 subjects were recruited, among which 218 were diagnosed with IBS-C and 88 were included as healthy controls. IBS-C patients had significantly lower intake of wholegrain products, fried foods, dairy products, fruits, and vegetables compared to healthy controls. The daily intake of energy, certain macronutrients, and micronutrients among IBS-C patients was significantly lower than the healthy subjects. Less than 5% of IBS-C patients and healthy subjects achieved the standard recommendation for dietary fiber. Also, various vitamin intake (B₁, B₂, B₆, folate, B₁₂, E, K, and potassium) among IBS-C patients did not meet the standard RNI.

Conclusions

Dietary intakes of IBS-C patients did not meet the recommended intake for Malaysian and showed the nutritional inadequacies compared to the control subjects. Our study highlighted the importance of dietary evaluation prior to planning strategies for dietary intervention targeting IBS-C patients.

[Is the diet low in FODMAP really effective and safe for irritable bowel syndrome?: A scoping review]

At present, there is no aetiological treatment available for irritable bowel syndrome, and dietary modifications, particularly the low-FODMAP (monosaccharide, disaccharide, oligosaccharides and fermentable polyols) diet is increasingly used to control the symptoms of irritable bowel syndrome, although its actual efficacy and safety are unknown. The objective of this overview is to determine whether the low FODMAP diet is really effective and safe in the long term in the dietary management of irritable bowel syndrome. The review, following an appropriate methodology, was carried out with 25 studies, which were retrieved full text. Of these, 3 were meta-analyses, 2 were systematic reviews, and 3 were both types of studies. The rest of the studies were, in general, of low methodological quality and very heterogeneous, with a low level of evidence and low degree of recommendation. It can be concluded that, in the short term, the low-FODMAP diet is effective in most patients with irritable bowel syndrome, so its use as first-line therapy could be supported. However, of all the studies, only one was prospective for long-term follow-up, between 6 and 18 months, with good results. More follow-up studies, designed for this purpose, are needed to investigate long-term effects. Furthermore, if this type of diet is advised, it should be led by specialised dietitians.

Low FODMAP Diet Is Not Effective in Children with Functional Abdominal Pain: A Randomized Controlled Trial

INTRODUCTION

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) has been shown to reduce symptoms among adult patients and children with irritable bowel syndrome. There are no studies investigating the effectiveness of the low FODMAP diet in pediatric patients with functional abdominal pain (FAP).

OBJECTIVE

The study aimed to evaluate the effectiveness of the low FODMAP diet in reducing gastrointestinal symptoms in children with FAP in comparison to the control diet based on the National Institute for Health and Care Excellence (NICE) guidelines.

METHODS

Twenty-seven children with diagnosed FAP were randomized to 2 groups. Each group received an intervention: the low FODMAP diet or the diet based on NICE. All food was prepared and delivered by a catering company. Data regarding gastrointestinal symptoms were recorded by participants during the 2-week baseline assessment and 4-week dietary intervention. The frequencies of abdominal pain and stools were reported as a number of events per day. The severity of abdominal pain was assessed using the Wong-Baker FACES Pain Rating Scale. The assessment of stool consistency was based on the Bristol Stool Form Scale.

RESULTS

The tendency toward the improvement in abdominal symptoms was noted in the low FODMAP group but without statistical significance. No significant differences in stool consistency were observed in this group. The NICE group experienced significant reduction in abdominal pain intensity and frequency (p < 0.01) and improvement in stool consistency (93% reporting normal stool, p < 0.05).

CONCLUSIONS

The results of this pilot study suggest that the low FODMAP diet is not effective in the reduction of symptoms in children with FAP.

Low FODMAP Diet: Evidence, Doubts, and Hopes

Food is often considered to be a precipitating factor of irritable bowel syndrome (IBS) symptoms. In recent years, there has been a growing interest in FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides, And Polyols), which can be found in many common foods. A low FODMAP diet (LFD) is increasingly suggested for IBS treatment. However, long-term, large, randomized controlled studies are still lacking, and certainties and doubts regarding LFDs have grown, often in a disorderly and confused manner. Some potential LFD limitations and concerns have been raised, including nutritional adequacy, cost, and difficulty in teaching the diet and maintaining it. Most of these limitations can be solved with the involvement of a skilled nutritionist, who can clearly explain the different phases of the LFD and ensure nutritional adequacy and compliance. Further studies should focus on new methods of teaching and learning the LFD and on predictors of response. Moreover, particular interest should be focused on the possible use of LFD in gastrointestinal diseases other than functional disorders and, possibly, also in non-gastrointestinal diseases. The aim of the present review was to clarify the effective and appropriate indications and limitations of an LFD and to discuss its possible future uses.

The long-term effect and adherence of a low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in patients with irritable bowel syndrome

BACKGROUND

Short-term trials with a low-FODMAP (fermentable oligosaccharides disaccharides monosaccharides and polyols) diet (LFD) show promising results in the symptomatic management of irritable bowel syndrome (IBS). The present study investigated the long-term adherence to an LFD diet, factors associated with adherence, and associations between LFD and quality of life (QOL), IBS symptoms and disease course on a long-term basis.

METHODS

A retrospective cross-sectional study was conducted. Two hundred and thirty-four patients were enrolled from Ghent University hospital. Health-related QOL, long-term adherence to the LFD, disease course and IBS symptoms were assessed using a validated and self-developed questionnaire.

RESULTS

Ninety (38.5%) patients completed the questionnaires. The median time span between the first dietary consultation and completion of the questionnaires was 99.5 weeks (approaching 2 years). The predominant disease course was mild IBS with an indolent course (43.0%). Eighty percent reported still following a diet in which certain FODMAP-rich food types are avoided. Eighty patients (88.9%) were satisfied that they follow or had followed the diet. The IBS-QOL did not differ between patients following the diet strictly and patients deviating from the diet (P = 0.669). Patients still following the LFD experienced less severe abdominal pain than patients who stopped following the diet (P = 0.044).

CONCLUSIONS

The long-term adherence and satisfaction with the LFD is high in patients with IBS. Nevertheless, patients indicated that it was difficult to follow the LFD in daily life. Practical issues, social factors and the absence of symptoms were indicated as the main reasons for a drop in adherence.

IRRITABLE BOWEL SYNDROME, FOOD INTOLERANCE AND NON- CELIAC GLUTEN SENSITIVITY. A NEW CLINICAL CHALLENGE

Approximately 80% of irritable bowel syndrome (IBS) patients report that their symptoms are triggered after ingesting one or specific food groups. Gluten, wheat and related proteins (e.g., amylase-trypsin inhibitors, and fermentable oligo-di-mono-saccharides and polyols (FODMAPs) are the most relevant IBS symptom triggers, although the true 'culprit(s)' is/are still not well established. The concept of causal relationship between gluten intake and the occurrence of symptoms in the absence of celiac disease and wheat allergy was termed non-celiac gluten sensitivity (NCGS). The borderline between celiac disease, wheat allergy, IBS and NCGS is not always clearly distinguishable, and the frequency and clinical identity of NGCS are still unclear. An overlap between IBS and NCGS has been detected. The incomplete knowledge of the etiopathogenesis of these clinical conditions, lack of data on their real epidemiology, as well as the absence of a gold standard for their diagnosis, make the overall picture difficult to understand "It is crucial to well define the interaction between IBS, food intolerance and NGCS, since the role of diet in IBS and its dietary management is an essential tool in the treatment of a large number of these patients". The objective of the present review is to provide an overview highlighting the interaction between IBS, food intolerance and NCGS in order to unravel whether gluten/wheat/FODMAP sensitivity represents 'facts' and not 'fiction' in IBS symptoms.

A Retrospective Study on Dietary FODMAP Intake in Celiac Patients Following a Gluten-Free Diet

Our aim was to evaluate the intake of foods containing fermentable oligo/di/mono-saccharides and polyols (FODMAP) as a possible factor that induces gastrointestinal symptoms in treated celiac disease (CD) patients. We collected seven-day weighed food records for 104 CD patients and 91 healthy volunteers. All evaluated food items were from sources with high and low content of FODMAP, which were divided into cereals and sweets, sweeteners and soft drinks, fruits, dried fruits, and vegetables. Nutrient intake was calculated using the food database of the European Institute of Oncology. The symptoms reported were assessed by a Rome IV Irritable bowel syndrome (IBS) diagnostic questionnaire and by specific questions for the evaluation of functional gastrointestinal disorders (FGIDs). The 12% of CD patients met IBS symptoms criteria as opposed to 6% of controls (p = 0.09) and 27% of patients reported FGIDs symptoms vs. 22% of healthy controls (p = 0.42). The intake by CD patients was significantly higher than healthy volunteers for: sweeteners and sugars with low content of FODMAP (p = 0.0007), fruits, dried fruits, and vegetables high in FODMAP (p = 0.003) and low in FODMAP (p = 0.04) when compared to controls. CD patients had a lower intake of cereals and sweets with a high content of FODMAP (p = 0.00001). Healthy volunteers consumed significantly higher alcoholic beverages and fats high in FODMAP (both p < 0.044). The mean daily intake of other food categories did not differ between both groups. Even though CD patients had a low intake of gluten-free cereals high in FODMAP, they still consumed a significant amount of fruits and vegetables high in FODMAP. The clinical effect of a concomitant gluten-free diet and low-FODMAP diet should be prospectively evaluated as a supportive therapy in CD patients.

Association between self-reported vegetarian diet and the irritable bowel syndrome in the French NutriNet cohort

BACKGROUND

There is growing interest in using diet counselling in the management of patients with irritable bowel syndrome (IBS). Among new emerging diets, vegetarian diets (VD) seem to be experiencing an important popularity, partly because of their alleged health benefits. A recent study performed among a rural Indian population showed that predominant VD could be associated with IBS.

OBJECTIVE

This cross-sectional study aimed at assessing the association between the VD and IBS, among a large French cohort, the NutriNet-santé study.

METHODS

Subjects participating in the NutriNet-Santé cohort study completed a questionnaire based on Rome III criteria (N = 41,682). Anthropometrics, socio-demographical and lifestyle data, including VD, were collected prior to the completion of Rome III questionnaire via self-administered questionnaires. Association between VD and IBS and its subtypes was investigated through multivariate logistic regression.

RESULTS

The included subjects were mainly women (78.0%) and the mean age was 49.8±14.3 years. Among these individuals, 2,264 (5.4%) presented an IBS, and 805 (1.9%) reported a VD. Overall, VD was not associated with IBS or subtypes. A stable VD (i.e. self-declared at least three times) was associated with IBS (aOR 2.60 95%CI [1.37-4.91]), IBS mixed (aOR 2.97 95%CI [1.20-7.36]) and IBS diarrhoea (aOR 2.77 95%CI [1.01-7.59]).

CONCLUSIONS

This study suggests that a long term VD could be associated with IBS. Nevertheless, further studies are needed to confirm these results, and investigate the multiple aspects of the vegetarian diet, possibly related to the IBS.

Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!

A substantial proportion of patients with irritable bowel syndrome (IBS) associate their symptoms with the ingestion of specific foods. Therefore, in recent years, scientific research has increasingly focused on the role of diet in IBS and dietary management is now considered an important tool in IBS treatment. This article reviews the main dietary approaches in IBS emphasizing evidence from experimental and observational studies and summarizing the main diet and lifestyle recommendations provided by dietary guidelines and scientific literature. Despite the limited evidence for a beneficial role, general advice on healthy eating and lifestyle is recommended as the first-line approach in the dietary management of IBS. Standard recommendations include adhering to a regular meal pattern, reducing intake of insoluble fibers, alcohol, caffeine, spicy foods, and fat, as well as performing regular physical activity and ensuring a good hydration. Second-line dietary approach should be considered where IBS symptoms persist and recommendations include following a low FODMAP diet, to be delivered only by a healthcare professional with expertise in dietary management. The efficacy of this diet is supported by a growing body of evidence. In contrast, the role of lactose or gluten dietary restriction in the treatment of IBS remains subject to ongoing research with a lack of high-quality evidence. Likewise, further clinical trials are needed to conclude the efficacy of probiotics on IBS symptoms.