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Czuber-Dochan W, Morgan M, Hughes LD, Lomer MCE, Lindsay JO, Whelan K. Perceptions and psychosocial impact of food, nutrition, eating and drinking in people with inflammatory bowel disease: a qualitative investigation of food-related quality of life. J Hum Nutr Diet 2019; 33:115-127. [PMID: 31131484 DOI: 10.1111/jhn.12668] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Extensive research has provided an important understanding of the impact of inflammatory bowel disease (IBD) on nutrient intake, requirements and metabolism. By contrast, there has been limited research examining the psychosocial aspects of food, eating and drinking in IBD. The present study aimed to address this unmet need. METHODS Qualitative semi-structured interviews regarding the perceptions and psychosocial impact of food, eating and drinking were undertaken with 28 purposively selected people with IBD. Interviews were audio-recorded and transcribed verbatim. Colaizzi's framework was used to structure the data analysis. RESULTS Five major themes were identified. IBD symptoms and both surgical and medical treatments were described as having a direct impact on eating and drinking, with participants also using different food-related strategies to control IBD symptoms. These included a process of experimentation to identify trigger foods, following a severely restricted and limited diet, eating small portions, and eating more frequently. However, their limited knowledge about if, and how, food affected their symptoms, often resulted in negative coping strategies that impacted on psychosocial functioning, including a lack of enjoyment of eating, being afraid to eat and finding social occasions stressful. Managing food and drinking also made food shopping and preparation more burdensome, creating problems with families, at work and for social life, as well as the need for careful preparation and advanced planning of activities. CONCLUSIONS Inflammatory bowel disease has a profound impact on psychosocial aspects of food and nutrition, which impacts on 'food-related quality of life' (FRQoL). Further research is required to identify interventions that will improve FRQoL in patients with IBD.
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Affiliation(s)
- W Czuber-Dochan
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - M Morgan
- Institute of Pharmacological Sciences, King's College London, London, UK
| | - L D Hughes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M C E Lomer
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J O Lindsay
- Barts Health NHS Trust, The Royal London Hospital, London, UK.,Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - K Whelan
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Whelan K, Martin LD, Staudacher HM, Lomer MCE. The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice. J Hum Nutr Diet 2018; 31:239-255. [DOI: 10.1111/jhn.12530] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- K. Whelan
- King's College London; Department of Nutritional Sciences, Faculty of Life Sciences & Medicine; School of Life Course Sciences; London UK
| | - L. D. Martin
- King's College London; Department of Nutritional Sciences, Faculty of Life Sciences & Medicine; School of Life Course Sciences; London UK
| | - H. M. Staudacher
- King's College London; Department of Nutritional Sciences, Faculty of Life Sciences & Medicine; School of Life Course Sciences; London UK
- Guy's and St Thomas’ NHS Foundation Trust; Department of Gastroenterology; London UK
- University of Queensland; Faculty of Medicine, Princess Alexandra Southside Clinical Unit; Queensland Australia
| | - M. C. E. Lomer
- King's College London; Department of Nutritional Sciences, Faculty of Life Sciences & Medicine; School of Life Course Sciences; London UK
- Guy's and St Thomas’ NHS Foundation Trust; Department of Gastroenterology; London UK
- Guy's and St Thomas’ NHS Foundation Trust; Department of Nutrition and Dietetics; London UK
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McKenzie YA, Bowyer RK, Leach H, Gulia P, Horobin J, O'Sullivan NA, Pettitt C, Reeves LB, Seamark L, Williams M, Thompson J, Lomer MCE. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 2016; 29:549-75. [PMID: 27272325 DOI: 10.1111/jhn.12385] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The first British Dietetic Association (BDA) guidelines for the dietary management of irritable bowel syndrome (IBS) in adults were published in 2012. Subsequently, there has been a wealth of new research. The aim of this work was to systematically review the evidence for the role of diet in the management of IBS and to update the guidelines. METHODS Twelve questions relating to diet and IBS were defined based on review of the previous guideline questions, current evidence and clinical practice. Chosen topics were on healthy eating and lifestyle (alcohol, caffeine, spicy food, elimination diets, fat and fluid intakes and dietary habits), milk and dairy, dietary fibre, fermentable carbohydrates, gluten, probiotics and elimination diets/food hypersensitivity. Data sources were CINAHL, Cochrane Register of Controlled Trials, Embase, Medline, Scopus and Web of Science up to October 2015. Studies were assessed independently in duplicate using risk of bias tools specific to each included study based on inclusion and exclusion criteria for each question. National Health and Medical Research Council grading evidence levels were used to develop evidence statements and recommendations, in accordance with Practice-based Evidence in Nutrition Global protocol used by the BDA. RESULTS Eighty-six studies were critically appraised to generate 46 evidence statements, 15 clinical recommendations and four research recommendations. The IBS dietary algorithm was simplified to first-line (healthy eating, provided by any healthcare professional) and second-line [low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) to be provided by dietitian] dietary advice. CONCLUSIONS These guidelines provide updated comprehensive evidence-based details to achieve the successful dietary management of IBS in adults.
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Affiliation(s)
| | - R K Bowyer
- Department of Nutrition and Dietetics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - H Leach
- Department of Nutrition and Dietetics, Southampton NHS Foundation Trust, Southampton, UK
| | - P Gulia
- Dr Ashok Ayurveda Clinic, Birmingham, UK
| | - J Horobin
- Department of Nutrition and Dietetics, North Middlesex University Hospital NHS Trust, London, UK
| | - N A O'Sullivan
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK
| | - C Pettitt
- Faculty of Medicine, Imperial College London, London, UK
| | - L B Reeves
- Allergy Services, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Seamark
- Specialist Gastroenterology Community Dietetic Service, Somerset Partnership NHS Foundation Trust, Bridgwater, UK
| | - M Williams
- Specialist Gastroenterology Community Dietetic Service, Somerset Partnership NHS Foundation Trust, Bridgwater, UK
| | | | - M C E Lomer
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.,Department of Nutrition and Dietetics, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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McKenzie YA, Thompson J, Gulia P, Lomer MCE. British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 2016; 29:576-92. [DOI: 10.1111/jhn.12386] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - P. Gulia
- Dr Ashok Ayurveda Clinic; Birmingham UK
| | - M. C. E. Lomer
- Diabetes and Nutritional Sciences Division; King's College London; London UK
- Department of Nutrition and Dietetics; Guy's and St Thomas' NHS Foundation Trust; London UK
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Whigham L, Joyce T, Harper G, Irving PM, Staudacher HM, Whelan K, Lomer MCE. Clinical effectiveness and economic costs of group versus one-to-one education for short-chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome. J Hum Nutr Diet 2015; 28:687-96. [DOI: 10.1111/jhn.12318] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- L. Whigham
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division; King's College London; London UK
- Department of Nutrition and Dietetics; Imperial College NHS Healthcare Trust; London UK
| | - T. Joyce
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division; King's College London; London UK
- Department of Nutrition and Dietetics; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | | | - P. M. Irving
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division; King's College London; London UK
- Department of Gastroenterology; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - H. M. Staudacher
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division; King's College London; London UK
- Department of Nutrition and Dietetics; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - K. Whelan
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division; King's College London; London UK
| | - M. C. E. Lomer
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division; King's College London; London UK
- Department of Nutrition and Dietetics; Guy's and St Thomas’ NHS Foundation Trust; London UK
- Department of Gastroenterology; Guy's and St Thomas’ NHS Foundation Trust; London UK
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Lomer MCE. Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther 2015; 41:262-75. [PMID: 25471897 DOI: 10.1111/apt.13041] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 10/16/2014] [Accepted: 11/11/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Food intolerance is non-immunological and is often associated with gastrointestinal symptoms. AIM To focus on food intolerance associated with gastrointestinal symptoms and critically appraise the literature in relation to aetiology, diagnosis, mechanisms and clinical evidence. METHODS A search using the terms and variants of food intolerance, lactose, FODMAP, gluten, food chemicals within Pubmed, Embase and Scopus was carried out and restricted to human studies published in English. Additionally, references from relevant papers were hand searched for other appropriate studies. RESULTS Food intolerance affects 15-20% of the population and may be due to pharmacological effects of food components, noncoeliac gluten sensitivity or enzyme and transport defects. There have been significant advances in understanding the scientific basis of gastrointestinal food intolerance due to short-chain fermentable carbohydrates (FODMAPs). The most helpful diagnostic test for food intolerance is food exclusion to achieve symptom improvement followed by gradual food reintroduction. A low FODMAP diet is effective, however, it affects the gastrointestinal microbiota and FODMAP reintroduction to tolerance is part of the management strategy. CONCLUSIONS There is increasing evidence for using a low FODMAP diet in the management of functional gastrointestinal symptoms where food intolerance is suspected. Exclusion diets should be used for as short a time as possible to induce symptom improvement, and should be followed by gradual food reintroduction to establish individual tolerance. This will increase dietary variety, ensure nutritional adequacy and minimise impact on the gastrointestinal microbiota.
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Affiliation(s)
- M C E Lomer
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK; Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK
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Lee J, Allen R, Ashley S, Becker S, Cummins P, Gbadamosi A, Gooding O, Huston J, Le Couteur J, O'Sullivan D, Wilson S, Lomer MCE. British Dietetic Association evidence-based guidelines for the dietary management of Crohn's disease in adults. J Hum Nutr Diet 2013; 27:207-18. [PMID: 24313460 DOI: 10.1111/jhn.12176] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Crohn's disease is a debilitating chronic inflammatory bowel disease. Appropriate use of diet and nutritional therapy is integral to the overall management strategy of Crohn's disease. The aim was to develop evidence-based guidelines on the dietary management of Crohn's disease in adults. METHODS Questions relating to the dietary management of Crohn's disease were developed. These included the roles of enteral nutrition to induce remission, food re-introduction diets to structure food re-introduction and maintain remission, and dietary management of stricturing disease, as well as whether probiotics or prebiotics induce or maintain remission. A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic database search engines CINAHL, Cochrane Library, EMBASE, MEDLINE, Scopus and Web of Science. Evidence statements, recommendations, practical considerations and research recommendations were developed. RESULTS Fifteen research papers were critically appraised and the evidence formed the basis of these guidelines. Although corticosteroids appear to be more effective, enteral nutrition (elemental or non-elemental) can be offered as an alternative option to induce disease remission. After a course of enteral nutrition, food re-introduction diets may be useful to structure food re-introduction and help maintain disease remission. Dietary fibre is contraindicated in the presence of strictures as a result of the risk of mechanical obstruction. The use of probiotics and prebiotics is not currently supported. CONCLUSIONS As an alternative to corticosteroids, evidence supports enteral nutrition to induce disease remission. Food re-introduction diets provide structure to food re-introduction and help maintain disease remission. These guidelines aim to reduce variation in clinical practice.
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Affiliation(s)
- J Lee
- Department of Nutrition and Dietetics, Addenbrookes, Cambridge, UK
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Lomer MCE, Gourgey R, Whelan K. Current practice in relation to nutritional assessment and dietary management of enteral nutrition in adults with Crohn's disease. J Hum Nutr Diet 2013; 27 Suppl 2:28-35. [DOI: 10.1111/jhn.12133] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- M. C. E. Lomer
- Department of Gastroenterology; Guy's and St Thomas' NHS Foundation Trust; London UK
- Department of Nutrition and Dietetics; Guy's and St Thomas' NHS Foundation Trust; London UK
- Diabetes and Nutritional Sciences Division; School of Medicine; King's College London; London UK
| | - R. Gourgey
- Diabetes and Nutritional Sciences Division; School of Medicine; King's College London; London UK
| | - K. Whelan
- Diabetes and Nutritional Sciences Division; School of Medicine; King's College London; London UK
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Campbell HE, Escudier MP, Milligan P, Challacombe SJ, Sanderson JD, Lomer MCE. Development of a low phenolic acid diet for the management of orofacial granulomatosis. J Hum Nutr Diet 2013; 26:527-37. [PMID: 23574355 DOI: 10.1111/jhn.12046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a rare disease of unknown cause. A cinnamon- and benzoate-free diet is successful in up to 72% of patients. Phenolic acids are among the chemical constituents restricted in this diet, which avoids some but not all of these structurally similar compounds. The present study aimed to: (i) develop a novel diet low in phenolic acids; (ii) implement this in a small clinical trial; and (iii) assess its nutritional adequacy. METHODS A literature review identified 10 papers quantifying phenolic acids from which 91 10-mg phenolic acid exchanges were devised. A phenolic acid exclusion diet with precautionary micronutrient supplementation was designed and implemented in 10 patients. Phenolic acids were excluded for 6 weeks and were reintroduced at a rate of one exchange every second day for 6 weeks. Wilcoxon matched pairs tests analysed disease outcomes measured by an oral disease severity scoring tool at weeks 0, 6 and 12. Nutritional adequacy was assessed, excluding micronutrient supplementation, at weeks 0 and 6, and compared intakes with dietary reference values. RESULTS The diet was nutritionally inadequate for a range of micronutrients. Seven of 10 patients responded. Mean [standard deviation (SD)] severity scores improved from week 0-6 [20.8 (9.39) and 10.1 (5.72); P = 0.009] and were maintained in five patients who completed the reintroduction [6.6 (3.13) and 7.2 (5.54); P = 0.713]. CONCLUSIONS A low phenolic acid diet with micronutrient supplementation holds promise of a novel dietary treatment for OFG. Further work is required in larger studies to determine long-term outcomes.
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Affiliation(s)
- H E Campbell
- Diabetes and Nutritional Sciences Division, King's College London (KCL), London, UK; Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust (GSTFT), London, UK
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Campbell H, Escudier MP, Brostoff J, Patel P, Milligan P, Challacombe SJ, Sanderson JD, Lomer MCE. Dietary intervention for oral allergy syndrome as a treatment in orofacial granulomatosis: a new approach? J Oral Pathol Med 2013; 42:517-22. [DOI: 10.1111/jop.12041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 11/29/2022]
Affiliation(s)
- H. Campbell
- Diabetes and Nutritional Sciences Division; King's College London (KCL); London UK
- Department of Nutrition and Dietetics; Guy's and St Thomas' NHS Foundation Trust (GSTFT); London UK
- National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre at GSTFT and KCL; London UK
| | | | - J. Brostoff
- Diabetes and Nutritional Sciences Division; King's College London (KCL); London UK
| | - P. Patel
- Department of Gastroenterology; GSTFT; London UK
| | - P. Milligan
- Diabetes and Nutritional Sciences Division; King's College London (KCL); London UK
| | | | - J. D. Sanderson
- Diabetes and Nutritional Sciences Division; King's College London (KCL); London UK
- Department of Gastroenterology; GSTFT; London UK
| | - M. C. E. Lomer
- Diabetes and Nutritional Sciences Division; King's College London (KCL); London UK
- Department of Nutrition and Dietetics; Guy's and St Thomas' NHS Foundation Trust (GSTFT); London UK
- Department of Gastroenterology; GSTFT; London UK
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Cockerell KM, Watkins ASM, Reeves LB, Goddard L, Lomer MCE. Effects of linseeds on the symptoms of irritable bowel syndrome: a pilot randomised controlled trial. J Hum Nutr Diet 2012; 25:435-43. [DOI: 10.1111/j.1365-277x.2012.01263.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Davies RJ, Lomer MCE, Yeo SI, Avloniti K, Sangle SR, D’Cruz DP. Weight loss and improvements in fatigue in systemic lupus erythematosus: a controlled trial of a low glycaemic index diet versus a calorie restricted diet in patients treated with corticosteroids. Lupus 2012; 21:649-655. [DOI: 10.1177/0961203312436854] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background: Patients with systemic lupus erythematosus (SLE) may require prolonged periods of corticosteroid therapy which lead to excessive weight gain and increased cardiovascular risk. Objective: To assess the utility of a low glycaemic index diet in patients with corticosteroid dependent SLE in achieving weight loss and improving glycaemic control. Design: A total of 23 women were enrolled in a 6 week study. All had mild, stable SLE, were receiving corticosteroids and had a body mass index > 25 kg/m2. Subjects were randomly assigned to a low glycaemic index (Low GI) diet or a calorie restricted (Low Cal) diet. The primary end point was weight loss. Secondary end points included tolerability of diet, bio-markers of cardiovascular risk, disease activity, fatigue and sleep quality. Results: Weight loss in both treatment groups was significant (mean ± SD: Low GI diet 3.9 ± 0.9 kg; Low Cal diet 2.4 ± 2.2 kg, p < 0.01 from baseline in each group). There were also significant improvements in waist and hip measurements. However, the difference in weight loss and waist and hip measurements between the two diet groups was not statistically significant. There was a statistically significant reduction in Fatigue Severity Scale in both diet groups, ( p < 0.03). Both Low GI and Low Cal diets were well tolerated, resulting in no serious adverse effects or increase in disease activity. Conclusion: Significant weight loss is achievable over 6 weeks in a diet-specific trial in subjects with stable SLE, who are on low dose prednisolone. Both diets were equally tolerable, and did not cause flares in disease activity. Our results suggest that dietary manipulation may significantly improve fatigue in subjects with SLE.
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Affiliation(s)
- RJ Davies
- The Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London, UK; 2Nutrition and Dietetic Department, St Thomas’ Hospital, London, UK; and 3Department of Gastroenterology, St Thomas Hospital, London, UK
| | - MCE Lomer
- The Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London, UK; 2Nutrition and Dietetic Department, St Thomas’ Hospital, London, UK; and 3Department of Gastroenterology, St Thomas Hospital, London, UK
| | - SI Yeo
- The Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London, UK; 2Nutrition and Dietetic Department, St Thomas’ Hospital, London, UK; and 3Department of Gastroenterology, St Thomas Hospital, London, UK
| | - K Avloniti
- The Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London, UK; 2Nutrition and Dietetic Department, St Thomas’ Hospital, London, UK; and 3Department of Gastroenterology, St Thomas Hospital, London, UK
| | - SR Sangle
- The Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London, UK; 2Nutrition and Dietetic Department, St Thomas’ Hospital, London, UK; and 3Department of Gastroenterology, St Thomas Hospital, London, UK
| | - DP D’Cruz
- The Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London, UK; 2Nutrition and Dietetic Department, St Thomas’ Hospital, London, UK; and 3Department of Gastroenterology, St Thomas Hospital, London, UK
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McKenzie YA, Alder A, Anderson W, Wills A, Goddard L, Gulia P, Jankovich E, Mutch P, Reeves LB, Singer A, Lomer MCE. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. J Hum Nutr Diet 2012; 25:260-74. [PMID: 22489905 DOI: 10.1111/j.1365-277x.2012.01242.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a chronic debilitating functional gastrointestinal disorder. Diet and lifestyle changes are important management strategies. The aim of these guidelines is to systematically review key aspects of the dietary management of IBS, with the aim of providing evidence-based guidelines for use by registered dietitians. METHODS Questions relating to diet and IBS symptom management were developed by a guideline development group. These included the role of milk and lactose, nonstarch polysaccharides (NSP), fermentable carbohydrates in abdominal bloating, probiotics and empirical or elimination diets. A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic database search engines: Cinahl, Cochrane Library, Embase, Medline, Scopus and Web of Science. Evidence statements, recommendations, good practice points and research recommendations were developed. RESULTS Thirty studies were critically appraised. A dietetic care pathway was produced following a logical sequence of treatment and formed the basis of these guidelines. Three lines of dietary management were identified. first line: Clinical and dietary assessment, healthy eating and lifestyle management with some general advice on lactose and NSP. Second line: Advanced dietary interventions to improve symptoms based on NSP, fermentable carbohydrates and probiotics. Third line: Elimination and empirical diets. Research recommendations were also identified relating to the need for adequately powered and well designed randomised controlled trials. CONCLUSIONS These guidelines provide evidence-based details of how to achieve the successful dietary management of IBS.
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Affiliation(s)
- Y A McKenzie
- Nuffield Health The Manor Hospital, Oxford, UK Department of Nutrition and Dietetics, Royal Sussex County Hospital, Brighton, UK
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Campbell HE, Escudier MP, Patel P, Challacombe SJ, Sanderson JD, Lomer MCE. Review article: cinnamon- and benzoate-free diet as a primary treatment for orofacial granulomatosis. Aliment Pharmacol Ther 2011; 34:687-701. [PMID: 21815899 DOI: 10.1111/j.1365-2036.2011.04792.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Orofacial granulomatosis is a rare chronic granulomatous inflammatory disease of the lips, face and mouth. The aetiology remains unclear but may involve an allergic component. Improvements have been reported with cinnamon- and benzoate-free diets. AIMS To explore the prevalence of compound and food sensitivity and examine the dietary treatments used in orofacial granulomatosis. METHODS A comprehensive literature search was carried out and relevant studies from January 1933 to January 2010 were identified using the electronic database search engines; AGRIS 1991-2008, AMED 1985-2008, British Nursing and Index archive 1985-2008, EMBASE 1980-2008, evidence based medicine review databases (e.g. Cochrane DSR), International Pharmaceutical and Medline 1950-2008. RESULTS Common sensitivities identified, predominantly through patch testing, were to benzoic acid (36%) food additives (33%), perfumes and flavourings (28%), cinnamaldehyde (27%), cinnamon (17%), benzoates (17%) and chocolate (11%). The cinnamon- and benzoate-free diet has been shown to provide benefit in 54-78% of patients with 23% requiring no adjunctive therapies. A negative or positive patch test result to cinnamaldehyde, and benzoates did not predict dietary outcome. The most concentrated source of benzoate exposure is from food preservatives. Use of liquid enteral formulas can offer a further dietary therapy, particularly in children with orofacial granulomatosis. CONCLUSION Management of orofacial granulomatosis is challenging but cinnamon- and benzoate-free diets appear to have a definite role to play.
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Affiliation(s)
- H E Campbell
- Diabetes and Nutritional Sciences Division, King's College London-KCL, London, UK
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Staudacher HM, Whelan K, Irving PM, Lomer MCE. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011; 24:487-95. [PMID: 21615553 DOI: 10.1111/j.1365-277x.2011.01162.x] [Citation(s) in RCA: 292] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emerging evidence indicates that the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may result in symptoms in some patients with irritable bowel syndrome (IBS). The present study aimed to determine whether a low FODMAP diet is effective for symptom control in patients with IBS and to compare its effects with those of standard dietary advice based on the UK National Institute for Health and Clinical Excellence (NICE) guidelines. METHODS Consecutive patients with IBS who attended a follow-up dietetic outpatient visit for dietary management of their symptoms were included. Questionnaires were completed for patients who received standard (n = 39) or low FODMAP dietary advice (n = 43). Data were recorded on symptom change and comparisons were made between groups. RESULTS In total, more patients in the low FODMAP group reported satisfaction with their symptom response (76%) compared to the standard group (54%, P = 0.038). Composite symptom score data showed better overall symptom response in the low FODMAP group (86%) compared to the standard group (49%, P < 0.001). Significantly more patients in the low FODMAP group compared to the standard group reported improvements in bloating (low FODMAP 82% versus standard 49%, P = 0.002), abdominal pain (low FODMAP 85% versus standard 61%, P = 0.023) and flatulence (low FODMAP 87% versus standard 50%, P = 0.001). CONCLUSIONS A low FODMAP diet appears to be more effective than standard dietary advice for symptom control in IBS.
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Affiliation(s)
- H M Staudacher
- King's College London, Nutritional Sciences Division, London, UK
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Abstract
BACKGROUND Approximately 70% of the world population has hypolactasia, which often remains undiagnosed and has the potential to cause some morbidity. However, not everyone has lactose intolerance, as several nutritional and genetic factors influence tolerance. AIMS To review current clinical practice and identify published literature on the management of lactose intolerance. METHODS PubMed was searched using the terms lactose, lactase and diet to find original research and reviews. Relevant articles and clinical experience provided the basis for this review. RESULTS Lactose is found only in mammalian milk and is hydrolysed by lactase in the small intestine. The lactase gene has recently been identified. 'Wild-type' is characterized by lactase nonpersistence, often leading to lactose intolerance. Two genetic polymorphisms responsible for persistence have been identified, with their distribution concentrated in north Europeans. Symptoms of lactose intolerance include abdominal pain, bloating, flatulence and diarrhoea. Diagnosis is most commonly by the lactose hydrogen breath test. However, most people with hypolactasia, if given appropriate advice, can tolerate some lactose-containing foods without symptoms. CONCLUSION In clinical practice, some people with lactose intolerance can consume milk and dairy foods without developing symptoms, whereas others will need lactose restriction.
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Affiliation(s)
- M C E Lomer
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Abstract
Iron deficiency anaemia is one of the most common disorders in the world. Also, one third of inflammatory bowel disease (IBD) patients suffer from recurrent anaemia. Anaemia has significant impact on the quality of life of affected patients. Chronic fatigue, a frequent IBD symptom itself, is commonly caused by anaemia and may debilitate patients as much as abdominal pain or diarrhoea. Common therapeutic targets are the mechanisms behind anaemia of chronic disease and iron deficiency. It is our experience that virtually all patients with IBD associated anaemia can be successfully treated with a combination of iron sucrose and erythropoietin, which then may positively affect the misled immune response in IBD.
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Affiliation(s)
- C Gasche
- Department of Medicine 4, Division of Gastroenterology and Hepatology, Medical University Vienna, Austria.
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