Difference Between Skeletal Smooth and Cardiac Muscles
Ibs and short_chain_carbohydrates_ong
1. www.pronutritionist.net
Manipulation of dietary short
chain carbohydrates alters the
pattern of gas production and
genesis of symptoms in
irritable bowel syndrome
Ong D et al
J Gastroenterol Hepatol 2010;25:1366-1373
Page 1
Reijo Laatikainen, Authorized Nutritionist, MBA
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2. Page 2
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
www.pronutritionist.net
3. 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
3
4. 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
Page 4 Ong D et al. J Gastroenterol Hepatol 2010;25:1366-
1373
www.pronutritionist.net
5. 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
Page 5 Ong D et al. J Gastroenterol Hepatol 2010;25:1366-
1373
www.pronutritionist.net
6. Results (2/3)
www.pronutritionist.netOng D et al. J Gastroenterol Hepatol
2010;25:1366-1373
6
14
1
Pain during LOW
FODMAP (9g/d.)
none/mild
moderate/s
evere
6
9
Pain during HIGH
FODMAP (50 g/d.)
none/mild
moderate/sever
e
Abdominal pain/discomfort (# of IBS patients)
Only one out of the healthy participant (controls) developed moderate/ severe bloating on HIGH FODMAP diet
7. Results (3/3)
www.pronutritionist.netOng D et al. J Gastroenterol Hepatol
2010;25:1366-1373
7
Abdominal bloating (# of IBS patients)
12
3
Bloating during LOW FODMAP
(9g/d.)
none/mild
moderate/sever
e
4
11
Bloating during HIGH
FODMAP (50 g/d.)
none/mild
moderate/sev
ere
None of the healthy participants (controls) developed moderate/ severe bloating on HIGH FODMAP diet
8. 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
www.pronutritionist.netOng D et al. J Gastroenterol Hepatol
2010;25:1366-1373
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9. 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
www.pronutritionist.netOng D et al. J Gastroenterol Hepatol
2010;25:1366-1373
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