A diet high in FODMAPs as a novel dietary strategy in diabetes?

Chu, Natural; Chan, Juliana C.N.; Chow, Elaine

doi:10.1016/j.clnu.2022.07.036

Cited by 8 publications

(8 citation statements)

References 83 publications

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“…Enteroendocrine cells are present in the jejunum, and their greatest numbers are seen in the ileum and colon [60]. Fermentation of these short-chain carbohydrates stimulates the activity of SCFA-producing bacteria, such as Roseburia, Akkermanisa, and Bifidobacterium, which increase the production of SCFAs [28]. SCFAs are sensed by specific membrane receptors which may modulate immune responses to reduce inflammation factors, such as LPS, interleukin 6 (IL-6), and high-sensitivity C-reactive protein (hsCRP) [61], and stimulate endocrine receptors with increased gene expression of satiety-related peptides GLP-1, peptide YY, and proglucagon [62].…”

Section: Discussionmentioning

confidence: 99%

“…In a double-blind, parallel randomised clinical trial (RCT) involving 44 subjects with overweight/obesity and prediabetes, 15 g of GOS daily, when added to a regular diet, increased Bifidobacterium by five times but did not alter peripheral insulin sensitivity, SCFAs, LPSs, or inflammatory markers [27]. However, compared with prebiotic supplementation, FODMAPs from whole foods might exert additional effects on whole gut transit time and motility [28] and interact with other gut components, resulting in different effects. However, human studies on FODMAP consumption and associations with body composition and metabolic indices in prediabetes are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Higher Short-Chain Fermentable Carbohydrates Are Associated with Lower Body Fat and Higher Insulin Sensitivity in People with Prediabetes

Chu,

He,

Leung

et al. 2023

Nutrients

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The quality of carbohydrates has metabolic consequences in people with prediabetes. However, the causality of short-chain fermentable carbohydrate intakes and metabolic parameters has not been explored in the prediabetic or diabetic population. We investigated associations between different types of carbohydrates, including fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAPs), and polysaccharides (dietary fibre), and body composition and glucose/insulin responses in subjects with prediabetes. In this prospective cross-sectional study, 177 subjects with impaired glucose tolerance (IGT) (mean age: 60 (54–62) years, 41% men) underwent an assessment of body composition and completed six-point oral glucose tolerance tests (OGTT), Homeostatic Model Assessment of Insulin Resistance (HOMA2-IR), insulin sensitivity, detailed 3-day food records, and physical activity questionnaire. Daily habitual FODMAP intake decreased progressively with increasing BMI, ranging from 7.9 (6.2–12.7) g/d in subjects with normal BMI and 6.6 (4.6–9.9) g/d in subjects with overweight to 5.8 (3.8–9.0) g/d in subjects with obesity (p = 0.038). After adjustment for age and gender, galactooligosaccharides (GOSs) were negatively correlated with body fat (Standardised Beta coefficient β = −0.156, p = 0.006) and positively associated with insulin sensitivity (β = 0.243, p = 0.001). This remained significant after adjustment for macronutrients, fibre, and physical activity (p = 0.035 and p = 0.010, respectively). In individuals with IGT, higher dietary GOS intake was associated with lower body fat and higher insulin sensitivity independent of macronutrients and fibre intake, calling for interventional studies to evaluate the effect of FODMAP intake in prediabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Higher Short-Chain Fermentable Carbohydrates Are Associated with Lower Body Fat and Higher Insulin Sensitivity in People with Prediabetes

Chu,

He,

Leung

et al. 2023

Nutrients

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“…Food substitution rather than food reduction is essential to improve the health of people with diabetes or other chronic diseases. 139 Against this background, dietary factors may influence the efficacy and tolerability of metformin. Interestingly, in a recent study examining the effects of timing of drug administration on the prandial release of GLP1, metformin given just before meals rather than with meals was associated with the highest GLP1 response.…”

Section: Metformin and Dietary Intakementioning

confidence: 99%

Current type 2 diabetes guidelines: Individualized treatment and how to make the most of metformin

Chan,

Yang,

Chu

et al. 2024

Diabetes Obesity Metabolism

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Evidence‐based guidelines provide the premise for the delivery of quality care to preserve health and prevent disabilities and premature death. The systematic gathering of observational, mechanistic and experimental data contributes to the hierarchy of evidence used to guide clinical practice. In the field of diabetes, metformin was discovered more than 100 years ago, and with 60 years of clinical use, it has stood the test of time regarding its value in the prevention and management of type 2 diabetes. Although some guidelines have challenged the role of metformin as the first‐line glucose‐lowering drug, it is important to point out that the cardiovascular‐renal protective effects of sodium‐glucose co‐transporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists were gathered from patients with type 2 diabetes, the majority of whom were treated with metformin. Most national, regional and international guidelines recommend metformin as a foundation therapy with emphasis on avoidance of therapeutic inertia and early attainment of multiple treatment goals. Moreover, real‐world evidence has confirmed the glucose‐lowering and cardiovascular‐renal benefits of metformin accompanied by an extremely low risk of lactic acidosis. In patients with type 2 diabetes and advanced chronic kidney disease (estimated glomerular filtration rate 15‐30 mL/min/1.73m2), metformin discontinuation was associated with an increased risk of cardiovascular‐renal events compared with metformin persistence. Meanwhile, it is understood that microbiota, nutrients and metformin can interact through the gut‐brain‐kidney axis to modulate homeostasis of bioactive molecules, systemic inflammation and energy metabolism. While these biological changes contribute to the multisystem effects of metformin, they may also explain the gastrointestinal side effects and vitamin B12 deficiency associated with metformin intolerance. By understanding the interactions between metformin, foods and microbiota, healthcare professionals are in a better position to optimize the use of metformin and mitigate potential side effects. The United Kingdom Prospective Diabetes Study and the Da Qing Diabetes Prevention Program commenced 40 years ago provided the first evidence that type 2 diabetes is preventable and treatable. To drive real‐world impact from this evidence, payors, practitioners and planners need to co‐design and implement an integrated, data‐driven, metformin‐based programme to detect people with undiagnosed diabetes and prediabetes (intermediate hyperglycaemia), notably impaired glucose tolerance, for early intervention. The systematic data collection will create real‐world evidence to bring out the best of metformin and make healthcare sustainable, affordable and accessible.

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“…In a double-blind, parallel randomized clinical trial (RCT) involving 44 overweight/obese subjects with prediabetes, 15g of GOS daily when added to regular diet increased Bifidobacterium by 5-times but did not alter peripheral insulin sensitivity, SCFA, LPS or inflammatory markers (20). However, compared with prebiotic supplementation, FODMAPs from whole foods might exert additional effects on whole gut transit time and motility (21) and interact with other gut components resulting in different effects.…”

Section: Galactooligosaccharides (Gos) Supplementation Lowered Ldl-ch...mentioning

confidence: 99%

Higher habitual FODMAP intake is associated with lower body mass index, lower insulin resistance and higher short-chain fatty acid-producing microbiota in people with prediabetes

Chu

Ling

et al. 2022

Preprint

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Aims/hypothesis: The quantity and quality of FODMAPs can alter the relative abundance of gut microbiota with metabolic consequences although similar data are lacking in people with prediabetes. We investigated associations between habitual FODMAP contents, gut microbiota and glucose/insulin responses in subjects with prediabetes. Methods: In this prospective cross-sectional study, ninety- eight subjects with impaired glucose tolerance (IGT) (mean age: 57+/-7 years, 43 % men) had assessment of body composition, 6-point oral glucose tolerance tests (OGTT), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and 3-day dietary intake. We analysed faecal samples in a sub-group of 20 subjects with IGT and 10 subjects with normal glucose tolerance by 16S rRNA microbiome analysis. Results: Obese subjects with IGT had the lowest daily FODMAP intake compared with their non-overweight and non-obese counterparts (5.7 (3.9-7.9) vs 7.1 (5.0-11.3) vs 9.9 (4.1-22.4) g/day, p=0.024) despite having similar total daily energy intake. Total content of FODMAPs was negatively correlated with body fat. After adjustment for age and gender, total FODMAPs were negatively associated with BMI and HOMA-IR. This remained significant after adjustment for macronutrients and physical activity (p=0.032 and p=0.036 respectively). FODMAP contents were strongly associated with short-chain fatty acid (SCFA)-producing bacteria, such as Lactobacillus (p=0.011), Akkermansia muciniphila (p=0.012), and Bifidobacterium longum (p=0.010), the abundance of which were negatively correlated with 2-hr plasma glucose (r = -0.524, p =0.003). Conclusion: In individuals with IGT, higher habitual FODMAP intake was associated with lower body fat and insulin resistance and increased abundance of SCFA-producing bacteria, calling for interventional studies to evaluate the effects of FODMAP intake in prediabetes.

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A diet high in FODMAPs as a novel dietary strategy in diabetes?

Cited by 8 publications

References 83 publications

Higher Short-Chain Fermentable Carbohydrates Are Associated with Lower Body Fat and Higher Insulin Sensitivity in People with Prediabetes

Higher Short-Chain Fermentable Carbohydrates Are Associated with Lower Body Fat and Higher Insulin Sensitivity in People with Prediabetes

Current type 2 diabetes guidelines: Individualized treatment and how to make the most of metformin

Higher habitual FODMAP intake is associated with lower body mass index, lower insulin resistance and higher short-chain fatty acid-producing microbiota in people with prediabetes

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