Dietary Carbohydrates and Childhood Functional Abdominal Pain

Abstract

Childhood functional gastrointestinal disorders (FGIDs) affect a large number of children throughout the world. Carbohydrates (which provide the majority of calories consumed in the Western diet) have been implicated both as culprits for the etiology of symptoms and as potential therapeutic agents (e.g., fiber) in childhood FGIDs. In this review, we detail how carbohydrate malabsorption may cause gastrointestinal symptoms (e.g., bloating) via the physiologic effects of both increased osmotic activity and increased gas production from bacterial fermentation. Several factors may play a role, including: (1) the amount of carbohydrate ingested; (2) whether ingestion is accompanied by a meal or other food; (3) the rate of gastric emptying (how quickly the meal enters the small intestine); (4) small intestinal transit time (the time it takes for a meal to enter the large intestine after first entering the small intestine); (5) whether the meal contains bacteria with enzymes capable of breaking down the carbohydrate; (6) colonic bacterial adaptation to one's diet, and (7) host factors such as the presence or absence of visceral hypersensitivity. By detailing controlled and uncontrolled trials, we describe how there is a general lack of strong evidence supporting restriction of individual carbohydrates (e.g., lactose, fructose) for childhood FGIDs. We review emerging evidence suggesting that a more comprehensive restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) may be effective. Finally, we review how soluble fiber (a complex carbohydrate) supplementation via randomized controlled intervention trials in childhood functional gastrointestinal disorders has demonstrated efficacy.

Low FODMAP diet in children and adolescents with functional bowel disorder: A clinical case note review

“…These data are unique but complementary to those demonstrated in shorter studies by other groups. 2,8,14,21 The increased rates of anxiety in patients with FBD is consistent with other studies that show high rates of anxiety-related disorders in pediatric patients with FBD. 22,23 Given that 17% of children in this study experienced stress and anxiety, psychological strategies need to be used in concert with dietary interventions.…”

“…Although the present study was retrospective, it showed the LFD to be an appropriate treatment for children with FBD in a real‐world setting. These data are unique but complementary to those demonstrated in shorter studies by other groups …”

“…patients with IBS. 2,8,14,21 These studies have shown a rapid symptom reduction within 2 days, which is substantially faster than adult studies. 19 The present study did not assess the timeline of LFD impact on symptoms; however, this would be useful to test in future prospective studies as this will help to establish clearer pediatric guidelines.…”

“…In children, data on the use of LFD as a treatment strategy for FBD are relatively lacking. Researchers from the United States have performed a number of clinical trials on LFD in pediatric patients with IBS . These studies have shown a rapid symptom reduction within 2 days, which is substantially faster than adult studies .…”

Feasibility and Acceptability of a Personalized Assessment of Chronic Abdominal Pain Triggers

“…Similarly, there is ample evidence to support a diffuse inflammatory mechanism in some, but not all, patients [12,13,14]. Recent studies at the intersection of biology and behavior indicate that a patient's biological make-up also plays a role in determining whether a given behavior (e.g., consuming carbohydrates) will produce pain symptoms [15]. In sum, these findings suggest significant heterogeneity in children with CAP.…”