Supplementing Dietary Fibers With a Low FODMAP Diet in Irritable Bowel Syndrome: A Randomized Controlled Crossover Trial

So, Daniel; Yao, Chu K; Ardalan, Zaid S.; Thwaites, Phoebe A; Kalantar‐zadeh, Kourosh; Muir, Jane G.

doi:10.1016/j.cgh.2021.12.016

Cited by 30 publications

(46 citation statements)

References 37 publications

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“…Finally, a major goal when initiating fiber supplementation is to avoid exacerbating IBS symptoms, which presents as a real risk for fibers that contain readily fermentable and, hence, gas-producing components, such as fructans alone or when present in wheatbran and resistant starch. The use of nonfermented or very slowly fermented fibers such as sugarcane bagasse and psyllium are relatively well tolerated (17,18) and both, by virtue of slowing fermentation and the rate of gas production, may be well tolerated when used with fermentable fiber (17)(18)(19). Clinical experience indicates, however, that a gradual introduction of additional fiber is better tolerated than initiating a large dose.…”

Section: Fiber Supplementationmentioning

confidence: 99%

The Role of Food in the Treatment of Bowel Disorders: Focus on Irritable Bowel Syndrome and Functional Constipation

2022

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Irritable bowel syndrome (IBS) and functional constipation (FC) are among the most common disorders of gut–brain interaction, affecting millions of individuals worldwide. Most patients with disorders of gut–brain interaction perceive food as a trigger for their gastrointestinal symptoms, and specific dietary manipulations/advice have now been recognized as a cornerstone therapeutic option for IBS and FC. We discuss in detail the 2 most common dietary interventions used for the management of IBS-general dietary advice based on the National Institute for Health and Care Excellence guidelines and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). We summarize the literature around the possible mechanisms of FODMAP-mediated IBS pathophysiology, the current 3-step, top-down approach of administering a low FODMAP diet (LFD) (restriction phase, followed by reintroduction and personalization), the efficacy data of its restriction and personalization phases, and possible biomarkers for response to an LFD. We also summarize the limitations and challenges of an LFD along with the alternative approach to administering an LFD (e.g., bottom-up). Finally, we discuss the available efficacy data for fiber, other dietary interventions (e.g., Mediterranean diet, gluten-free diet, and holistic dietary interventions), and functional foods (e.g., kiwifruit, rhubarb, aloe, and prunes) in the management of IBS and FC.

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Section: Fiber Supplementationmentioning

confidence: 99%

The Role of Food in the Treatment of Bowel Disorders: Focus on Irritable Bowel Syndrome and Functional Constipation

2022

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“…Diets were well-tolerated, and no adverse effects were reported. We also used a 100mm Visual Analogue Scale to quantify gastrointestinal symptoms as previously utilised, 19 where >30 mm out of a scale of 100 mm is considered a clinically significant increase in symptoms.…”

Section: Methodsmentioning

confidence: 99%

Gut microbial metabolites lower 24-hour systolic blood pressure in untreated essential hypertensive patients

Jama

Rhys-Jones

Nakai

et al. 2022

Preprint

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BackgroundFibres remain undigested until they reach the colon, where some are fermented by gut microbiota, producing metabolites called short-chain fatty acids (SCFAs). SCFAs lower blood pressure (BP) of experimental models, but their translational potential is unknown. We aimed to determine whether SCFAs lower 24-hour systolic BP (SBP) in untreated participants with essential hypertension.MethodsWe performed a phase II randomized placebo-controlled double-blind cross-over trial using SCFA-supplementation, delivered as acetylated and butyrylated high amylose maize starch (HAMSAB). Twenty treatment-naïve hypertensive participants were recruited from the community and randomised to 40g/day of HAMSAB or placebo. Participants completed each arm for three-weeks, with a three-week washout period between them. The primary endpoint was a 24-hour SBP decrease.ResultsParticipants were on average 55.8±11.2-years old (mean±SD), had a body mass index (BMI) of 25.7±2.5km2/m, 30% were female, baseline 24-hour SBP 136±6mmHg. No adverse effects were reported. After the intervention, the placebo-subtracted reduction in 24-hour SBP was 6.1±9.9mmHg (P= 0.027). This was independent of age, sex, BMI and study arm. There was no statistical significance in the placebo arm. Day and night SBP were reduced by 6.5±12.3mmHg (P=0.01) and 5.7±9.8mmHg (P=0.02), respectively, and 24-h central SBP by 7.2±14.7 mmHg (P=0.005). HAMSAB increased levels of acetate and butyrate by 7.8-fold (P=0.016), shifted the microbial ecosystem, and expanded the prevalence of SCFA-producers.ConclusionsWe observed a clinically relevant reduction in 24-hour SBP in participants with essential hypertension treated with the gut microbial-derived metabolites acetate and butyrate. These metabolites may represent a novel option for lowering BP.

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“…[74][75][76] In fact, a randomized, double-blind, triplecross-over feeding study in 26 patients with IBS consuming low-FODMAP diets showed that concurrent supplementation of minimally fermentable sugarcane bagasse alone improved the quality of the feces (dry stools were moister, wet stools drier). 77 When sugarcane bagasse was cosupplemented with fermentable resistant starch, carbohydrate fermentation increased and was evenly distributed around the colon. 78 Importantly, the supplements tested in two different cohorts of patients with IBS were well tolerated and did not diminish the symptomatic benefits of the low-FODMAP diet 77 Thus, fiber supplements with specific characteristics may add value to the benefits of restricting FODMAPs alone.…”

Section: Lesson #8: Value-adding To the Fodmap Dietmentioning

confidence: 99%

“…77 When sugarcane bagasse was cosupplemented with fermentable resistant starch, carbohydrate fermentation increased and was evenly distributed around the colon. 78 Importantly, the supplements tested in two different cohorts of patients with IBS were well tolerated and did not diminish the symptomatic benefits of the low-FODMAP diet 77 Thus, fiber supplements with specific characteristics may add value to the benefits of restricting FODMAPs alone.…”

Section: Lesson #8: Value-adding To the Fodmap Dietmentioning

confidence: 99%

“…Findings from studies in rats, pigs, and healthy humans suggest that supplementation with a combination of fermentable fiber (providing substrate to saccharolytic bacteria) and a minimally fermentable fiber (to push fermentation distally) enables uniform distribution of carbohydrate fermentation around the bowel, even on a FODMAP restricted diet 74–76 . In fact, a randomized, double‐blind, triple‐cross‐over feeding study in 26 patients with IBS consuming low‐FODMAP diets showed that concurrent supplementation of minimally fermentable sugarcane bagasse alone improved the quality of the feces (dry stools were moister, wet stools drier) 77 . When sugarcane bagasse was cosupplemented with fermentable resistant starch, carbohydrate fermentation increased and was evenly distributed around the colon 78 .…”

Section: Lesson #8: Value‐adding To the Fodmap Dietmentioning

confidence: 99%

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Diet as a therapeutic tool in chronic gastrointestinal disorders: Lessons from the FODMAP journey

Gibson

Halmos

et al. 2022

J of Gastro and Hepatol

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Supplementing Dietary Fibers With a Low FODMAP Diet in Irritable Bowel Syndrome: A Randomized Controlled Crossover Trial

Cited by 30 publications

References 37 publications

The Role of Food in the Treatment of Bowel Disorders: Focus on Irritable Bowel Syndrome and Functional Constipation

The Role of Food in the Treatment of Bowel Disorders: Focus on Irritable Bowel Syndrome and Functional Constipation

Gut microbial metabolites lower 24-hour systolic blood pressure in untreated essential hypertensive patients

Diet as a therapeutic tool in chronic gastrointestinal disorders: Lessons from the FODMAP journey

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