Consumption of Lactose, Other FODMAPs and Diarrhoea during Adjuvant 5-Fluorouracil Chemotherapy for Colorectal Cancer

Abstract

Chemotherapy-induced mucosal injury of the small intestine may interfere with the enzymes and transporters responsible for the hydrolysis and absorption of dietary carbohydrates causing diarrhoea, abdominal discomfort and pain. The aim of this study was to investigate the association between the consumption of foods rich in FODMAPs (fermentable oligo-, di- and monosaccharides and polyols) and gastrointestinal symptoms in patients receiving adjuvant therapy for colorectal cancer. The patients (n = 52) filled in a 4-day food diary at baseline and during therapy and kept a symptom diary. The intakes of FODMAP-rich foods were calculated as portions and the intakes were divided into two consumption categories. Patients with high consumption of FODMAP-rich foods had diarrhoea more frequently than those with low consumption (for lactose-rich foods the odds ratio (OR) was 2.63, P = 0.03; and for other FODMAP-rich foods 1.82, P = 0.20). Patients with high consumption of both lactose-rich and other FODMAP-rich foods had an over 4-fold risk of developing diarrhoea as compared to those with low consumption of both (OR, 4.18; P = 0.02). These results were confirmed in multivariate models. Conclusion: Consumption of lactose-rich foods results in an increased risk of diarrhoea during adjuvant therapy for colorectal cancer, especially when the consumption of other FODMAP-rich foods is also high.

A Review of the Efficacy of the Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) Diet in Managing Gastrointestinal Symptoms Related to Cancer Treatment

“…The currently available research has yielded useful insights on possible associations between the low FODMAP diet and cancer outcomes. For example, the observational studies (Table 1) by Schaefer et al [26] and Holma et al [27] indicate that a low FODMAP diet may potentially ameliorate symptoms and reduce side effects in some cancer patients undergoing treatment. Specifically, a low FODMAP diet has been found to be beneficial for reducing the incidence of rectal toxicity during radiotherapy for patients with prostate cancer and reducing diarrhea associated with chemotherapy [29,30].…”

“…Additionally, individuals who consumed high quantities of lactose-rich and other FODMAPrich foods were more than four times as likely to develop diarrhea compared to those with low consumption of these foods. The study concluded that there was a significant association between total FODMAP intake and diarrhea symptoms, suggesting that reducing FODMAP intake could potentially alleviate diarrhea during chemotherapy [27].…”

“…However, the five studies reviewed shed light on the potential benefits of a low FODMAP diet for cancer patients undergoing various treatments [26][27][28][29][30]. Collectively, the findings suggest that reducing FODMAP intake may have a positive impact on reducing GI symptoms and improving patients' quality of life [26][27][28][29][30]. However, it is important to note the limitations of these studies.…”

Probiotic Supplements on Oncology Patients’ Treatment-Related Side Effects: A Systematic Review of Randomized Controlled Trials

“…In this context, the results showed that the L. rhamnosus GG ATCC 53,103 strain did not alter the production of pH or methane, as opposed to studies such as Salminen and collaborators (1988) [ 37 ], in which L. acidophilus NCDO1748 was administered and increased flatulence was observed, pointing directly to the lactulose content as a non-absorbable substrate, a mechanism favoring the production of methane and probiotic absorption. In this sense, Osterlund and collaborators (2004) [ 35 ] provide information on lactose intolerance caused by low intestinal villus height in relation to its depth of treatment, resulting in malabsorption syndrome and therefore hindering the production of diarrhea, flatulence, and abdominal pain [ 58 ]. In line with the overall evidence, it is worth noting how adverse effects can be managed by modifying gut microbiota and methane production mechanisms [ 30 , 59 ].…”

Genetically Determined Circulating Lactase/Phlorizin Hydrolase Concentrations and Risk of Colorectal Cancer: A Two-Sample Mendelian Randomization Study

“…However, the negative impacts of lactose maldigestion among lactase-non-persistent individuals are actually determined by continuous residual LPH expression levels [ 6 , 28 , 29 ]. In addition, CRC patients undergoing adjuvant 5-fluorouracil chemotherapy can develop secondary lactose intolerance due to gastrointestinal damage [ 30 , 31 ], disrupting small intestine enzyme and transporter functions [ 32 ]. Consequently, the potential for reverse causation (i.e., CRC leading to reduced LPH levels and thus milk intake) remains plausible.…”