Gluten and fructan intake and their associations with gastrointestinal symptoms in irritable bowel syndrome: A food diary study

Algera, Joost P.; Störsrud, Stine; Lindström, Annika; Simrén, Magnus; Törnblom, Hans

doi:10.1016/j.clnu.2021.09.002

Cited by 19 publications

(17 citation statements)

References 41 publications

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“…Some particularities of both dietary strategies applied, namely low FODMAPs and an anti-inflammatory diet, may crossover during the intervention, such as the exclusion of lactose-free dairy in low FODMAPs and dairies in an anti-inflammatory diet. Additionally, removing gluten also removes fructans, one of the FODMAPs sub-unit ( 75 ), which has been identified as a possible cause of gastrointestinal symptoms, namely irritable bowel syndrome ( 76 , 77 ). In this context, it is not possible to infer the impact of gluten exclusion in the outcomes analyzed in the present study.…”

Section: Discussionmentioning

confidence: 99%

An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial

et al. 2022

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BackgroundFibromyalgia (FM) has been associated with dysbiosis and low-grade inflammation. Studies have reported that diet influences clinical features in FM.ObjectiveTo evaluate the effect of an anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols (FODMAP) diet on clinical outcomes of patients with FM.MethodsThis two arms Randomized Controlled Trial (NCT04007705) included 46 female patients with FM. The intervention group (n = 22) adopted an anti-inflammatory diet for 3 months, excluding gluten, dairy, added sugar, and ultra-processed foods, along with a low FODMAPs diet in the first month. The control group (n = 24) followed general healthy eating recommendations. Both diets were applied by a certified dietitian. Before and after the intervention, participants were assessed regarding pain, fatigue, gastrointestinal symptoms, quality of sleep, and quality of life, through the Revised Fibromyalgia Impact Questionnaire (FIQR), Visual Analogue Pain Scale (VAS), Visual Analog Scale from gastrointestinal symptoms (VAS GI), Brief Pain Inventory (BPI), Pittsburg Sleep Quality Index (PSQI), Fatigue Severity Survey (FSS), and The Short Form Health Survey (SF-36). A blood sample was collected and high-sensitive C-Reactive Protein and Erythrocyte Sedimentation Rate were quantified. Paired Samples t-test/Wilcoxon and independent samples t-test/Mann−Whitney were used to compare variables between groups.ResultsAfter intervention, there was an improvement in intervention group scores of FIQR (p = 0.001), VAS (p = 0.002), BPI (p = 0.011), FSS (p = 0.042), VAS_GI (p = 0.002), PSQI (p = 0.048), and SF36 (p = 0.045) compared to control group. Inflammatory biomarkers (hs-CRP, ESR) did not change in both groups. The intervention was beneficial in the intervention group, regardless of age, disease duration, body mass index variation, and body fat change between baseline and post-intervention.ConclusionAn anti-inflammatory and low-FODMAP diet improved clinical features in patients with FM and may be useful as a complement to pharmacological therapy.Clinical Trial Registration[https://clinicaltrials.gov/ct2/show/NCT04007705], identifier [NCT04007705].

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Section: Discussionmentioning

confidence: 99%

An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial

et al. 2022

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“…However, in a randomized study targeting participants with intestinal symptoms, the GSRS measurement needs to be used as the basis for evaluation [31]. On average, elderly women show more severe GI symptoms than men and have higher GSRS scores [32]. A potential explanation is that hormonal changes resulting from the menopause can increase their susceptibility to mucosal damage and interfere with tissue repair in the digestive tract [33].…”

Section: Discussionmentioning

confidence: 99%

Intake of MPRO3 over 4 Weeks Reduces Glucose Levels and Improves Gastrointestinal Health and Metabolism

et al. 2021

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Human gut microbiota are involved in different metabolic processes, such as digestion and nutrient synthesis, among others. For the elderly, supplements are a major means of maintaining health and improving intestinal homeostasis. In this study, 51 elderly women were administered MPRO3 (n = 17), a placebo (n = 16), or both (MPRO3: 1 week, placebo: 3 weeks; n = 18) for 4 weeks. The fecal microbiota were analyzed by sequencing the 16S rRNA gene V3–V4 super-variable region. The dietary fiber intake increased, and glucose levels decreased with 4-week MPRO3 intake. Reflux, indigestion, and diarrhea syndromes gradually improved with MPRO3 intake, whereas constipation was maintained. The stool shape also improved. Bifidobacterium animalis, B. pseudolongum, Lactobacillus plantarum, and L. paracasei were relatively more abundant after 4 weeks of MPRO3 intake than in those subjects after a 1-week intake. Bifidobacterium and B. longum abundances increased after 1 week of MPRO3 intake but decreased when the intake was discontinued. Among different modules and pathways, all 10 modules analyzed showed a relatively high association with 4-week MPRO3 intake. The mineral absorption pathway and cortisol biosynthesis and secretion pathways correlated with the B. animalis and B. pseudolongum abundances at 4 weeks. Therefore, 4-week MPRO3 intake decreased the fasting blood glucose level and improved intestinal health and metabolism.

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“…Fructans have been suggested to be responsible for the pathophysiology of NCG/WS, with a double-blind placebo-controlled challenge of 59 individuals demonstrating fructans, rather than gluten, inducing symptoms in self-reported NCG/WS ( 20 ). However, a recent study failed to note an association between fructan intake and gastrointestinal symptoms ( 21 ). Wheat germ agglutinins have also been postulated in the pathophysiology of NCG/WS, having been shown to alter enterocyte permeability in vitro ( 22 ) and being shown to stimulate proinflammatory cytokines ( 14 , 23 ).…”

Section: Nonceliac Gluten/wheat Sensitivitymentioning

confidence: 99%

Evidence-Based and Emerging Diet Recommendations for Small Bowel Disorders

et al. 2022

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Diet plays a key role in the manifestation and severity of gastrointestinal symptoms, with increasing research interest on the role of diet in small bowel disorders. There are predominantly 3 small bowel conditions that have potential dietary interventions. Self-reported nonceliac gluten/wheat sensitivity is prevalent. Although gluten is believed to be a potential trigger for symptoms, other components of wheat may also be triggers, including fructans, alpha-amylase trypsin inhibitors, and wheat germ agglutinins. The diagnosis can be challenging, given the lack of validated biomarkers. A gluten-free diet that excludes the abovementioned triggers is the cornerstone of treatment; however, unlike celiac disease, there is uncertainty about the level of adherence or whether the gluten-free diet is a lifelong intervention. Several primary gastrointestinal disorders are associated with an increase in inflammatory cells including eosinophils. Diet seems to be an important driver of disease pathogenesis in eosinophilic gastroenteritis, with elimination and elemental diets showing promise in management, with further robust trials required. Small intestinal bacterial overgrowth is an example of microbial dysbiosis, with renewed interest in diet being postulated to cause an adaptive change of the microbes colonizing the small intestine. However, the diagnosis of small intestinal bacterial overgrowth is limited by a lack of sensitive and specific tests, with significant knowledge gaps in relation to therapeutic measures to manage and cure small intestinal bacterial overgrowth. Currently, antimicrobials are the established management option. There have been significant clinical advances in dietary interventions related to the small bowel, but this area is currently a novel and advancing field for both patients and clinicians.

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Gluten and fructan intake and their associations with gastrointestinal symptoms in irritable bowel syndrome: A food diary study

Cited by 19 publications

References 41 publications

An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial

An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial

Intake of MPRO3 over 4 Weeks Reduces Glucose Levels and Improves Gastrointestinal Health and Metabolism

Evidence-Based and Emerging Diet Recommendations for Small Bowel Disorders

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