Perspective: Assessing Tolerance to Nondigestible Carbohydrate Consumption

Abstract

Human intestinal enzymes do not hydrolyze non-digestible carbohydrates (NDCs), and thus, they are not digested and absorbed in the small intestine. Instead, NDCs are partially to completely fermented by the intestinal microbiota. Select NDCs are associated with health benefits such as laxation, and blood cholesterol and glucose-lowering effects. NDCs provide functional attributes to processed foods, including sugar or fat replacers, thickening agents, and bulking agents. Additionally, NDCs are incorporated in processed foods to increase their fiber content. Although consumption of NDCs can benefit health and contribute functional characteristics to foods, they can cause gastrointestinal symptoms, such as flatulence and bloating. As gastrointestinal symptoms negatively affect consumer well-being and their acceptance of foods containing NDC ingredients, it is crucial to consider tolerance when designing food products and testing their physiological health benefits in clinical trials. This perspective provides recommendations for the approach to assess gastrointestinal tolerance to NDCs, with a focus on study design, population criteria, intervention, comparator, and outcomes. Special issues related to studies in children and implications for stakeholders also are discussed. It is recommended that the evaluation of gastrointestinal tolerance to NDCs be conducted in randomized, blinded, controlled crossover studies using standard gastrointestinal questionnaires, with attention to study participant's background diets, health status, lifestyle, and medications.

Can prebiotics help tackle the childhood obesity epidemic?

“…Specifically, rice bran supplementation significantly improved the weight for age z-scores in the infants from Mali, where rice is the dominant staple food, compared to that of Nicaraguan infants who had different gut microbiota and metabolome composition (78). On the other hand, gastrointestinal tolerance differs with the type and amount of prebiotics consumed and is affected by the highly individualized response (79). For example, most of the highly fermentable ITFs may be tolerated in the generally healthy adult population at daily intakes of up to 15 g, depending on their DP (80).…”

“…Early studies suggest that infants and young children tolerate ITFs up to 0.8g/kg body weight per day (82), which has been corroborated by the interventions discussed herein (Table 1). The gastrointestinal tolerance of other types of prebiotics in children is less documented and warrants formal evaluation in interventional trials (79). Last but not least, prolonged consumption of inulin fiber enriched foods unexpectedly led to potentially dysregulated bile acid and/or SCFA metabolism in recent murine studies (83,84), contributing to type 2 inflammation and increasing the risk of hepatocellular carcinoma in a microbiotadependent manner.…”

Assessing Gastrointestinal Tolerance in Healthy Adults: Reliability and Validity of a Weekly Questionnaire

“…Interventional studies with a minimum of one baseline GSRS were included. For assessing daily gastrointestinal symptoms (bloating, flatulence, abdominal cramping, stomach noises, nausea), 7 days of reporting at baseline using a Likert scale (0 = none, 3 = mild, 6 = very severe), as typically used in such studies [ 25 ], was required. Daily reporting of Bristol Stool Form (BSF) [ 26 ] and bowel movement frequency, if available, were also included.…”

Dietary Patterns, Gut Microbiota and Sports Performance in Athletes: A Narrative Review

“…Notably, athletes in many sports often consume a high amount of fast-absorbed carbohydrates to maximize glycogen storage. However, they also aim to avoid non-digestible carbohydrates in order to prevent intestinal issues and other unfavorable syndromes that can negatively impact sports performance, such as bloating and diarrhea [ 130 ]. While a high intake of fast-absorbed carbohydrates can increase energy storage during training or competition, a low intake of dietary fiber may lead to the reduced production of short-chain fatty acids (SCFAs), altered intestinal transit times, and a loss of bacterial diversity [ 3 ], all of which have negative implications for long-term health [ 131 ].…”