Low Fermentable Oligosaccharides, Disaccharides Monosaccharides, Polyols Diet Therapy in Irritable Bowel Syndrome

Yıl 2023, Cilt: 12 Sayı: 2, 417 - 424, 23.06.2023

Ayşe Damla Düşünsel , Gül Eda Kılınç

https://doi.org/10.53424/balikesirsbd.1004488

Cited By: 1

Öz

Irritable bowel syndrome (IBS) is a functional bowel disease characterized by disturbances in bowel movements and defecation. IBS has symptoms such as bloating, abdominal pain, diarrhea, and constipation. According to the symptoms seen in the patient, applications such as psychological therapy and diet therapy are recommended together with drug therapy. The Low Fermentable Oligo-, Di- and Mono-saccharides and Polyols (FODMAP) diet is one of the most popular treatments for IBS recently. FODMAPs are osmotically active, poorly absorbed, and rapidly fermentable short-chain carbohydrates, which can cause digestive and absorption problems in the gut as a result of excessive consumption. They can cause bloating and abdominal symptoms by forming various gases as a result of their rapid fermentation in the intestine and due to their osmotic activity. It was thought that FODMAPs could trigger the symptoms of IBS patients and that patients with a low-FODMAP diet could improve their symptoms. Many studies on this subject have proven the positive effects of the low-FODMAP diet in the treatment of IBS. However, due to the restrictive nature of the diet, potential risks arise such as reduced sustainability in the long term, causing nutritional deficiencies and adverse effects on the microbiota. Some studies, these risks were emphasized and various results were obtained, but it was not clear. The purpose of this review is to examine the relationship between a low FODMAP diet and IBS.

Anahtar Kelimeler

FODMAP, Irritable Bowel Syndrome, Low-FODMAP Diet

İrritabl Bağırsak Sendromunda Düşük Fermente Edilebilir Oligosakkaritler, Disakkaritler, Monosakkaritler, Polioller Diyet Tedavisi

Öz

İrritabl bağırsak sendromu (İBS) bağırsak hareketleri ve dışkılamadaki bozuklarla karakterize, işlevsel bağırsak hastalığıdır. İBS karında şişkinlik, karın ağrısı, diyare, konstipasyon gibi semptomlara sahiptir. Hastada görülen semptomlara göre ilaç tedavisiyle birlikte psikolojik tedavi, diyet tedavisi gibi uygulamalar önerilmektedir. Düşük Fermente Edilebilir Oligo-, Di- ve Mono-sakkaritler ve Polioller (FODMAP) diyeti son zamanlarda İBS tedavisinde öne çıkan tedavilerinden biridir. FODMAP’ler ozmotik olarak aktif, zayıf şekilde emilen ve hızlıca fermente olabilen kısa zincirli karbonhidratlar olup aşırı tüketilmeleri sonucu bağırsakta sindirimde ve emilimde problemlere neden olabilmektedir. Bu durumda bağırsakta hızlıca fermantasyonları sonucu çeşitli gazlar oluşturarak ve ozmotik aktiflikleri nedeniyle şişkinliğe, abdominal semptomlara neden olabilmektedir. Bu nedenle FODMAP’lerin İBS hastalarının semptomlarını tetikleyebileceği ve düşük FODMAP diyeti ile hastaların semptomlarında iyileşmeler gösterebileceği düşünülmüştür. Bu konuda yapılan birçok çalışma düşük FODMAP diyetinin İBS tedavisindeki olumlu etkilerini kanıtlamıştır. Ancak diyetin kısıtlayıcı olması nedeniyle uzun vadede sürdürülebilirliğinin azalması, beslenme yetersizliklerine neden olması ve mikrobiyota üzerinde olumsuz etkilere neden olması gibi potansiyel riskler ortaya çıkmaktadır. Bazı çalışmalarda bu riskler üzerinde durulmuş ve çeşitli sonuçlar alınmıştır ancak bir netlik kazanmamıştır. Bu derlemenin amacı düşük FODMAP diyeti ile İBS arasındaki ilişkiyi incelemektir.

Anahtar Kelimeler

Düşük FODMAP Diyeti, FODMAP, İrritabl Bağırsak Sendromu

Kaynakça

• Altobelli, E., Negro, V. D., Angeletti, P. M. & Latella, G. (2017). Low-FODMAP diet improves irritable bowel syndrome symptoms: a meta-analysis. Nutrients, 9(9), 940. http://dx.doi.org/10.3390/nu9090940.
• Aziz, I. & Simrén, M. (2020). Irritable bowel syndrome In E. C. Kuipers (Ed.), Encyclopedia of Gastroenterology (2nd ed) (pp. 312-323). ABD: Academic Press.
• Basger, B. (2019). Irritable Bowel Syndrome (IBS) In Z. U. D. Babar (Ed.), Encyclopedia of Pharmacy Practice and Clinical Pharmacy (pp. 866-878). ABD: Academic Press.
• Bellini, M., Gambaccini, D., Bazzichi, L., Bassotti, G., Mumolo, M. G., Fani, B., et al. (2017). Bioelectrical impedance vector analysys in patients with irritable bowel syndrome on a low FODMAP diet: a pilot study. Techniquesin Coloproctolgy, 21, 451–459.
• Bellini, M., Tonarelli, S., Nagy, A. G., Pancetti, A., Costa, F., Ricchiuti, A., et al. (2020a). Low FODMAP diet: evidence, doubts, and hopes. Nutrients, 12(1), 148. https://doi.org/10.3390/nu12010148.
• Bellini, M., Tonarelli, S., Barracca, F., Morganti, R., Pancetti, A., Bertani, L., et al. (2020b). A low-FODMAP diet for irritable bowel syndrome: some answers to the doubts from a long-term follow-up. Nutrients, 12(8), 2360. https://doi.org/10.3390/nu12082360.
• Böhn, L., Storsrud, S., Liljebo, T., Collin, L., Lindfors, P., Tornblom, H. Et al. (2015). Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology, 149, 1399–1407.
• Catassi, G., Lionetti, E., Gatti, S. & Catassi, C. (2017). The low FODMAP diet: many question marks for a catchy acronym. Nutrients, 9, 292.
• Chumpitazi, B. P., Hollister, E. B., Oezguen, N., Tsai, C. M., McMeans, A. R., Luna, R. A., et al. (2014). Gut microbiota influences low fermentable substrate diet efficacy in children with irritable bowel syndrome. Gut Microbes, 5, 165–175.
• Ede, E. & Yoldaş İlktaç, H. (2019). İrritable bağırsak sendromunda güncel diyet yaklaşımları. İstanbul Sabahattin Zaim Üniversitesi Fen Bilimleri Enstitüsü Dergisi, 1(1), 1-6.
• Eswaran, S. L., Chey, W. D., Han-Markey, T., Ball, S. & Jackson, K. A. (2016).A randomized controlled trial comparing the low FODMAP diet vs. modified NICE guidelines in US adults with IBS-D. The American Journal of Gastroenterology, 111, 1824-1832.
• Eswaran, S. L., Dolan, R. D., Ball, S. C., Jackson, K. & Chey, W. (2020). The impact of a 4-week low-FODMAP and mNICE diet on nutrient intake in a sample of us adults with irritable bowel syndrome with diarrhea. Journal Of The Academy Of Nutrition And Dietetics, 120(4), 641-649.
• Farmer, A. D. & Ruffle, J. K. (2019). Irritable bowel syndrome. Motility And Functional Bowel Disease, 47(6), 350-353.
• Ficna, J. (2020) Introduction to irritable bowel syndrome: general overview and epidemiology In Ficna J (Ed.), A Comprehensive Overview of Irritable Bowel Syndrome (pp. 1-7). ABD: Academic Press.
• Ford, A. C., Sperber, A. D., Corsetti, M. & Camilleri, C. (2020). Irritable bowel syndrome. The Lancet, 396, 1675-1688.
• Gearry, R. B., Irving, P. M., Barrett, J. S., Nathan, D. M., Shepherd, S. J. & Gibson, P. R. (2009). Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease-a pilot study. Journal of Crohn's and Colitis, 3, 8-14.
• Goyal, O., Batta, S., Nohria, S., Kishore, H., Goyal, P., Sehgal, R., et. al. (2021). Low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet in patients with diarrhea-predominant irritable bowel syndrome: A prospective, randomized trial. Journal of Gastroenterology and Hepatology, 36(8), 2107-2115. https://doi.org/10.1111/jgh.15410.
• Gravina, A. G., Dallio, M., Romeo, M., Di Somma, A., Cotticelli, G., Loguercio, C., et al. (2020). Adherence andeffects derived from FODMAP diet on irritable bowel syndrome: a real life evaluation of a large follow-upobservation. Nutrients, 12(4), 928.
• Halmos, E. P., Power, V. A., Shepherd, S. J., Gibson, P. R. & Muir, J. G. (2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 146, 67–75.
• Halmos, E. P., Christophersen, C.T., Bird, A. R., Shepherd, S. J., Gibson, P. R. & Muir J. G. (2015). Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut, 64, 93–100.
• Harvie, R. M., Chisholm, A. W., Bisanz, J. E., Burton, J. P., Herbison, P., Schultz, K., et al. (2017). Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World Journal of Gastroenterology, 23, 4632-4643.
• Hellström, P. M. (2019). Pathophysiology of the irritable bowel syndrome - Reflections of today. Best Practice & Research Clinical Gastroenterology, 40-41, 101620.
• Kingsley, M. & Moshiree, B. (2020). Irritable bowel syndrome. In : Rao SSC, Lee YY, Uday C (eds), Clinical and Basic Neurogastroenterology and Motility. Academic Press, ABD, pp 421-434.
• Méance, S., Giordano, J., Chuang, E. & Schneider, H. (2017). Food regulations: Low FODMAP labeling and communication goals. Journal of Gastroenterology and Hepatology, 32, 62–63.
• McIntosh, K., Reed, D. E., Schneider, T., Dang, F., Keshteli, A. H., De Palma, G., et al. (2017). FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut, 66, 1241–1251.
• McKenzie, Y. A., Thompson, J., Gulia, P. & Lomer, M. C. E. (2016). British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults. Journal of Human Nutrition and Dietetics, 29(5), 576–592.
• Molina-Infante, J., Serra, J., Fernandez-Ban͂ares, F. & Mearin, F. (2016). The low-FODMAP diet for irritable bowel syndrome: lights and shadows. Gastroenterology & Hepatology, 39(2), 55-65.
• Murillo, A. Z., Arévalo, F. E. & Jáuregui, E. P. (2016). Diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in the treatment of irritable bowel syndrome: indications and design. Endocrinologia y nutricion, 63(3), 132-138.
• Nanayakkara, W. S., Skidmore, P. M. L., O’brien, L., Wilkinson, T. J. & Gearry, R. B. (2016). Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clinical and Experimental Gastroenterology, 9, 131-142.
• O’Keeffe, M., Jansen, C., Martin, L., Williams, M., Seamark, L., Staudacher, H. M., et. al. (2017a). Long-term impact of the low-FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome. Neurogastroenterology & Motility, 30(1). https://doi.org/10.1111/nmo.13154.
• O’Keeffe, M. & Lomer, M. C. (2017b). Who should deliver the low FODMAP diet and what educational methods are optimal: a review. Journal of Gastroenterology and Hepatology, 32, 23–26.
• Paduano, D., Cingolani, A., Tanda, E. & Usai, P. (2019). Effect of Three Diets (Low FODMAP, Gluten-free and Balanced) on Irritable Bowel Syndrome Symptoms and Health-Related Quality of Life. Nutrients, 11(7), 1566.
• Rej, A., Shaw, C. C., Buckle, R. L., Trott, N., Agrawal, A., Mosey, K., et. al. (2021). The low FODMAP diet for IBS; A multicentre UK study assessing long term follow up. Digestive and Liver Disease, 53(11), 1404-1411.
• Schumann, D., Klose, P., Lauche, R., Dobos, G., Langhorst, J. & Cramer, H. (2018). Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Nutrition, 45, 24–31.
• Scott, K. P., Duncan, S. H., Louis, P. & Flint, H. J. (2011). Nutritional influences on the gut microbiota and the consequences for gastrointestinal health. Biochemical Society Transactions, 39, 1073–1078.
• Staudacher, H. M., Lomer, M. C., Anderson, J. L., Barrett, J. S., Muir, J. G., Irving, P. M., et al. (2012). Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. The Journal of Nutrition., 142, 1510–1518.
• Staudacher, H. M., Lomer, M. C. E., Farquharson, F. M., Louis, P., Fava, F., Franciosi, E., et al. (2017a). A Diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and probiotic restores Bifidobacterium species: a randomized controlled trial. Gastroenterology, 153, 936–947.
• Staudacher, H. M. & Whelan, K. (2017b). The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut, 66, 1517-1527.
• Ustaoğlu, T., Tek, N. A. & Yıldırım, A. E. (2020). İrritabl bağırsak sendromunda (İBS) FODMAP diyetinin İBS semptomları, beslenme durumu ve yaşam kalitesi üzerine etkilerinin değerlendirilmesi. Beslenme ve Diyet Dergisi, 48(1), 43-54.
• Weynants, A., Goossens, L., Genetello, M., De Looze, D. & Van Winckel, M. (2019). The long-term effect and adherence of a low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in patients with irritable bowel syndrome. Journal of Human Nutrition and Dietetics, 33(2), 159-169. https://doi.org/10.1111/jhn.12706.
• Whelan, K., Martin, L. D., Staudacher, H. M. & Lomer, M. C. E. (2018). The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice. Journal of Human Nutrition and Dietetics, 31, 239-255.
• Włodarczyk, M. & Sobolewska- Włodarczyk, A. (2020). Clinical diagnosis of irritable bowel syndrome, Chapter 8. In : Ficna J (eds), A Comprehensive Overview of Irritable Bowel Syndrome. Academic Press, ABD, pp 99-106.
• Zhang, Y., Feng, L., Wang, X., Fox, M., Luo, L., Du, L., et. al. (2021). Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet compared with traditional dietary advice for diarrhea-predominant irritable bowel syndrome: a parallel-group, randomized controlled trial with analysis of clinical and microbiological factors associated with patient outcomes. The American Journal of Clinical Nutrition, 113(6), 1531-1545.