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A starch- and sucrose-reduced diet may lead to improvement of intestinal and extraintestinal symptoms in more conditions than irritable bowel syndrome and congenital sucrase-isomaltase deficiency.
Roth, B, Ohlsson, B
Nutrition (Burbank, Los Angeles County, Calif.). 2024;117:112254
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Studies have shown that a starch and sucrose-reduced diet (SSRD) leads to considerable improvements of gastrointestinal and extraintestinal symptoms in patients with irritable bowel syndrome (IBS). The purpose of this pilot study was to see if a SSRD would be beneficial in other conditions with similar symptoms. Two people took part in the study. A man with functional diarrhoea and a woman with microscopic colitis. The SSRD consists of low intakes of sugar-rich products, but continued or increased intakes of all meats and fish, fat, natural dairy products, eggs, berries, fruits, nuts, seeds, and vegetables low in starch. Fiber-rich bread and pasta and raw or wild rice were recommended instead of white bread and more processed rice and pasta. During the 4-week intervention, the participants lost weight and waist circumference reduced. The degree of satiety after a meal was increased and the sweet cravings were strongly reduced. The gastrointestinal symptoms improved in the participant with diarrhoea but was unaffected in the participant with microscopic colitis. Reductions of diarrhoea and of bloating and flatulence were most pronounced in both patients. The psychological well-being was improved during the intervention. Extraintestinal symptoms were also reduced during the SSRD, especially urinary urgency and belching. This is a small intervention study and therefore not possible to make generalised claims or recommendations. However, healthcare practitioners could look at SSRD when working with IBS patients as a therapeutic dietary option.
Abstract
OBJECTIVES A starch- and sucrose-reduced diet has been found to improve gastrointestinal and extraintestinal symptoms in irritable bowel syndrome, as well as reduce weight and improve psychological well-being. Our hypothesis was that a starch- and sucrose-reduced diet would also be beneficial in other conditions with similar symptoms. The aim of the present research letter was to describe the role of a starch- and sucrose-reduced diet in a pilot project in patients with diarrhea having varying causes. METHODS One man, age 36 y, suffering from functional diarrhea and one woman, 56 y, suffering from microscopic colitis, were randomized to a starch- and sucrose-reduced diet for 4 wk. At baseline, dietary information was given, and blood samples collected. Weight and waist circumference were measured. The participants completed the irritable bowel syndrome severity scoring system for evaluating specific gastrointestinal and extraintestinal symptoms and visual analog scale for irritable bowel syndrome for evaluation of specific gastrointestinal symptoms and psychological well-being. The degrees of satiety and sweet craving were measured on visual analog scales. After 4 wk, all procedures were repeated. RESULTS Weight, body mass index, and waist circumference were decreased during the intervention. The total amount of gastrointestinal symptoms was decreased in the participants with functional diarrhea, and diarrhea and bloating were decreased in both participants. Both had reduced extraintestinal symptoms and improved psychological well-being. Blood levels had mainly unchanged or slightly increased values of measurements reflecting nutrient intake. CONCLUSIONS A starch- and sucrose-reduced diet may lead to weight reduction, reduced symptoms, and improved well-being in several patient categories, not only in patients suffering from irritable bowel syndrome. Future randomized trials should be done.
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Associations of fat and carbohydrate intake with cardiovascular disease and mortality: prospective cohort study of UK Biobank participants.
Ho, FK, Gray, SR, Welsh, P, Petermann-Rocha, F, Foster, H, Waddell, H, Anderson, J, Lyall, D, Sattar, N, Gill, JMR, et al
BMJ (Clinical research ed.). 2020;368:m688
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Dietary advice on the amounts of carbohydrates, protein and fat that should be consumed to decrease heart disease risk is inconsistent, as the data supporting guidelines is conflicting. This prospective cohort study of 195,658 people over roughly 10 years aimed to determine the association of macronutrients i.e., carbohydrate, fat, protein, sugar, starch and fibre consumption with death and heart disease. The results showed that the relationships between many macronutrients and heart disease were not as previously thought. Individuals with higher sugar or carbohydrate intakes were associated with a greater risk of heart disease. Individuals with a higher intake of monounsaturated fat were associated with lower risk of heart disease. Intakes of starch and saturated fat were not associated with an increased risk of heart disease at all. The relationship between heart disease and protein, fibre and polyunsaturated fat was not straight forward and depending on how much was in the diet determined the risk of heart disease. It was concluded that many of the relationships between macronutrients and heart disease risk are not simple and any dietary advice given should be based on an individual’s current intake. Dietary advice on carbohydrates needs to take into account the different associations of starch and sugar. This paper could be used by healthcare professionals to understand that dietary advice needs to be personalised based on current intakes.
Abstract
OBJECTIVE To investigate the association of macronutrient intake with all cause mortality and cardiovascular disease (CVD), and the implications for dietary advice. DESIGN Prospective population based study. SETTING UK Biobank. PARTICIPANTS 195 658 of the 502 536 participants in UK Biobank completed at least one dietary questionnaire and were included in the analyses. Diet was assessed using Oxford WebQ, a web based 24 hour recall questionnaire, and nutrient intakes were estimated using standard methodology. Cox proportional models with penalised cubic splines were used to study non-linear associations. MAIN OUTCOME MEASURES All cause mortality and incidence of CVD. RESULTS 4780 (2.4%) participants died over a mean 10.6 (range 9.4-13.9) years of follow-up, and 948 (0.5%) and 9776 (5.0%) experienced fatal and non-fatal CVD events, respectively, over a mean 9.7 (range 8.5-13.0) years of follow-up. Non-linear associations were found for many macronutrients. Carbohydrate intake showed a non-linear association with mortality; no association at 20-50% of total energy intake but a positive association at 50-70% of energy intake (3.14 v 2.75 per 1000 person years, average hazard ratio 1.14, 95% confidence interval 1.03 to 1.28 (60-70% v 50% of energy)). A similar pattern was observed for sugar but not for starch or fibre. A higher intake of monounsaturated fat (2.94 v 3.50 per 1000 person years, average hazard ratio 0.58, 0.51 to 0.66 (20-25% v 5% of energy)) and lower intake of polyunsaturated fat (2.66 v 3.04 per 1000 person years, 0.78, 0.75 to 0.81 (5-7% v 12% of energy)) and saturated fat (2.66 v 3.59 per 1000 person years, 0.67, 0.62 to 0.73 (5-10% v 20% of energy)) were associated with a lower risk of mortality. A dietary risk matrix was developed to illustrate how dietary advice can be given based on current intake. CONCLUSION Many associations between macronutrient intake and health outcomes are non-linear. Thus dietary advice could be tailored to current intake. Dietary guidelines on macronutrients (eg, carbohydrate) should also take account of differential associations of its components (eg, sugar and starch).
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Influence of diet on the gut microbiome and implications for human health.
Singh, RK, Chang, HW, Yan, D, Lee, KM, Ucmak, D, Wong, K, Abrouk, M, Farahnik, B, Nakamura, M, Zhu, TH, et al
Journal of translational medicine. 2017;15(1):73
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Gut microbiome plays an important role in modulating the risk of many chronic diseases through its impact on host immunity and metabolic health. Diet, in turn, can alter the composition of the microbiota. This paper reviewed current understanding of the effects of common dietary components and three select diets on gut microbiota composition and host health. Dietary components included plant and animal protein, saturated and unsaturated fats, digestible and non-digestible carbohydrates, probiotics and polyphenols. The diets included Western diet, gluten-free diet and Mediterranean diet. Based on the reviewed papers, the authors concluded that diet can modify the intestinal microbiome, which in turn has a profound impact on overall health. The impact can be beneficial or detrimental, depending on the abundance and identity of microbial populations and the nature of their interactions with the host. The authors also state that further research using large, long-term clinical trials to evaluate a greater variety of food components would be helpful in making specific dietary recommendations to patients.
Abstract
Recent studies have suggested that the intestinal microbiome plays an important role in modulating risk of several chronic diseases, including inflammatory bowel disease, obesity, type 2 diabetes, cardiovascular disease, and cancer. At the same time, it is now understood that diet plays a significant role in shaping the microbiome, with experiments showing that dietary alterations can induce large, temporary microbial shifts within 24 h. Given this association, there may be significant therapeutic utility in altering microbial composition through diet. This review systematically evaluates current data regarding the effects of several common dietary components on intestinal microbiota. We show that consumption of particular types of food produces predictable shifts in existing host bacterial genera. Furthermore, the identity of these bacteria affects host immune and metabolic parameters, with broad implications for human health. Familiarity with these associations will be of tremendous use to the practitioner as well as the patient.
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Starch Digestion-Related Amylase Genetic Variant Affects 2-Year Changes in Adiposity in Response to Weight-Loss Diets: The POUNDS Lost Trial.
Heianza, Y, Sun, D, Wang, T, Huang, T, Bray, GA, Sacks, FM, Qi, L
Diabetes. 2017;66(9):2416-2423
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Salivary and pancreatic amylases are responsible for the digestion of starchy foods. Specific genes that encode these amylases control both the activity and amount produced. While increasing evidence suggests the AMY1 gene is associated with obesity, existing results have not been conclusive. The aim of this study was to investigate whether genetic variations involved in starch metabolism are associated with long-term changes in adiposity among 692 overweight and obese individuals. Participants were randomly assigned to diets varying in macronutrient content for two years. Anthropometric measurements were recorded at baseline and every six months and blood samples were taken at baseline, 6 and 24 months. This study found the AMY1-AMY2 rs11185098 genotype to be associated with higher amylase activity, as well as reductions in body weight and waist circumference. Based on these results, the authors conclude overweight and obese individuals carrying this genotype may experience greater loss of adiposity during weight-loss interventions.
Abstract
Salivary and pancreatic amylases (encoded by AMY1 and AMY2 genes, respectively) are responsible for digesting starchy foods. AMY1 and AMY2 show copy number variations that affect differences in amylase amount and activity, and AMY1 copies have been associated with adiposity. We investigated whether genetic variants determining amylase gene copies are associated with 2-year changes in adiposity among 692 overweight and obese individuals who were randomly assigned to diets varying in macronutrient content. We found that changes in body weight (BW) and waist circumference (WC) were significantly different according to the AMY1-AMY2 rs11185098 genotype. Individuals carrying the A allele (indicating higher amylase amount and activity) showed a greater reduction in BW and WC at 6, 12, 18, and 24 months than those without the A allele (P < 0.05 for all). The association was stronger for long-term changes compared with short-term changes of these outcomes. The genetic effects on these outcomes did not significantly differ across diet groups. In conclusion, the genetic variant determining starch metabolism influences the response to weight-loss dietary intervention. Overweight and obese individuals carrying the AMY1-AMY2 rs11185098 genotype associated with higher amylase activity may have greater loss of adiposity during low-calorie diet interventions.
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Effects of Three Commercially Available Sports Drinks on Substrate Metabolism and Subsequent Endurance Performance in a Postprandial State.
Qin, L, Wang, QR, Fang, ZL, Wang, T, Yu, AQ, Zhou, YJ, Zheng, Y, Yi, MQ
Nutrients. 2017;9(4)
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The depletion of stored glucose and the reduction of the availability of carbohydrates can contribute to fatigue during moderate-to-high intensity exercise. Studies have shown that carbohydrate consumption can reduce the depletion of stored energy and that the combination of protein and carbohydrate supplementation resulted in greater replenishment during intense exercise. Nowadays, most commercial sports beverages contain both carbohydrates and proteins. The present study looked at the postprandial effects of commercially available beverages on carbohydrate and fat metabolism and exercise performance. Ten healthy male participants with a history of running or cycling exercise participated in two studies in a double-blinded, counterbalanced manner. Commercially available beverages with low carbohydrate, high carbohydrate, and a combination of proteins and carbohydrates were tested, and it was found that a beverage containing both proteins and carbohydrates maintained insulin levels and provided greater energy during endurance exercise. It is important to conduct future studies on athletes with higher fitness levels to evaluate the benefits of commercially available beverages. Based on the findings of this study, healthcare professionals can learn more about the benefits of commercially available beverages that combine carbohydrates and proteins and have a low carbohydrate content.
Abstract
Purpose: To examine the effects of commercially available sports beverages with various components on substrate metabolism and subsequent performance. Methods: Two studies were conducted in a double-blinded, counterbalanced manner. Study I was designed to determine the glycemic index, while study II determined the utilization of substrates and subsequent exercise performance. Ten healthy male participants (age 21.70 ± 2.41 years, height 176.60 ± 5.23 cm, weight 66.58 ± 5.38 kg, V̇O2max 48.1 ± 8.4 mL/kg/min) participated in both study I and study II. Three types of commercially available sports beverage powders were used. The powders consisted primarily of oligosaccharides (low molecular weight carbohydrates, L-CHO), hydrolyzed starch (high molecular weight CHO, H-CHO), and whey protein powder with carbohydrate (CHO-PRO). They were dissolved in purified water with identical CHO concentration of 8% (w/v). In study I, each participant underwent two oral glucose tolerance tests (OGTT) and one glycemic response test for each sports drink. In study II, participants cycled for 60 min at 70% V̇O2max, one hour after consuming a standardized breakfast. One of four prescribed beverages (L-CHO, H-CHO, CHO-PRO, and Placebo control, PLA) was served at 0, 15, 30, 45 min during the exercise. Six hours after the first exercise session, participants came back for a "time to exhaustion test" (TTE). Blood samples were drawn at 0, 30, and 60 min in the first exercise session, while arterial blood gas analysis was conducted at 0, 30, and 60 min in both sessions. Subjective feelings (rating of perceived exertion and abdominal discomfort) were also evaluated every 30 min during exercise. Results: Compared to the reference standardized glucose solution, the glycemic index of the L-CHO beverage was 117.70 ± 14.25, while H-CHO was 105.50 ± 12.82, and CHO-PRO was 67.23 ± 5.88. During the exercise test, the insulin level at 30 and 60 min was significantly lower than baseline following the treatment of L-CHO, H-CHO, and PLA (p < 0.05). The CHO oxidation rate at 60 min in the first exercise session was significantly higher than that at 60 min in the second exercise session following the L-CHO treatment (p < 0.05). Time to exhaustion was not significantly different (p > 0.05). Conclusion: The CHO sports beverage with additional PRO maintains insulin production during endurance cycling at 70% V̇O2max in the postprandial state. L-CHO sports beverage suppresses fat utilization during the subsequent exercise performance test. The subsequent exercise performance (as evaluated by TTE) was not influenced by the type of CHO or the addition of PRO in the commercially available sports beverages used in the present study.
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Diets that differ in their FODMAP content alter the colonic luminal microenvironment.
Halmos, EP, Christophersen, CT, Bird, AR, Shepherd, SJ, Gibson, PR, Muir, JG
Gut. 2015;64(1):93-100
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A low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet is being increasingly recommended for the management of IBS. However, the FODMAP diet can be low in potential prebiotic and fermentable fibre which may have an adverse effect on gut bacteria diversity and other colonic health biomarkers. This study set out to identify how a low FODMAP diet affected the pH, short-chain fatty acid concentrations and bacterial abundance and diversity in comparison to a typical Australian diet. The randomised cross over study consisted of 27 IBS and 6 healthy subjects who were blinded to 21 days of a low FODMAP diet and then, following a washout period of 21 days following their usual diet they were crossed over to the typical Australian diet for 21 days. The study found increased faecal pH, similar short chain fatty acid concentrations, a greater microbial diversity and reduced bacterial abundancy in faecal samples whilst following the low FODMAP diet. It was concluded that caution should be used when reducing FODMAP intake in the long term and that a low FODMAP diet should not be recommended for asymptomatic populations.
Abstract
OBJECTIVE A low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) diet reduces symptoms of IBS, but reduction of potential prebiotic and fermentative effects might adversely affect the colonic microenvironment. The effects of a low FODMAP diet with a typical Australian diet on biomarkers of colonic health were compared in a single-blinded, randomised, cross-over trial. DESIGN Twenty-seven IBS and six healthy subjects were randomly allocated one of two 21-day provided diets, differing only in FODMAP content (mean (95% CI) low 3.05 (1.86 to 4.25) g/day vs Australian 23.7 (16.9 to 30.6) g/day), and then crossed over to the other diet with ≥21-day washout period. Faeces passed over a 5-day run-in on their habitual diet and from day 17 to day 21 of the interventional diets were pooled, and pH, short-chain fatty acid concentrations and bacterial abundance and diversity were assessed. RESULTS Faecal indices were similar in IBS and healthy subjects during habitual diets. The low FODMAP diet was associated with higher faecal pH (7.37 (7.23 to 7.51) vs. 7.16 (7.02 to 7.30); p=0.001), similar short-chain fatty acid concentrations, greater microbial diversity and reduced total bacterial abundance (9.63 (9.53 to 9.73) vs. 9.83 (9.72 to 9.93) log10 copies/g; p<0.001) compared with the Australian diet. To indicate direction of change, in comparison with the habitual diet the low FODMAP diet reduced total bacterial abundance and the typical Australian diet increased relative abundance for butyrate-producing Clostridium cluster XIVa (median ratio 6.62; p<0.001) and mucus-associated Akkermansia muciniphila (19.3; p<0.001), and reduced Ruminococcus torques. CONCLUSIONS Diets differing in FODMAP content have marked effects on gut microbiota composition. The implications of long-term reduction of intake of FODMAPs require elucidation. TRIAL REGISTRATION NUMBER ACTRN12612001185853.