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The Relationship between Low Serum Vitamin D Levels and Altered Intestinal Barrier Function in Patients with IBS Diarrhoea Undergoing a Long-Term Low-FODMAP Diet: Novel Observations from a Clinical Trial.
Linsalata, M, Riezzo, G, Orlando, A, D'Attoma, B, Prospero, L, Tutino, V, Notarnicola, M, Russo, F
Nutrients. 2021;(3)
Abstract
Decreased serum vitamin D (VD) levels have been associated with gastrointestinal (GI) disorders, including irritable bowel syndrome (IBS). VD can also modulate the intestinal barrier. Given the link between the GI barrier's alterations and diet, attention has aroused the positive effects of the Low FODMAP Diet (LFD) on IBS patients' symptom profile. We evaluated the GI symptoms and the urinary and circulating markers of GI barrier function, the markers of inflammation and intestinal dysbiosis in 36 IBS patients with predominant diarrhea (IBS-D) (5 men and 31 women, 43.1 ± 1.7 years) categorized for their circulating VD levels in low (L-VD) and normal (N-VD) (cutoff = 20 ng/mL). Evaluations were performed before and after 12 weeks of LFD. At the baseline, L-VD patients showed a significantly worse symptom profile and altered small intestinal permeability (s-IP) than N-VD. After LFD, a significant increase in the circulating VD levels in both the subgroups and a significant improvement of s-IP in L-VD patients occurred. Finally, VD levels negatively correlated with the symptom score and fecal zonulin. These data highlight the close relationship between VD and the intestinal barrier and support their involvement in IBS-D pathophysiology. Moreover, the potentially positive role of LFD in the management of IBS-D was confirmed.
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A Low FODMAP Diet Is Nutritionally Adequate and Therapeutically Efficacious in Community Dwelling Older Adults with Chronic Diarrhoea.
O'Brien, L, Skidmore, P, Wall, C, Wilkinson, T, Muir, J, Frampton, C, Gearry, R
Nutrients. 2020;(10)
Abstract
The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)diet has been extensively researched, but not in the management of older adults with functional gastrointestinal symptoms. This study determines the positive and negative impacts of this dietary treatment in older adults with chronic diarrhea. A non-blinded intervention study was conducted with adults over 65 years with chronic diarrhea referred for colonoscopy where no cause was found. Participants followed a dietitian-led low FODMAP diet for six weeks and completed a structured assessment of gastrointestinal symptoms, the Hospital Anxiety and Depression scale, and a four-day food diary before and after the intervention. Twenty participants, mean age 76 years, were recruited. Adherence to the low FODMAP diet was acceptable; mean daily FODMAP intake reduced from 20.82 g to 3.75 g (p < 0.001) during the intervention and no clinically significant changes in macro- or micronutrient intakes were observed. There were clinically significant improvements in total gastrointestinal symptoms (pre diet 21.15/88 (standard deviation SD = 10.99), post diet 9.8/88 (SD = 9.58), p < 0.001) including diarrhea (pre diet 9.85 (SD = 3.84), post diet 4.05 (SD = 3.86), p < 0.001) and significant reductions in anxiety (pre diet 6.11/21 (SD = 4.31), post diet 4.26/21 (SD = 3.38), p < 0.05). In older adults the low FODMAP diet is clinically effective and does not jeopardise nutritional intake when supervised by an experienced dietitian.
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A feasibility study investigating the impact of a dietitian-led low in fermentable oligosaccharide, disaccharide, monosaccharide and polyols diet group education programme with irritable bowel syndrome.
Chan, D, Skidmore, P, O'Brien, L, Watson, S, Gearry, R
The New Zealand medical journal. 2020;(1522):42-51
Abstract
AIMS: To investigate the feasibility and effectiveness of dietitian-led education on using the low fermentable oligosaccharide, disaccharide, monosaccharide and polyols (FODMAP) diet in adults with irritable bowel syndrome (IBS) in Christchurch, New Zealand. METHODS Patients with IBS (n=25) were referred by their general practitioner to attend a group education programme. The number recruited and subsequent attendance were used to evaluate feasibility. The Structured Assessment of Gastrointestinal Symptoms (SAGIS) questionnaire and Hospital Anxiety and Depression Scale (HADS) were compared at baseline and at follow-up. Semi-structured telephone interviews assessed the acceptability of the education programme. RESULTS Of the 25 recruited participants, 17 attended the group education programme. The SAGIS score decreased significantly (p<0.05) between baseline (mean 1.844) and follow-up (mean 0.607). Similarly, there was non-significant trend of lower HADS anxiety and depression scores from baseline to follow-up. Symptomatic improvement was reported by 13 participants (76.5%), while two participants (11.8%) did not improve and two others (11.8%) had not implemented the diet. Overall, participants were positive and grateful for the improvement the diet had made to their symptoms. CONCLUSIONS A dietitian-led low FODMAP group education programme in Christchurch adults with IBS was found to be both feasible and effective.
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Variation of carbohydrate intake in diabetic children on carbohydrate counting.
Robart, E, Giovannini-Chami, L, Savoldelli, C, Baechler-Sadoul, E, Gastaud, F, Tran, A, Chevalier, N, Hoflack, M
Diabetes research and clinical practice. 2019;:227-235
Abstract
AIMS: Carbohydrate counting (CC) is a technique for managing diabetes particularly based on the counting of carbohydrates. It allows diabetic patients to vary their amount of carbohydrates from one meal to another by adjusting their insulin dose. The primary objective was to determine the variation of carbohydrate intake (CI) in children on CC. METHOD This was a prospective study conducted between 2014 and 2016. We collected the amount of carbohydrates eaten at each meal by 77 diabetic over a period of 28 days (i.e. 8068 data). We analyzed the number and percentage of significant CI variation rates from one day to another, both for the whole day and for each meal. The CI variation rate was deemed significant if it was greater than or equal to 30%. RESULTS The percentage of significant CI variation rates was 30% at the daily level, 34% for breakfast, 44% for lunch and dinner, and 53% for snack. The percentage of significant variation rates varied according to age, treatment and occurrence of events. CONCLUSION Children varied their CI significantly from one meal to another more than one in three times. CC offers flexibility and a better quality of life for children using this method.
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Use of modified Atkins diet in glucose transporter type 1 deficiency syndrome.
Amalou, S, Gras, D, Ilea, A, Greneche, MO, Francois, L, Bellavoine, V, Delanoe, C, Auvin, S
Developmental medicine and child neurology. 2016;(11):1193-1199
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Abstract
AIM: Glucose transporter type 1 deficiency syndrome (GLUT1-DS) results from impaired glucose transport into the brain, and is treated with a ketogenic diet. A few reports have suggested effectiveness of treatment using the modified Atkins diet (MAD). We aimed to assess the efficacy of MAD as a treatment for GLUT1-DS. METHOD We evaluated the efficacy of MAD in 10 patients (four males, six females; mean age at diagnosis [SD] 6.2y [1.7], min-max: 4mo-12y) with GLUT1-DS. RESULTS MAD was started at diagnosis in eight patients, including two infants. The mean duration (SD) under MAD was 2.5 [0.6] years (range 6mo-6y). Seven patients with epilepsy started MAD at GLUT1-DS diagnosis, and all experienced improvements in their epilepsy: five out of seven were seizure-free at M1, and three out of six at M3 and M6. The initiation of MAD allowed symptoms to be controlled in the three patients with movement disorders but without seizures. Two patients switched from the ketogenic diet to MAD. This switch was not responsible for the recurrence of any symptoms, and led to improvements in both physical abilities and growth parameters. INTERPRETATION MAD, which is a less restrictive and more palatable diet than the ketogenic diet, seems to have comparable effectiveness. Moreover, a switch from the ketogenic diet to MAD appears to be beneficial for patients with GLUT1-DS.