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1.
Nutrition, Physical Activity and Supplementation in Irritable Bowel Syndrome.
Radziszewska, M, Smarkusz-Zarzecka, J, Ostrowska, L
Nutrients. 2023;(16)
Abstract
Irritable Bowel Syndrome (IBS) is a chronic, recurrent functional disorder of the intestine diagnosed based on the Rome IV criteria. Individuals suffering from IBS often associate the severity of their symptoms with the food they consume, leading them to limit the variety of foods they eat and seek information that could help them determine the appropriate selection of dietary items. Clear nutritional recommendations have not been established thus far. NICE recommends a rational approach to nutrition and, if necessary, the short-term implementation of a low FODMAP diet. Currently, the FODMAP diet holds the greatest significance among IBS patients, although it does not yield positive results for everyone affected. Other unconventional diets adopted by individuals with IBS lack supporting research on their effectiveness and may additionally lead to a deterioration in nutritional status, as they often eliminate foods with high nutritional value. The role of physical activity also raises questions, as previous studies have shown its beneficial effects on the physical and mental well-being of every individual, and it can further help alleviate symptoms among people with IBS. Supplementation can be a supportive element in therapy. Attention is drawn to the use of probiotics, vitamin D, and psyllium husk/ispaghula. This review aims to analyze the existing scientific research to determine the impact of various food items, physical activity, and dietary supplementation with specific components through dietary supplements on the course of IBS.
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2.
Nutrition and Supplementation in Ulcerative Colitis.
Radziszewska, M, Smarkusz-Zarzecka, J, Ostrowska, L, Pogodziński, D
Nutrients. 2022;(12)
Abstract
Ulcerative colitis (UC) belongs to the group of inflammatory bowel diseases (IBD). UC is an incurable, diffuse, and chronic inflammatory process of the colonic mucosa with alternating periods of exacerbation and remission. This review aimed to analyze the scientific research conducted to date to determine what impact different nutritional plans and dietary supplements may have on the course of UC. The latest 98 articles about nutrition and supplementation in ulcerative colitis were used to prepare the work. Certain components in food can greatly influence the course of UC, inducing changes in the composition and function of the gut microbiome. This activity may be an important part of therapy for people with IBD. The Mediterranean diet has shown the most promising results in the treatment of patients with UC due to its high content of biologically active foods. Patients with UC may benefit from the UC Exclusion Diet (UCED); however, it is a new nutritional plan that requires further research. Patents frequently resort to unconventional diets, which, because of their frequent elimination of nutrient-rich foods, can worsen the health and nutritional status of those who follow them. The benefits of omega-3 fatty acids and probiotics supplementation may have additional therapeutic effects; however, the evidence is not unequivocal.
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3.
Effect of a Multi-Strain Probiotic Supplement on Gastrointestinal Symptoms and Serum Biochemical Parameters of Long-Distance Runners: A Randomized Controlled Trial.
Smarkusz-Zarzecka, J, Ostrowska, L, Leszczyńska, J, Cwalina, U
International journal of environmental research and public health. 2022;(15)
Abstract
As many as 70% of athletes who practice endurance sports report experiencing gastrointestinal (GI) symptoms, such as abdominal pain, intestinal gurgling or splashing (borborygmus), diarrhea or the presence of blood in the stool, that occur during or after intense physical exercise. The aim of the study was to evaluate the effect of a multi-strain probiotic on the incidence of gastrointestinal symptoms and selected biochemical parameters in the serum of long-distance runners. After a 3-month intervention with a multi-strain probiotic, a high percentage of runners reported subjective improvement in their general health. Moreover, a lower incidence of constipation was observed. In the group of women using the probiotic, a statistically significant (p = 0.035) increase in serum HDL cholesterol concentration and a favorable lower concentration of LDL cholesterol and triglycerides were observed. These changes were not observed in the group of men using the probiotic. Probiotic therapy may reduce the incidence and severity of selected gastrointestinal symptoms in long-distance runners and improve subjectively assessed health condition.
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The Influence of Reducing Diets on Changes in Thyroid Parameters in Women Suffering from Obesity and Hashimoto's Disease.
Ostrowska, L, Gier, D, Zyśk, B
Nutrients. 2021;13(3)
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Hashimoto’s disease is also known as autoimmune thyroiditis or chronic lymphocytic thyroiditis. It is the most common type of thyroiditis and autoimmune endocrinopathy. Weight gain is frequently the first symptom of hypothyroidism. The treatment of hypothyroidism (including autoimmune disorders) is based mainly on pharmacological treatment aimed at supplementing the deficiency of thyroid hormones. The aim of this study was to evaluate the effectiveness of two different reducing diets and their influence on changes in thyroid parameters in female patients. This study is an interventional/observational study of 100 women aged 18–65 years with previously diagnosed Hashimoto’s disease and obesity. The women were randomly assigned to group A (the test group, n = 50) or group B (the control group). Results show that: - the elimination diets enabled an average weight loss of 21.17 kg, and the reducing diets a weight loss of 17.03 kg. - effective weight reduction led to improvement of thyroid parameters in patients suffering from obesity and Hashimoto’s disease. - an individually adjusted elimination diet may lead to better therapeutic results. Authors conclude that elimination diets are a more effective tool in reducing body fat mass in women with Hashimoto’s disease compared to standard balanced reducing diets with the same energy value and main nutrient content.
Abstract
Hashimoto's disease is listed among the most common endocrine causes of obesity. As treatment of obesity in women with Hashimoto's disease is frequently unsuccessful, the aim of this study was to evaluate the effectiveness of two different reducing diets and their influence on changes in thyroid parameters in female patients. A six-month observational/interventional study was performed on 100 women aged 18-65 years, previously diagnosed with Hashimoto's disease and obesity and receiving L-thyroxine. The women were randomly assigned to the test group (group A, n = 50) following elimination/reducing diets, and the control group (group B, n = 50) following reducing diets with the same caloric content (without elimination). Anthropometric and thyroid parameters were evaluated at the beginning, after 3 months and after 6 months of treatment. In both groups a significant decrease in BMI and body fat percentage was achieved, but in test group A the decrease in BMI and body fat percentage was significantly greater than in control group B (p < 0.002 and p = 0.026, respectively). Serum TSH (thyroid stimulating hormon) levels decreased significantly more in group A than in group B (p < 0.001). Group A exhibited significantly greater increases in fT4 and fT3 levels than the control group (p < 0.001) as well as significantly greater decreases in the levels anti-TPO (thyroid peroxidase) (p < 0.001) and anti-TG (thyreoglobulin) antibodies (p = 0.048). The application of reducing diets with product elimination was found to be a more beneficial tool for changing anthropometric and thyroid parameters in women suffering from obesity and Hashimoto's disease than classic reducing diets with the same energy values and macronutrient content.
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5.
Salivary Adipokine and Cytokine Levels as Potential Markers for the Development of Obesity and Metabolic Disorders.
Zyśk, B, Ostrowska, L, Smarkusz-Zarzecka, J
International journal of molecular sciences. 2021;(21)
Abstract
Currently, the number of people suffering from obesity is increasing worldwide. In addition, the disease is affecting younger individuals. Therefore, it is essential to search for new diagnostic methods and markers for early assessment of the risk of obesity, metabolic disorders, and other comorbidities. The discovery of the secretory function of adipose tissue and coexistence of low-grade chronic inflammation with obesity set a new direction in this disease diagnosis using the assessment of the concentration of inflammatory markers secreted by adipose tissue. The aim of this review was to determine, based on previous findings, whether saliva can be useful in the diagnosis of obesity and its early metabolic complications and whether it can be an alternative diagnostic material to serum.
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6.
Igg Food Antibody Guided Elimination-Rotation Diet Was More Effective than FODMAP Diet and Control Diet in the Treatment of Women with Mixed IBS-Results from an Open Label Study.
Ostrowska, L, Wasiluk, D, Lieners, CFJ, Gałęcka, M, Bartnicka, A, Tveiten, D
Journal of clinical medicine. 2021;10(19)
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IBS, also known as irritable bowel syndrome, is a debilitating condition characterised by abdominal pain, irregular bowel movements, and changes in the consistency of stool. Symptoms of IBS may appear shortly after eating a meal. Excluding foods high in FODMAP carbohydrates, such as fermentable oligo- and di-saccharides, mono- and disaccharides, and polyols, or following an elimination rotation diet to reduce IgG-dependent food hypersensitivity, which has been shown to improve IBS symptoms previously. The purpose of this open-label study is to investigate the effectiveness of a low-FODMAPS diet and an elimination rotation diet based on IgG as well as a control diet in reducing symptoms of IBS. During the eight-week study, 73 female subjects with a mix of IBS were assigned to either of the three dietary treatments. Compared to the other diet groups, the IgG based elimination rotation diet group showed a significant improvement in the IBS symptoms and comorbid symptoms after the intervention period. In order to determine whether IgG-mediated food hypersensitivity plays a role in IBS and the efficacy of an IgG-dependent elimination rotation diet in the general population, further robust research is required. Healthcare professionals, however, can make use of these results to gain a better understanding of how an IgG based elimination diet tailored to each individual can improve IBS symptoms.
Expert Review
Conflicts of interest:
None
Take Home Message:
- After implementing the three diets, among patients with IBS-M, a statistically significant reduction of the frequency of the idiopathic abdominal pain, abdominal pain after a meal, abdominal pain during defecation, and sensation of incomplete defecation before and after the diet plans, were only found in Group 2.
- Significantly, only in the Group 2 IgG based elimination-rotation-diet was there a high decrease or complete disappearance of dyspeptic IBS symptoms and co-morbidities together with IBS symptoms.
- This study shows that a personalised dietary approach is more effective in treating IBS than generalised diet recommendations, with elimination diets focused on IgG antibodies providing the best results.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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X
C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Science supports the use of a low-FODMAP diet for symptom relief of IBS. However, more recently evidence suggests that IBS is a low-grade inflammatory disease that may result from or lead to IgG-dependent food hyper-sensitivities.
This study compared the effectiveness of three dietary treatment plans in 73 female patients diagnosed with mixed-form IBS based on Rome III criteria and no other gastrointestinal condition over 8 weeks.
The 3 dietary groups were:
- Group 1-low FODMAP diet
- Group 2- IgG based elimination-rotation-diet
- Group 3-control diet (control group)
Diets of G1 and G2 were determined individually by a dietitian, based on low-FODMAP dietary information and results from IgG food sensitivity testing respectively. Group 3 received nutrition advice from a gastroenterologist.
In G1, some of the IBS symptoms significantly improved (mucus in stool, p = 0.031; bloating, p < 0.001). Gurgling sensation and gastric fullness also reach statistical significance in G1.
IBS symptoms as well as co-morbid symptoms significantly improved or disappeared completely in G2 (idiopathic abdominal pain, p < 0.001; abdominal pain after a meal, p < 0.001; abdominal pain during defecation, p = 0.008; sensation of incomplete defecation p = 0.001; difficulty to defecate (constipation) p = 0.002; bloating p = < 0.001; gurgling sensation < 0.001; gastric fullness p = < 0.001. However, blood and mucus in the stool were impossible to test because the symptoms were not reported by any patient during the 2nd examination). (p-values less than 0.05 were considered statistically significant).
In group G3 no statistically significant improvements were seen in any measure.
Based on the results of this open-label study, it was concluded that personalised dietary interventions were more effective in the treatment of IBS-M patients than generalised diet recommendations. Dietary elimination based on IgG food sensitivity test results had the greatest impact on IBS and related symptoms.This study supports results from other studies showing an IgG-guided diet as an effective strategy in co-morbid conditions such as fatigue, headache/migraine, and skin conditions.
Conflicts of Interest
C.F.J.L., M.G. and A.B. are employees of the Institute of Microecology in Poznan ,where the ImuPro tests were determined. D.T. is the Head of Laboratory and shareholder of Lab1, offering ImuPro tests in Norway.
Clinical practice applications:
- Low FODMAP diets studies (NICE) showed GI improvements for abdominal pain, abdominal cramps, diarrhoea, gas, and bloating, largely because FODMAPs mainly cause an excessive production of gas, leading to discomfort and pain and an increased osmotic effect leading to increased bowel movement and diarrhoea. However 30% of patients still suffered from bloating on the FODMAP diet. Gurgling sensation decreased from 65% to 15%, and gastric fullness decreased from 58% to 11% in the patients on the low FODMAP diet.
- A potential new approach to resolve functional symptoms of gastrointestinal conditions could be to start with an IgG-guided elimination diet, as it was proven to be the more effective diet in this open study, and in cases of persistent symptoms, it could be combined with a low-FODMAP diet.
- Calprotectin is currently one of the best-known diagnostic markers indicating mucosa inflammation and changes in the inflammation intensity. In this study serious intestinal inflammation was diagnosed at the faecal calprotectin concentration of >50 mg/kg of stool. During the first examination, no statistically significant differences were found in calprotectin concentrations between the compared groups of patients, and the values were low, suggesting that the included patients suffered from low-grade inflammation and were suitable for diet alteration as the best choice of treatment.
Limitations:
- The main limitations of this study are the open-labeled nature, the low number of participants and the bias of only including female participants with only the patients in the G2 group tested for IgG food antibodies.
- Foods consumed by the patients before they entered the study were not ascertained.
Considerations for future research:
- Claims that IgG food antibodies only reveal exposure to food and not intolerance should be reinvestigated in larger double-blinded studies.
Abstract
Irritable bowel syndrome (IBS) is a chronic disease with recurrent abdominal pain, disturbed bowel emptying, and changes in stool consistency. We compared the effectiveness of three different dietary treatment plans (G1-FM-low FODMAP diet, G2-IP IgG based elimination-rotation-diet, and as control group, the G3-K control diet recommended by an attending gastroenterologist) in treating patients diagnosed with mixed irritable bowel syndrome. A total of seventy-three female patients diagnosed with a mixed form of irritable bowel syndrome (IBS-M) were enrolled in the study. The diet of each patient in Group 1 (G1-FM) and 2 (G2-IP) was determined individually during a meeting with a dietitian. Patients from Group 3 (G3-K) received nutrition advice from a gastroenterologist. Significant differences in the reduction of IBS symptoms were found between the groups. IBS symptoms as well as comorbid symptoms significantly improved or disappeared completely in the G2-IP group (idiopathic abdominal pain, p < 0.001; abdominal pain after a meal, p < 0.001; abdominal pain during defecation, p = 0.008), while in the G1-FM group, some of the IBS symptoms significantly improved (mucus in stool, p = 0.031; bloating, p < 0.001). In group G3-K no significant improvement was seen. Based on the results of this open-label study, it was concluded that various dietary interventions in the treatment of IBS-M patients do not uniformly affect the course and outcomes of disease management. Rotation diets based on IgG show significantly better results compared to other diets.
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Analysis of the Impact of a Multi-Strain Probiotic on Body Composition and Cardiorespiratory Fitness in Long-Distance Runners.
Smarkusz-Zarzecka, J, Ostrowska, L, Leszczyńska, J, Orywal, K, Cwalina, U, Pogodziński, D
Nutrients. 2020;(12)
Abstract
Use of probiotic supplements, the benefits of which have not been proven in sportspeople, is becoming more widespread among runners. The aim of this study was to evaluate the effect of a multi-strain probiotic on body composition, cardiorespiratory fitness and inflammation in the body. The randomised, double-blind study included 66 long-distance runners. The intervention factor was a multi-strain probiotic or placebo. At the initial and final stages of the study, evaluation of body composition and cardiorespiratory fitness was performed and the presence of inflammation determined. In the group of men using the probiotic, an increase in lean body mass (p = 0.019) and skeletal muscle mass (p = 0.022) was demonstrated, while in the group of women taking the probiotic, a decrease in the content of total body fat (p = 0.600) and visceral fat (p = 0.247) was observed. Maximum oxygen consumption (VO2max) increased in women (p = 0.140) and men (p = 0.017) using the probiotic. Concentration of tumour necrosis factor-alpha decreased in women (p = 0.003) and men (p = 0.001) using the probiotic and in women (p = 0.074) and men (p = 0.016) using the placebo. Probiotic therapy had a positive effect on selected parameters of body composition and cardiorespiratory fitness of study participants and showed a tendency to reduce inflammation.
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The relationship between the leptin/ghrelin ratio and meals with various macronutrient contents in men with different nutritional status: a randomized crossover study.
Adamska-Patruno, E, Ostrowska, L, Goscik, J, Pietraszewska, B, Kretowski, A, Gorska, M
Nutrition journal. 2018;17(1):118
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Obesity is a chronic disease caused mostly by an excessive supply of energy delivered with food in relation to energy expenditure, which leads to fat accumulation. The aim of the study was to investigate the leptin/ghrelin ratio (appetite-regulating hormones) in response to meal intake with various macronutrient contents, and to assess the fasting and postprandial (after meal) differences between normal and overweight or obese men. The study is a crossover designed study which was conducted among 46 non-diabetic men. The participants were randomly divided into two groups. Each group included men with normal weight and overweight/obesity. Results indicate that in normal body weight men, a more beneficial leptin/ghrelin ratio was noted after the high-carbohydrate fat-free meal intake, compared to the normal-carbohydrate/high-protein and high-fat/low-carbohydrate meal. Furthermore, overweight/obese men presented with a significantly higher leptin/ghrelin ratio in a fasting state and after intake of each of the three meals. Authors conclude that overweight/obese individuals can be recommended to chose meals with lower carbohydrate content.
Abstract
BACKGROUND Hormones, which influence satiety and hunger, play a significant role in body energy balance regulation. Ghrelin is a peptide that plays an important role in short-term appetite regulation, whereas leptin is a factor that controls long-term energy balance and is considered as a satiety hormone. The aim of this study was to evaluate the leptin/ghrelin ratio in a fasting state and after the intake of meals with varying macronutrient contents and to assess the possible differences between normal body weight and overweight/obese men. METHODS We examined 46 healthy adult men (23 with normal body weight and 23 overweight/obese) aged 21-58, who were divided into two groups. In the crossover study, participants received isocaloric (450 kcal) meals with different macronutrient contents: men from the first group received high-carbohydrate (HC) and normo-carbohydrate (NC) meals, and in the second group, participants received high-carbohydrate and high-fat (HF) meals. The ratio of leptin/ghrelin levels was calculated from leptin and total ghrelin serum concentrations in a fasting state and 30, 60, 120, 180 and 240 min after meal intake. One-way ANOVA and Wilcoxon signed-rank tests were carried out. The normality of the variable distribution was checked with the Shapiro-Wilk test, the homogeneity of variances was verified with the Levene test, and the false discovery rate p-value adjustment method was used. RESULTS The leptin/ghrelin ratio was significantly higher in overweight/obese men than individuals with normal body weight in a fasting state, as well as postprandially. We observed trends towards a higher leptin/ghrelin ratio values from the 60 min after HC-meal intake compared to the NC- and HF-meals in normal body weight participants, while in overweight/obese men, we did not note any significant differences dependent on the meal type. CONCLUSIONS We have observed a significantly different postprandial leptin/ghrelin ratio in normal body weight and overweight/obese men, and our results suggest that in men with normal body weight, a greater feeling of satiety may occur after high-carbohydrate meal intake, which was not noted in the overweight/obese individuals.
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Probiotic strains as the element of nutritional profile in physical activity – new trend or better sports results?
Smarkusz, J, Ostrowska, L, Witczak-Sawczuk, K
Roczniki Panstwowego Zakladu Higieny. 2017;(3):229-235
Abstract
A diet, individually customized to the needs of sportsmen and sportswomen prepares them better for competition and achievement of better sports results. However, disorders of the gastrointestinal tract and frequently recurrent upper respiratory tract infections pose a common problem observed among athletes of disciplines such as triathlon, cycling and marathon. Diarrhea, splashing in the intestines or gastrointestinal bleeding make it difficult to start and win in the race. Recently researchers have paid special attention to the therapeutic effect of probiotic strains on the human body. Various probiotic strains may have a beneficial effect on elimination of disorders mentioned above among athletes of these disciplines. Still, researchers continue looking for answers to the question how a specific probiotic strain is able to reduce the risk of the gastrointestinal tract and the respiratory system disorders appearing during training or competition. Attention is also drawn to the possible impact of probiotics on the physical capacity athletes and their athletic performance. Probiotic strains properly applied may have a positive influence on the athletes’ bodies, but still randomized controlled trials are required to prove this thesis.
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Intake of Meals Containing High Levels of Carbohydrates or High Levels of Unsaturated Fatty Acids Induces Postprandial Dysmetabolism in Young Overweight/Obese Men.
Adamska, E, Ostrowska, L, Gościk, J, Waszczeniuk, M, Krętowski, A, Górska, M
BioMed research international. 2015;:147196
Abstract
Postprandial metabolic response depends on the meals' components and can be different in normal weight and obese people. However, there are some discrepancies between various reports. The aim of this study was to determine the metabolic response after intake of standardised meals with various fat and carbohydrate contents and to determine the differences among normal weight and overweight/obese individuals. The study group comprised 46 healthy men. The participants were divided into two groups and study was carried out using a crossover method. Group I received high- and normal-carbohydrate meals, whereas group II received high-carbohydrate and high-fat meals. Glucose, insulin, triglyceride, and free fatty acids levels were measured at fasting state and at 30, 60, 120, 180, and 240 minutes after meal intake. Despite the lack of differences in glucose levels, insulin levels were higher among overweight/obese individuals after each meal. TG and FFA levels were higher after normal-carbohydrate and high-fat meals. Moreover, in overweight/obese young men after high-fat meal intake postprandial hypertriglyceridemia was observed, even if meals contained predominantly unsaturated fatty acids, and fasting triglycerides levels were in normal range. The conducted study showed that postprandial metabolic response depends not only on the meal macronutrient content but also on the current body mass index (BMI).