Diet and probiotics for managing carbohydrate intolerance

The academic content material on this publish, elaborated in collaboration with Bromatech, was independently developed and accredited by the GMFH publishing workforce and editorial board.

Meals is a serious set off of gastrointestinal signs in IBS

Lately, hostile reactions to particular meals elements have surged inside Western populations. 84% of patients with IBS perceive eating any food as a trigger to their gastrointestinal distress. Among the many main dietary culprits accountable for signs corresponding to bloating, stomach distension, ache, and altered bowel habits (constipation or diarrhea), carbohydrates—particularly FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols)—, and meals wealthy in biogenic amines and fatty meals, play a major function¹.

Gastrointestinal signs related to carbohydrate malabsorption primarily come up from two mechanisms concerned within the acute results within the gastrointestinal tract. Firstly, when carbohydrates are inadequately digested and absorbed, they function a substrate for intestinal micro organism, fostering bacterial fermentation. This leads to extreme manufacturing of hydrogen, methane, and carbon dioxide, contributing to bloating and stomach distension. Secondly, a food regimen wealthy in unabsorbed sugars will increase the osmotic load within the intestinal lumen, resulting in accelerated meals transit and diarrhea².

As well as, a excessive FODMAP food regimen could result in an elevated abundance of Gram-negative micro organism, which drives a rise in luminal pro-inflammatory lipopolysaccharide that finally will increase barrier loss and mast cell activation concerned within the elevated visceral hypersensitivity seen in most sufferers with IBS³.

Mechanisms by which FODMAPs would possibly influence intestine perform

FODMAPs are short-chain carbohydrates, together with lactose, extra fructose, polyols, fructans, fructo-oligosaccharides (FOS), and galacto-oligosaccharides (GOS). These compounds are naturally present in quite a lot of meals, corresponding to fruits, greens, cereals, legumes, dairy merchandise, and sweeteners⁴.

As a consequence of sluggish transport mechanisms or ineffective enzymatic exercise, they’re poorly absorbed within the small gut. Upon ingestion, they continue to be partially undigested and attain the colon, the place they’re fermented by the intestine microbiota, producing fuel and drawing in water through osmotic results. This course of contributes to bloating, visceral hypersensitivity, stomach ache, and transit disturbances, significantly diarrhea, in predisposed people.

The low-FODMAP food regimen: scientific advantages and potential drawbacks

A number of critiques and meta-analyses have demonstrated {that a} low-FODMAP food regimen (LFD) considerably improves total signs in all IBS subtypes^5. Research point out that LFD is superior to manage diets in delicate people, significantly in assuaging bloating and stomach ache whereas selling normalization of bowel habits, lowering each diarrhea and constipation^6-9.

Nonetheless, regardless of these advantages, a LFD will not be with out potential long-term penalties. Analysis has highlighted considerations concerning the dietary adequacy of this food regimen, particularly when adopted with out skilled steerage. Frequent deficiencies embrace lowered fiber consumption on account of restricted consumption of plant-based meals. Moreover, extreme exclusion of dairy merchandise could result in decrease calcium, folate, and riboflavin ranges. Vitamin C deficiency can also be a priority when vegetable and fruit consumption is overly restricted^10,11.

One other vital side is the influence of a LFD on intestine microbiota range. Research point out that LFD can exacerbate intestine microbiota imbalances, resulting in a major discount in useful bacterial genera corresponding to Bifidobacterium. Nonetheless, the results of the low FODMAP food regimen on different taxa and alpha range was not constant and no results was noticed on particular person and complete short-chain fatty acids and fecal pH¹².

Probiotics for managing carbohydrate intolerances

A promising adjunct to dietary administration is using strain-specific probiotics, which can assist modulate the intestine microbiota in sufferers with IBS. By lowering gas-producing bacterial species, probiotics may alleviate signs related to carbohydrate malabsorption. Moreover, probiotics could improve micronutrient absorption, growing the bioavailability of important nutritional vitamins and minerals on the intestinal degree^13,14.

Particular probiotics have proven efficacy in enhancing lactose digestion and absorption. Lactose intolerance, one of the frequent disaccharidase deficiencies (affecting lactase, sucrase, and maltase enzymes), manifests as stomach ache, bloating, and diarrhea upon lactose consumption¹⁵. Lactase deficiency (hypolactasia) promotes lactose fermentation by intestine micro organism, exacerbating fermentative dysbiosis and resulting in discomfort and osmotic diarrhea.¹⁶ Sure Lactobacillus species reveal a useful impact on account of their genomic capacity to provide beta-galactosidase, an enzyme important for lactose degradation¹⁷.

Probiotics can also assist offset intestine microbiota adjustments seen on a low FODMAP food regimen. The coadministration of a selected probiotic mix with a mix of Lactobacillus, Bifidobacterium, and Streptococcus species along with a low FODMAP food regimen was additionally profitable in growing the variety of Bifidobacterium species within the fecal microbiome decreased with the low FODMAP food regimen in grownup sufferers with IBD¹⁸.

Conclusion

An integrative strategy that mixes adherence to a low-FODMAP food regimen with strain-specific probiotics could provide an efficient technique for managing signs related to carbohydrate malabsorption, together with FODMAP and lactose intolerance. This twin strategy can enhance gastrointestinal signs in FGID sufferers, significantly these with IBS, whereas additionally fostering intestine microbial steadiness and mitigating the hostile results of dietary restriction on microbiota range.

References:

1. Zingone F, Bertin L, Maniero D, et al. Myths and Facts about Food Intolerance: A Narrative Review. Vitamins. 2023; 15(23):4969. doi: 10.3390/nu15234969.
2. Omer A, Quigley EMM. Carbohydrate Maldigestion and Malabsorption. Clin Gastroenterol Hepatol. 2018; 16(8):1197-1199. doi: 10.1016/j.cgh.2018.01.048.
3. Singh P, Tuck C, Gibson PR, et al. The role of food in the treatment of bowel disorders: focus on irritable bowel syndrome and functional constipation. Am J Gastroenterol. 2022; 117(6):947-957. doi: 14309/ajg.0000000000001767.
4. Ispiryan L, Zannini E, Arendt EK. FODMAP modulation as a dietary therapy for IBS: Scientific and market perspective. Compr Rev Meals Sci Meals Saf. 2022 Mar;21(2):1491-1516. doi: 10.1111/1541-4337.12903.
5. Dean G, Chey SW, Singh P, et al. A diet low in fermentable oligo-, di-, monosaccharides and polyols improves abdominal and overall symptoms in persons with all subtypes of irritable bowel syndrome. Neurogastroenterol Motil. 2024; 36(8):e14845. doi: 10.1111/nmo.14845
6. Holtmann G, Shah A, Morrison M. Pathophysiology of Functional Gastrointestinal Disorders: A Holistic Overview. Dig Dis. 2017;35 Suppl 1:5-13. doi: 10.1159/000485409.
7. Carbone F, Van den Houte Okay, Besard L, et al. Diet or medication in primary care patients with IBS: the DOMINO study – a randomised trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute. Intestine. 2022;71(11):2226-2232. doi:10.1136/gutjnl-2021-325821
8. Halmos EP, Energy VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75.e5. doi:10.1053/j.gastro.2013.09.046
9. Algera JP, Demir D, Törnblom H, Nybacka S, Simrén M, Störsrud S. Low FODMAP diet reduces gastrointestinal symptoms in irritable bowel syndrome and clinical response could be predicted by symptom severity: A randomized crossover trial. Clin Nutr. 2022;41(12):2792-2800. doi:10.1016/j.clnu.2022.11.001
10. Sultan N, Varney JE, Halmos EP, et al. How to Implement the 3-Phase FODMAP Diet Into Gastroenterological Practice. J Neurogastroenterol Motil. 2022;28(3):343-356. doi:10.5056/jnm22035
11. Bellini M, Tonarelli S, Nagy AG, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Vitamins. 2020;12(1):148. Revealed 2020 Jan 4. doi:10.3390/nu12010148
12. So D, Loughman A, Staudacher HM. Effects of a low FODMAP diet on the colonic microbiome in irritable bowel syndrome: a systematic review with meta-analysis. Am J Clin Nutr. 2022;116(4):943-952. doi:10.1093/ajcn/nqac176
13. Markowiak P, Śliżewska Okay. Effects of Probiotics, Prebiotics, and Synbiotics on Human Health. Vitamins. 2017;9(9):1021. Revealed 2017 Sep 15. doi:10.3390/nu9091021
14. Barkhidarian B, Roldos L, Iskandar MM, Saedisomeolia A, Kubow S. Probiotic Supplementation and Micronutrient Status in Healthy Subjects: A Systematic Review of Clinical Trials. Vitamins. 2021;13(9):3001. Revealed 2021 Aug 28. doi:10.3390/nu13093001
15. Bayless TM, Brown E, Paige DM. Lactase Non-persistence and Lactose Intolerance. Curr Gastroenterol Rep. 2017;19(5):23. doi:10.1007/s11894-017-0558-9
16. Deng Y, Misselwitz B, Dai N, Fox M. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. Vitamins. 2015;7(9):8020-8035. Revealed 2015 Sep 18. doi:10.3390/nu7095380
17. Ahn SI, Kim MS, Park DG, Han BK, Kim YJ. Effects of probiotics administration on lactose intolerance in adulthood: A meta-analysis. J Dairy Sci. 2023;106(7):4489-4501. doi:10.3168/jds.2022-22762
18. Staudacher HM, Lomer MCE, Farquharson FM, et al. A Diet Low in FODMAPs Reduces Symptoms in Patients With Irritable Bowel Syndrome and A Probiotic Restores Bifidobacterium Species: A Randomized Controlled Trial. Gastroenterology. 2017;153(4):936-947. doi:10.1053/j.gastro.2017.06.010