{"id":91547,"date":"2023-04-27T11:15:55","date_gmt":"2023-04-27T09:15:55","guid":{"rendered":"https:\/\/aprifel-pp.mentalworks.biz\/?post_type=article_revue&#038;p=91547"},"modified":"2023-04-28T10:19:49","modified_gmt":"2023-04-28T08:19:49","slug":"practical-advice-on-the-role-of-diet-in-treating-patients-with-irritable-bowel-syndrome","status":"publish","type":"article_revue","link":"https:\/\/aprifel-pp.mentalworks.biz\/en\/global-fv-newsletter-article\/practical-advice-on-the-role-of-diet-in-treating-patients-with-irritable-bowel-syndrome\/","title":{"rendered":"Practical advice on the role of diet in treating patients with Irritable Bowel Syndrome"},"content":{"rendered":"\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"900\" height=\"450\" src=\"https:\/\/aprifel-pp.mentalworks.biz\/wp-content\/uploads\/2023\/04\/article-2-ok.jpg\" alt=\"\" class=\"wp-image-91613\"\/><\/figure>\n\n\n\n<p><strong>Irritable bowel syndrome (IBS) affects the digestive system and can substantially impact quality of life. More than 80% of patients with IBS associate their gastrointestinal symptoms with eating food (<a href=\"https:\/\/journals.lww.com\/ajg\/Abstract\/2013\/05000\/Self_Reported_Food_Related_Gastrointestinal.2.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">Bohn, 2013<\/a>).<\/strong><\/p>\n\n\n\n<p><strong>The present article is an expert review of the American Gastroenterological Association (AGA) in order to provide best practice advice statements, primarily to clinical gastroenterologists, covering the role of diet in IBS treatment (<a href=\"https:\/\/www.gastrojournal.org\/article\/S0016-5085(21)04084-1\/fulltext\" target=\"_blank\" rel=\"noreferrer noopener\">Chey, 2022)<\/a>.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Referral to a registered dietitian nutritionist is recommended for most irritable bowel syndrome patients<\/h2>\n\n\n\n<p>Most patients with IBS associate their gastrointestinal symptoms with eating food. The first recommendation for these patients is therefore to refer them to a registered dietitian nutritionist for dietary advice if 1\/ they have insight into their meal-related gastrointestinal symptoms, 2\/ they are motivated to change their diet, 3\/they wish to collaborate with a dietitian and 4\/ they do not have an <span class='tooltipsall tooltip_post_id_custom_d022bfdefffb4046fd1c77da8ec652f3 classtoolTipsCustomShortCodeOnlyForMultiTooltips'>eating disorder<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_d022bfdefffb4046fd1c77da8ec652f3',\"Including anorexia nervosa, bulimia nervosa, binge eating disorder and avoidant or restrictive food intake disorder.\",'0'); });<\/script>. Restrictive diet interventions for patients at risk for malnutrition and those who are food insecure are not recommended (figure 1).<\/p>\n\n\n\n<p>When setting up an appointment with a dietitian, the clinician and patient should provide previous medical and demographic information, including test and procedure results, biochemical data and anthropometric data. It is recommended that patients keep a food diary for at least three days and a corresponding symptom chart prior to their appointment. Ongoing communication and collaboration between the treating physician and the registered nurse is crucial to ensure that the patient&#8217;s care plan is aligned and optimized.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"606\" height=\"443\" src=\"https:\/\/aprifel-pp.mentalworks.biz\/wp-content\/uploads\/2023\/04\/Image1-3.png\" alt=\"\" class=\"wp-image-91548\"\/><figcaption class=\"wp-element-caption\">Figure 1. Approach to patients with IBS (Chey, 2022; Dionne, 2018; Eswaran, 2016; Moayyedi, 2014; Paduano, 2019; Garcia-Martinez, 2018)<\/figcaption><\/figure><\/div>\n\n\n<h2 class=\"wp-block-heading\">Even if a low FODMAPs diet can reduce the symptoms, it should always be monitored by a dietician<\/h2>\n\n\n\n<p>The most common macronutrients found to trigger IBS symptoms are carbohydrates. In particular, <span class='tooltipsall tooltip_post_id_custom_daa8a8423ef01a0349154127a9c86980 classtoolTipsCustomShortCodeOnlyForMultiTooltips'>FODMAPs<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_daa8a8423ef01a0349154127a9c86980',\"Low\u2013 fermentable oligo-, di-, and monosaccharides and polyols\",'0'); });<\/script> are short-chain, poorly digestible and poorly absorbed sugars that can trigger symptoms in some patients with IBS. It has been found to reduce overall and individual symptoms in randomized controlled trials.<\/p>\n\n\n\n<p>A meta-analysis including 7 randomized controlled trials showed a significant reduction in symptoms when comparing a low FODMAP diet and other interventions in 397 people with IBS (Dionne, 2018). A more recent meta-analysis confirms these results and the efficacy of this diet in the short term to relieve overall symptoms, abdominal pain and bloating (Black, 2021). It appears that short-term FODMAP restriction has little impact on micronutrient intake and overall diet quality could even be improved if the patient is monitored by a dietitian (Eswaran, 2020; Staudacher, 2020). However, studies have limitations related with their methodology, such as lack of blinding and small sample size.<\/p>\n\n\n\n<p>Multiple clinical trials have shown that a 4-6 weeks of low-FODMAP diet is sufficient to determine whether a patient with IBS will respond (Dionne, 2018). This short duration reduces the risk of complications related to excessive food restriction, which can lead to long-term eating disorders (McGowan, 2021). As described in figure 2, the low-FODMAP diet is divided into 3 phases:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>restriction during 4\u20136 weeks,<\/li>\n\n\n\n<li>reintroduction of FODMAP foods,<\/li>\n\n\n\n<li>personalization based on results from reintroduction.<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"575\" height=\"313\" src=\"https:\/\/aprifel-pp.mentalworks.biz\/wp-content\/uploads\/2023\/04\/Image2-1.png\" alt=\"\" class=\"wp-image-91550\"\/><figcaption class=\"wp-element-caption\">Figure 2 : Low-FODMAP diet for patients with IBS (Chey, 2021; Chey, 2022)<\/figcaption><\/figure><\/div>\n\n\n<p>Healthy eating advice are also beneficial for some patients with IBS.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Soluble fiber is efficacious in treating global symptoms of irritable bowel syndrom<\/h2>\n\n\n\n<p>Dietary fiber is a carbohydrate not absorbed or digested in the small intestine. We distinguish between <span class='tooltipsall tooltip_post_id_custom_79f2cfb23dff12c8dd1ca8bfa2cdfac1 classtoolTipsCustomShortCodeOnlyForMultiTooltips'>soluble fiber<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_79f2cfb23dff12c8dd1ca8bfa2cdfac1',\"Found in psyllium, ispaghula husk, corn fiber, calcium polycarbophil, methylcellulose, oat bran, and the flesh of fruits and vegetables\",'0'); });<\/script> and <span class='tooltipsall tooltip_post_id_custom_cc350da973e867badb8a75a97cc9a917 classtoolTipsCustomShortCodeOnlyForMultiTooltips'>insoluble fiber<\/span><script type=\"text\/javascript\">jQuery(\"document\").ready(function(){ toolTips('.tooltip_post_id_custom_cc350da973e867badb8a75a97cc9a917',\"Found in wheat bran, whole grains, and fruit and vegetable skins and seeds\",'0'); });<\/script> whose consumption does not have the same effect on patients with IBS. A systematic review and meta-analysis of 15 randomized controlled trials showed that soluble fiber may have positive impact on patients with IBS. Conversely, insoluble fiber can increase bloating and abdominal pain. Therefore, 2021 American College of Gastroenterology Guidelines on the management of IBS recommends the use of soluble fiber for the treatment and improvement of global IBS symptoms (Lacy, 2021).<\/p>\n\n\n\n<p>Regarding a gluten free diet, there is a lack of strong evidence supporting the efficacy of this diet in relieving IBS symptoms. Further efforts to identify and validate biomarkers that predict response to dietary interventions are needed to deliver \u201cpersonalized nutrition.\u201d<\/p>\n\n\n\n<p><strong>Based on<\/strong>: Chey WD, et al. AGA Clinical Practice Update on the Role of Diet in Irritable Bowel Syndrome: Expert Review. Gastroenterology. 2022 May;162(6):1737-1745.e5.<\/p>\n\n\n\n<div class=\"block__stylized-list\">\n    <div class=\"block__stylized-list__leading\" id=\"block__stylized-list__leading\">\n        <i class=\"fa-classic fa-regular fa-pen-to-square\" aria-hidden=\"true\"><\/i>\n        <strong>Methodology<\/strong>\n    <\/div>\n    <div id=\"block__stylized-list__content\" style=\"display: none;\"><ul>\n<li>This article is from an expert review commissioned and approved by the AGA CPU Committee and the AGA Board of Directors.<\/li>\n<li>The review was internally reviewed by the CPU Committee and externally peer-reviewed according to Gastroenterology standard procedures.<\/li>\n<li>The recommendations are based on an analysis of the existing literature combined with expert opinion.<\/li>\n<li>As this is not a systematic review, formal assessment of the quality of the evidence or strength of the considerations presented was not performed.<br \/>\n<\/div>\n<\/div>\n\n\n\n<div class=\"block__solid-colored\">\n    <div class=\"block__solid-colored__leading\">\n        <i class=\"fa-classic fa-regular fa-square-check\" aria-hidden=\"true\"><\/i>\n        <strong>Key messages<\/strong>\n    <\/div>\n    <div class=\"block__solid-colored__content\"><p>All of the best practices recommended by the American Gastroenterological Association (AGA) Clinical Practice Update (CPU) are listed below:<\/p>\n<ul>\n<li>Referred to a registered dietician nutritionist.<\/li>\n<li>Routine screening for disordered eating or eating disorders by careful dietary history is critical because they are common and often overlooked in gastrointestinal conditions.<\/li>\n<li>Specific diet interventions should be attempted for a predetermined length of time. If there is no clinical response, the diet intervention should be abandoned for another treatment alternative, for example, a different diet, medication, or other form of therapy.<\/li>\n<li>In preparation for a visit with a RDN, patients should provide dietary information that will assist in developing an individualized nutrition care plan.<\/li>\n<li>Soluble fiber is efficacious in treating global symptoms of IBS.<\/li>\n<li>The low-FODMAP diet is currently the most\u00a0 evidence-based diet intervention for IBS.<\/li>\n<li>The low-FODMAP diet consists of the following 3 phases:<br \/>\n1) restriction (lasting no more than 4\u20136 weeks),<br \/>\n2) reintroduction of FODMAP foods, and<br \/>\n3) personalization based on results from reintroduction.<\/li>\n<li>Although observational studies found that most patients with IBS improve with a gluten-free diet, randomized controlled trials have yielded mixed results.<\/li>\n<li>There are limited data showing that selected biomarkers can predict response to diet interventions in patients with IBS, but there is insufficient evidence to support their routine use in clinical practice.<br \/>\n<\/div>\n<\/div>\n\n\n\n<div class=\"block__reference\">\n    <div class=\"block__reference__leading\" id=\"block__reference__leading\">\n        <i class=\"fa-classic fa-solid fa-share-from-square\" aria-hidden=\"true\"><\/i>\n        <strong>References<\/strong>\n    <\/div>\n    <div class=\"block__reference__entries\" id=\"block__reference__entries\" style=\"display: none;\">\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span>Black CJ, et al. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis [published online ahead of print August 10, 2021]. Gut <\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span> Bohn L, et al. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013;108:634\u2013641<\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span>Chey WD, et al. Behavioral and diet therapies in integrated care for patients with irritable bowel syndrome. Gastroenterology 2021;160:47\u201362.<\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span>Dionne J, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol 2018; 113:1290\u20131300. <\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span>Eswaran SL, et al. A randomized controlled trial comparing the low FODMAP diet vs. modified NICE Guidelines in US adults with IBS-D. Am J Gastroenterol 2016;111:1824\u20131832. <\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span> Eswaran S, et al. 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. J Acad Nutr Diet 2020;120:641\u2013649. <\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span> Garcia-Martinez I, et al. A leukocyte activation test identifies food items which induce release of DNA by innate immune peripheral blood leucocytes. Nutr Metab (Lond) 15, 26 (2018).<\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span>Lacy BE, et al. ACG Clinical Guideline: management of irritable bowel syndrome. Am J Gastroenterol 2021;116:17\u201344<\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span>McGowan A, Harer KN. Irritable bowel syndrome and eating disorders: a burgeoning concern in gastrointestinal clinics. Gastroenterol Clin North Am 2021; 50:595\u2013610<\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span>Moayyedi P, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014;109:1367\u20131374. <\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span>Paduano D, et al. Effect of three diets (low-FODMAP, gluten-free and balanced) on irritable bowel syndrome symptoms and health-related quality of life. Nutrients 2019;11:1566. <\/span>\n            <\/div>\n                    <div class=\"block__reference__entry\">\n                <i class=\"fa-classic fa-solid fa-share\" aria-hidden=\"true\"><\/i>\n                <span>Staudacher HM, et al. Nutrient intake, diet quality, and diet diversity in irritable bowel syndrome and the impact of the low FODMAP diet. J Acad Nutr Diet 2020;120:535\u2013547.<\/span>\n            <\/div>\n            <\/div>\n<\/div>\n","protected":false},"template":"","class_list":["post-91547","article_revue","type-article_revue","status-publish","hentry"],"acf":{"auteur":"","source":"","revue":[{"ID":91543,"post_author":"25","post_date":"2023-04-27 11:11:57","post_date_gmt":"2023-04-27 09:11:57","post_content":"<!-- wp:image {\"id\":91605,\"sizeSlug\":\"full\",\"linkDestination\":\"none\"} -->\n<figure class=\"wp-block-image size-full\"><img src=\"https:\/\/aprifel-pp.mentalworks.biz\/wp-content\/uploads\/2023\/04\/edito.ok_.jpg\" alt=\"\" class=\"wp-image-91605\"\/><\/figure>\n<!-- \/wp:image -->\n\n<!-- wp:paragraph -->\n<p><strong>Irritable bowel syndrome<\/strong> (IBS) is a<strong> functional gastrointestinal disorder<\/strong>. With an approximative <strong>global prevalence of 11.2%<\/strong>, IBS is a commonly diagnosed disorder that can have a substantial impact on patients\u2019 quality of life as well as a huge economic impact on society (<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32702295\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oka, 2020<\/a>). The <strong>pathogenesis <\/strong>of IBS is <strong>multifactorial<\/strong>, and IBS can be associated with altered intestinal motility, visceral hypersensitivity, altered brain\u2013gut interactions, dysbiosis, increased intestinal permeability, and\/or mucosal immune activation (<a href=\"https:\/\/journals.lww.com\/ajg\/Fulltext\/2018\/06002\/American_College_of_Gastroenterology_Monograph_on.1.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">Ford, 2018<\/a>). Although there is <strong>not a specific food that triggers the condition<\/strong>, people suffering from this disorder report that certain foods, or their combination, can promote or aggravate symptoms.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>This month, the issue of the Global Fruit and Veg Newsletter <strong>sheds light on this syndrome<\/strong> with <strong>three recent articles<\/strong>. It covers the <strong>mechanistic approach<\/strong> of how <strong>diet<\/strong>, and more particularly <strong>FODMAPs<\/strong>, can dysregulate the colonic mucus barrier as well as <strong>dietary advice<\/strong> for irritable bowel syndrome, with a <strong>focus on a key nutrient<\/strong> -dietary fiber- that provides functional and physiological benefits.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>The <a href=\"https:\/\/aprifel-pp.mentalworks.biz\/en\/global-fv-newsletter-article\/how-does-the-intake-of-fermentable-carbohydrate-alter-barrier-function\/\" target=\"_blank\" rel=\"noreferrer noopener\">first article<\/a> from a French group of researchers explores the <strong>mechanistic implication of an increased intake of dietary fermentable carbohydrates<\/strong> in <strong>mucus barrier particularities<\/strong>. The study shows that excessive intake of fermentable carbohydrates can cause colonic mucus barrier dysregulation in mice, by a process that involves glycating agents and increases mucosal mast cell counts.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>The <a href=\"https:\/\/aprifel-pp.mentalworks.biz\/en\/global-fv-newsletter-article\/practical-advice-on-the-role-of-diet-in-treating-patients-with-irritable-bowel-syndrome\/\" target=\"_blank\" rel=\"noreferrer noopener\">second article<\/a> is an <strong>expert review <\/strong>of the American Gastroenterological Association (AGA) providing <strong>advice statements<\/strong>, mainly to gastroenterologists, with regards to the<strong> role of diet in IBS treatment<\/strong>.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>The <a href=\"https:\/\/aprifel-pp.mentalworks.biz\/en\/global-fv-newsletter-article\/health-benefits-of-dietary-fibre-in-childhood\/\" target=\"_blank\" rel=\"noreferrer noopener\">third article<\/a> focuses on the<strong> role of dietary fibre<\/strong> intake in <strong>healthy children<\/strong> but also in case of <strong>functional digestive disorders<\/strong> such as IBS and constipation. This review highlights the importance of the quality of fiber consumed and emphasizes that a healthy diet should contain both fermentable and bulking fiber.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:acf\/pictureable {\"name\":\"acf\/pictureable\",\"data\":{\"authors_0_fully_name\":\"Pauline Jou\u00ebt\",\"_authors_0_fully_name\":\"field_pictureable_author_fully_name\",\"authors_0_profession\":\"Medical doctor - Universit\u00e9 Paris VII\",\"_authors_0_profession\":\"field_pictureable_author_profession\",\"authors_0_information\":\"\",\"_authors_0_information\":\"field_pictureable_author_information\",\"authors_0_picture\":91544,\"_authors_0_picture\":\"field_pictureable_author_picture\",\"authors\":1,\"_authors\":\"field_pictureable_authors\"},\"align\":\"center\",\"mode\":\"auto\"} \/-->\n\n<!-- wp:acf\/about {\"name\":\"acf\/about\",\"data\":{\"title\":\"About the author\",\"_title\":\"field_about_title\",\"content\":\"Pauline Jou\u00ebt is a medical doctor and has a PhD in epithelial biology and pathology (Universit\u00e9 Paris VII). She has worked as a researcher in Pr SARNA\u2019s laboratory, Wisconsin, USA, 1992-1994). She is Professeur associ\u00e9e at the Coll\u00e8ge de M\u00e9decine des H\u00f4pitaux de Paris, works full time at Avicenne Hospital (Bobigny, France) as a gastroenterologist, and at the INSERM U 987 unit (Dr Bouhassira, Boulogne-Billancourt). She currently is the President of the French Groupe of Neurogastroenterology (GFNG) and is part of the scientific committee of the french association for IBS patients (appssii.org).  \",\"_content\":\"field_about_content\"},\"align\":\"center\",\"mode\":\"auto\"} \/-->","post_title":"Food in functional gastro-intestinal disorders: friend or foe?","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"food-in-functional-gastro-intestinal-disorders-friend-or-foe","to_ping":"","pinged":"","post_modified":"2024-10-24 17:26:50","post_modified_gmt":"2024-10-24 15:26:50","post_content_filtered":"","post_parent":0,"guid":"https:\/\/aprifel-pp.mentalworks.biz\/?post_type=revue&#038;p=91543","menu_order":36,"post_type":"revue","post_mime_type":"","comment_count":"0","filter":"raw"}],"position":"2","references":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v23.6 (Yoast SEO v23.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Practical advice on the role of diet in treating patients with Irritable Bowel Syndrome \u00c9quation Nutrition - 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