Detection of FODMAP Intolerances and Symptom Improvement Following Dietary Intervention in Patients from Northwestern Mexico
DOI:
https://doi.org/10.22516/25007440.1293Keywords:
Breath Test, Irritable bowel syndrome, Food intolerance, FODMAP dietAbstract
Introduction: Fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) are associated with gastrointestinal symptoms in patients with gut-brain interaction disorders, negatively impacting quality of life if left untreated.
Objectives: To identify FODMAP intolerances in patients from Northwestern Mexico referred by gastroenterologists and to design low-FODMAP diets to alleviate their symptoms.
Methods: A single-group quasi-experimental study was conducted, including breath hydrogen tests to detect small intestinal bacterial overgrowth and intolerances to lactose, fructose, sorbitol, and fructans. Personalized low-FODMAP diets were designed to manage symptoms. Symptoms were assessed at baseline and post-intervention using a 100-mm visual analog scale, and 24-hour dietary recalls were applied.
Results: Of the 36 patients recruited, 21 (mean age: 35.9 years) completed the study, with 42% diagnosed with irritable bowel syndrome (IBS). At baseline, 92% reported abdominal bloating (mean severity: 6.5 ± 2.4) and flatulence (5.6 ± 2.8). Other reported symptoms included nausea (31%), reflux (28%), anxiety or stress (22%), and insomnia or irritability (17%). Intolerances were observed in 39% for lactose, 33% for fructose, 56% for sorbitol, and 61% for fructans. Following the dietary intervention, severity of abdominal bloating, abdominal pain, borborygmi, diarrhea, constipation, and flatulence decreased significantly (p ≤ 0.05). Energy and macronutrient intake remained stable throughout the study, whereas FODMAP intake decreased markedly.
Conclusion: A low-FODMAP dietary intervention tailored to pre-identified specific intolerances effectively reduced patients’ gastrointestinal symptoms.
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References
Shamah-Levy T, Vielma-Orozco E, Heredia-Hernández O, Romero-Martínez M, Mojica-Cuevas J, Cuevas-Nasu L, et al. Encuesta Nacional de Salud y Nutrición 2018-19: Resultados nacionales. Cuernavaca, México: Instituto Nacional de Salud Pública; 2020.
Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome foundation global study. Gastroenterology. 2021;160(1):99-114.e3. https://doi.org/10.1053/j.gastro.2020.04.014
Black CJ, Drossman DA, Talley NJ, Ruddy J, Ford AC. Functional gastrointestinal disorders: advances in understanding and management. Lancet. 2020;396(10263):1664-74. https://doi.org/10.1016/S0140-6736(20)32115-2
Rinninella E, Cintoni M, Raoul P, Gasbarrini A, Mele MC. Food additives, gut microbiota, and irritable bowel syndrome: a hidden track. Int J Environ Res Public Health 2020;17(23):8816. https://doi.org/10.3390/ijerph17238816
Smiliotopoulos T, Zampelas A, Houliaras G, Sgouros SN, Michas G, Bamias G, et al. Association of fructose consumption with prevalence of functional gastrointestinal disorders manifestations: results from Hellenic National Nutrition and Health Survey (HNNHS). Br J Nutr. 2023;130(11):1961-72. https://doi.org/10.1017/S0007114523001198
Tuck CJ, Biesiekierski JR, Schmid-Grendelmeier P, Pohl D. Food intolerances. Nutrients. 2019;11(7):1684. https://doi.org/10.3390/nu11071684
Varney J, Barrett J, Scarlata K, Catsos P, Gibson PR, Muir JG. FODMAPs: food composition, defining cutoff values and international application. J Gastroenterol Hepatol. 2017;32 Suppl 1:53-61. https://doi.org/10.1111/jgh.13698
Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Therap Adv Gastroenterol. 2012;5(4):261-8. https://doi.org/10.1177/1756283X11436241
Usai-Satta P, Oppia F, Lai M, Cabras F. Hydrogen breath tests: are they really useful in the nutritional management of digestive disease? Nutrients. 2021;13(3):974. https://doi.org/10.3390/nu13030974
Halmos EP, Power 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. https://doi.org/10.1053/j.gastro.2013.09.046
Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, Basilisco G, et al. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther. 2009;29 Suppl 1:1-49. https://doi.org/10.1111/j.1365-2036.2009.03951.x
Amieva-Balmori M, Coss-Adame E, Rao NS, Dávalos-Pantoja BM, Rao SSC. Diagnostic utility of carbohydrate breath tests for SIBO, fructose, and lactose intolerance. Dig Dis Sci 2020;65(5):1405-13. https://doi.org/10.1007/s10620-019-05889-9
Hammer HF, Fox MR, Keller J, Salvatore S, Basilisco G, Hammer J, et al. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus. United European Gastroenterol J. 2022;10(1):15-40. https://doi.org/10.1002/ueg2.12133
Secretaría de Salud. Norma Oficial Mexicana NOM-043-SSA2-2012, servicios básicos de salud. Promoción y educación para la salud en materia alimentaria. Criterios para brindar orientación [Internet]. Diario Oficial, 22 de enero de 2013 [consultado el 18 de febrero de 2016]. Disponible en: https://www.gob.mx/cms/uploads/attachment/file/138258/NOM-043-servicios-basicos-salud-educacion-alimentaria.pdf
Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas Carlos A, Popkin Barry M, Willett Walter C. Consumo de bebidas para una vida saludable: recomendaciones para la población mexicana. Salud Pública Mex. 2008;50(2):173-95.
Perets TT, Hamouda D, Layfer O, Ashorov O, Boltin D, Levy S, et al. Small intestinal bacterial overgrowth may increase the likelihood of lactose and sorbitol but not fructose intolerance false positive diagnosis. Ann Clin Lab Sci. 2017;47(4):447-51.
Zingone F, Bertin L, Maniero D, Palo M, Lorenzon G, Barberio B, et al. Myths and facts about food intolerance: a narrative review. Nutrients. 2023;15(23):4969. https://doi.org/10.3390/nu15234969
Aziz I, Simrén M. The overlap between irritable bowel syndrome and organic gastrointestinal diseases. Lancet Gastroenterol Hepatol. 2021;6(2):139-148. https://doi.org/10.1016/S2468-1253(20)30212-0
Oligschlaeger Y, Yadati T, Houben T, Condello Oliván CM, Shiri-Sverdlov R. Inflammatory bowel disease: A stressed “gut/feeling”. Cells. 2019;8(7):659. https://doi.org/10.3390/cells8070659
Jafari M, Sabahi P, Jahan F, Sotodeh Asl N. Effectiveness of cognitive-behavioral stress management for depression, anxiety, cognitive emotion regulation, and quality of life in patients with irritable bowel syndrome: a quasi-experimental study. Jundishapur J Chronic Dis Care. 2022;11(2):e122098. https://doi.org/10.5812/jjcdc.122098
Wilder-Smith CH, Materna A, Wermelinger C, Schuler J. Fructose and lactose intolerance and malabsorption testing: the relationship with symptoms in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2013;37(11):1074-83. https://doi.org/10.1111/apt.12306
Rosado JL. Intolerancia a la lactosa. Gac Med Mex. 2016;152 Suppl 1:67-73.
Reyes-Huerta JU, de la Cruz-Patiño E, Ramírez-Gutiérrez de Velasco A, Zamudio C, Remes-Troche JM. Intolerancia a la fructosa en pacientes con síndrome de intestino irritable; un estudio de casos y controles. Rev Gastroenterol Mex. 2010;75(4):405-11.
Raithel M, Weidenhiller M, Hagel AF, Hetterich U, Neurath MF, Konturek PC. The malabsorption of commonly occurring mono and disaccharides: levels of investigation and differential diagnoses. Dtsch Arztebl Int. 2013;110:775-82. https://doi.org/10.3238/arztebl.2013.0775
Sia T, Tanaka RO, Mousad A, Narayan AP, Si K, Bacchus L, et al. Fructose malabsorption and fructan malabsorption are associated in patients with irritable bowel syndrome. BMC Gastroenterol. 2024;24(1):143. https:// doi.org/10.1186/s12876-024-03230-x
Mehtab W, Agarwal A, Singh N, Malhotra A, Makharia GK. All that a physician should know about FODMAPs. Indian J Gastroenterol. 2019;38(5):378-90. https://doi.org/10.1007/s12664-019-01002-0
Alfaro-Cruz L, Heitkemper M, Chumpitazi BP, Shulman RJ. Literature review: Dietary intervention adherence and adherence barriers in functional gastrointestinal disorder studies. J Clin Gastroenterol. 2020;54(3):203-11. https://doi.org/10.1097/MCG.0000000000001280
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