Fermentable carbohydrate intake and food avoidance behaviour in elderly patients with irritable bowel syndrome: A case report
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Keywords

FODMAPs
dietary triggers
irritable bowel syndrome
fermentable carbohydrates
quality of life

How to Cite

Arumugam, M., Jimson Simon, J. ., Ismail, A. S. ., Kamarulzaman, N. A. S. ., Wong, Z., & Krishnasamy, S. (2020). Fermentable carbohydrate intake and food avoidance behaviour in elderly patients with irritable bowel syndrome: A case report. Life Sciences, Medicine and Biomedicine, 4(9). https://doi.org/10.28916/lsmb.4.9.2020.57

Abstract

Background: Fermentable carbohydrates or FODMAPs (Fermentable Oligo-, Di-, Monosaccharides, and Polyols) are short-chained, poorly absorbed carbohydrates which trigger gastrointestinal symptoms causing pain, bloating, distension, diarrhea, and constipation in Irritable Bowel Syndrome (IBS) patients. This debilitating condition has an impact on the quality of life of patients. In addition, due to lack of dietary intervention, it can result in food restriction to alleviate symptoms as patients avoid a wide variety of food and beverages. Objective: To compare FODMAP and nutrient intake, food avoidance behavior and quality of life in 2 long standing patients with IBS. Methods: Patients were selected on the basis of being diagnosed with IBS by a gastroenterologist. A 24-hour dietary recall with multiple pass method was used to assess intake. FODMAP intake was determined using published data. Symptom severity and quality of life was measured using a validated questionnaire. Meanwhile, food avoidance was assessed using a dietary trigger piloted questionnaire. Results: Two female Chinese patients with severe gastrointestinal symptoms were selected for this case series. Patient 1 was a 75-year-old female presenting with constipation-predominant IBS and patient 2 was a 61-year-old presenting with diarrhea-predominant IBS. Patient 1 had a higher energy intake: 2198 kcal, and FODMAP intake 10.6g/d, compared to patient 2 with an energy and FODMAP intake of 1800 kcal and 3.6g/d respectively. Both patients avoided a wide of range of food groups including cereals and grains, animal products, dairy and spicy foods. They also reported reduced scores for quality of life. Conclusion: Both patients had low intake of calcium as a result of food avoidance. This highlights the importance of appropriate and timely dietary intervention to this group of patients, to promote improved symptom management without compromising nutrient intake.

https://doi.org/10.28916/lsmb.4.9.2020.57
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References

Barrett, J. S., and P. R. Gibson. 2012. "Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAPs) and Nonallergic Food Intolerance: FODMAPs or Food Chemicals?" Therapeutic Advances in Gastroenterology 5 (4): 261-68.

https://doi.org/10.1177/1756283X11436241

Barrett, Jacqueline S., and Peter R. Gibson. 2010. "Development and Validation of a Comprehensive Semi-Quantitative Food Frequency Questionnaire That Includes FODMAP Intake and Glycemic Index." Journal of the American Dietetic Association 110 (10): 1469-76.

https://doi.org/10.1016/j.jada.2010.07.011

Biesiekierski, J. R., O. Rosella, R. Rose, K. Liels, J. S. Barrett, S. J. Shepherd, P. R. Gibson, and J. G. Muir. 2011. "Quantification of Fructans, Galacto-Oligosacharides and Other Short-Chain Carbohydrates in Processed Grains and Cereals." Journal of Human Nutrition and Dietetics 24 (2): 154-76.

https://doi.org/10.1111/j.1365-277X.2010.01139.x

Bohn, L, S Storsrud, and M Simren. 2013. "Nutrient Intake in Patients with Irritable Bowel Syndrome Compared with the General Population. "Neurogastroenterology and Motility : The Official Journal of the European Gastrointestinal Motility Society 25 (1): 23-30.e1. | n, Lena, Stine Störsrud, Hans Törnblom, Ulf Bengtsson, and Magnus Simrén. 2013. "Self-Reported Food-Related Gastrointestinal Symptoms in IBS Are Common and Associated with More Severe Symptoms and Reduced Quality of Life." The American Journal of Gastroenterology 108 (5): 634-41.

https://doi.org/10.1038/ajg.2013.105

Chey W et al. 2015. "Irritable Bowel Syndrome: A Clinical Review." JAMA - Journal of the American Medical Association 313 (9): 949-58.

https://doi.org/10.1001/jama.2015.0954

Drossman, Douglas, Enrico Corazziari, Michel Delvaux, R Spiller, Nicholas Talley, and W G Thompson. 2010. "Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders." Revista de Gastroenterologia de Mexico 75 (January): 511-16.

Eswaran, Shanti L et al, William D Chey, Theresa Han-Markey, Sarah Ball, and Kenya Jackson. 2016. "A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D." The American Journal of Gastroenterology 111 (12): 1824-32.

https://doi.org/10.1038/ajg.2016.434

Francis, C Y, J Morris, and P J Whorwell. 1997. "The Irritable Bowel Severity Scoring System: A Simple Method of Monitoring Irritable Bowel Syndrome and Its Progress." Alimentary Pharmacology & Therapeutics 11 (2): 395-402.

https://doi.org/10.1046/j.1365-2036.1997.142318000.x

Gibson, G R, and M B Roberfroid. 1995. "Dietary Modulation of the Human Colonic Microbiota: Introducing the Concept of Prebiotics." The Journal of Nutrition 125 (6): 1401-12.

https://doi.org/10.1093/jn/125.6.1401

Gibson, Peter R. 2017. "History of the Low FODMAP Diet." Journal of Gastroenterology and Hepatology (Australia) 32: 5-7.

https://doi.org/10.1111/jgh.13685

Halmos, Emma P, Victoria a Power, Susan J Shepherd, Peter R Gibson, and Jane G Muir. 2014. "A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome." Ygast 146 (1): 67-75.e5.

https://doi.org/10.1053/j.gastro.2013.09.046

Harer, Kimberly N, Christina Jagielski, William D Chey, and Megan Riehl. 2019. "Avoidant/Restrictive Food Intake Disorder (ARFID) Among Adult Gastroenterology Behavioral Health Patients: Comparison of ARFID vs. Non-ARFID Patients: 466." American Journal of Gastroenterology 114.

https://doi.org/10.14309/01.ajg.0000591396.38756.27

Hayes, P., C. Corish, E. O'Mahony, and E. M M Quigley. 2014. "A Dietary Survey of Patients with Irritable Bowel Syndrome." Journal of Human Nutrition and Dietetics 27 (SUPPL2): 36-47.

https://doi.org/10.1111/jhn.12114

Holtmann, Gerald J, Alexander C Ford, and Nicholas J Talley. 2016. "Pathophysiology of Irritable Bowel Syndrome." The Lancet Gastroenterology & Hepatology 1: 133-46.

https://doi.org/10.1016/S2468-1253(16)30023-1

Lee, Yeong Yeh, Anuar Waid, Huck Joo Tan, Andrew Seng Boon Chua, and William E. Whitehead. 2012. "Rome III Survey of Irritable Bowel Syndrome among Ethnic Malays." World Journal of Gastroenterology 18 (44): 6475-80.

https://doi.org/10.3748/wjg.v18.i44.6475

Ligaarden, Solveig C, Stian Lydersen, and Per G Farup. 2012. "Diet in Subjects with Irritable Bowel Syndrome: A Cross-Sectional Study in the General Population." BMC Gastroenterology 12: 61.

https://doi.org/10.1186/1471-230X-12-61

Longstreth, George F., W. Grant Thompson, William D. Chey, Lesley A. Houghton, Fermin Mearin, and Robin C. Spiller. 2006. "Functional Bowel Disorders." Gastroenterology 130 (5): 1480-91.

https://doi.org/10.1053/j.gastro.2005.11.061

Muir, Jane G., Rosmary Rose, Ourania Rosella, Kelly Liels, Jacqueline S. Barrett, Susan J. Shepherd, and Peter R. Gibson. 2009a. "Measurement of Short-Chain Carbohydrates in Common Australian Vegetables and Fruits by High-Performance Liquid Chromatography (HPLC)." Journal of Agricultural and Food Chemistry 57 (2): 554-65.

https://doi.org/10.1021/jf802700e

Muir, Jane G., Susan J. Shepherd, Ourania Rosella, Mary Rose, Jacqueline S. Barrett, and Peter R. Gibson. 2007. "Fructan and Free Fructose Content of Common Australian Vegetables and Fruit." Journal of Agricultural and Food Chemistry 55 (16): 6619-27.

https://doi.org/10.1021/jf070623x

Muir, Jane G, Rosmary Rose, Ourania Rosella, Kelly Liels, Jacqueline S Barrett, Susan J Shepherd, and Peter R Gibson. 2009. "Measurement of Short-Chain Carbohydrates in Common Australian Vegetables and Fruits by High-Performance Liquid Chromatography (HPLC) Measurement of Short-Chain Carbohydrates in Common Australian Vegetables and Fruits by High-Performance Liquid Chromatog," 554-65.

https://doi.org/10.1021/jf802700e

Monnikes, H. 2011. Quality of life in patients with irritable bowel syndrome. J Clin Gastroenterol 45 Suppl: S98-101.

https://doi.org/10.1097/MCG.0b013e31821fbf44

Murray, Kathryn, Victoria Wilkinson-Smith, Caroline Hoad, Carolyn Costigan, Eleanor Cox, Ching Lam, Luca Marciani, Penny Gowland, and Robin C Spiller. 2014. "Differential Effects of FODMAPs (Fermentable Oligo-, Di-, Mono-Saccharides and Polyols) on Small and Large Intestinal Contents in Healthy Subjects Shown by MRI." The American Journal of Gastroenterology 109 (1): 110-19.

https://doi.org/10.1038/ajg.2013.386

National Coordinating Committee on Food and Nutrition 2017. Recommended Nutrient Intake (Rni) for Malaysian. A report of the Technical Working group on Nutritional Guidelines. Putrajaya Ministry of Health Malaysia.

Ong, Derrick K., Shaylyn B. Mitchell, Jacqueline S. Barrett, Sue J. Shepherd, Peter M. Irving, Jessica R. Biesiekierski, Stuart Smith, Peter R. Gibson, and Jane G. Muir. 2010. "Manipulation of Dietary Short Chain Carbohydrates Alters the Pattern of Gas Production and Genesis of Symptoms in Irritable Bowel Syndrome." Journal of Gastroenterology and Hepatology (Australia) 25 (8): 1366-73.

https://doi.org/10.1111/j.1440-1746.2010.06370.x

Østgaard, Hege, Trygve Hausken, Doris Gundersen, and Magdy El-Salhy. 2012. "Diet and Effects of Diet Management on Quality of Life and Symptoms in Patients with Irritable Bowel Syndrome." Molecular Medicine Reports 5 (6): 1382-90.

Placidi, E., L. Marciani, C. L. Hoad, A. Napolitano, K. C. Garsed, S. E. Pritchard, E. F. Cox, C. Costigan, R. C. Spiller, and P. A. Gowland. 2012. "The Effects of Loperamide, or Loperamide plus Simethicone, on the Distribution of Gut Water as Assessed by MRI in a Mannitol Model of Secretory Diarrhoea." Alimentary Pharmacology and Therapeutics 36 (1): 64-73.

https://doi.org/10.1111/j.1365-2036.2012.05127.x

Prichard, Rebeca, Megan Rossi, Jane Muir, Chu K Yao, Kevin Whelan, and Miranda Lomer. 2016. "Fermentable Oligosaccharide, Disaccharide, Monosaccharide and Polyol Content of Foods Commonly Consumed by Ethnic Minority Groups in the United Kingdom." International Journal of Food Sciences and Nutrition 7486 (April): 1-8.

https://doi.org/10.3109/09637486.2016.1163328

Rajendra, S., and S. Alahuddin. 2004. "Prevalence of Irritable Bowel Syndrome in a Multi-Ethnic Asian Population." Alimentary Pharmacology and Therapeutics 19 (6): 704-6.

https://doi.org/10.1111/j.1365-2036.2004.01891.x

Schaafsma, Gertjan, and Joanne L. Slavin. 2015. "Significance of Inulin Fructans in the Human Diet." Comprehensive Reviews in Food Science and Food Safety 14 (1): 37-47.

https://doi.org/10.1111/1541-4337.12119

Shepherd S. et al. 2013. "Short-Chain Carbohydrates and Functional Gastrointestinal Disorders." The American Journal of Gastroenterology 108 (5): 707-17.

https://doi.org/10.1038/ajg.2013.96

Shepherd, Susan J., Francis C. Parker, Jane G. Muir, and Peter R. Gibson. 2008. "Dietary Triggers of Abdominal Symptoms in Patients With Irritable Bowel Syndrome: Randomized Placebo-Controlled Evidence." Clinical Gastroenterology and Hepatology 6 (7): 765-71.

https://doi.org/10.1016/j.cgh.2008.02.058

Staudacher, H. M. and Whelan, K. (2017) 'The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in irritable bowel syndrome', Gut, pp. 1-11.

https://doi.org/10.1136/gutjnl-2017-313750

Stevenson C. et al. 2014. "Food Avoidance in Irritable Bowel Syndrome Leads to a Nutrition-Deficient Diet." South African Journal of Clinical Nutrition 27 (1): 25-30.

https://doi.org/10.1080/16070658.2014.11734481

Tang, Yu-rong, Wei-wei Yang, Mei-lan Liang, Xin-yu Xu, Mei-feng Wang, Lin Lin, Yu-rong Tang, Wei-wei Yang, Mei-lan Liang, and Xin-yu Xu. 2012. "Age-Related Symptom and Life Quality Changes in Women with Irritable Bowel Syndrome." World Journal of Gastroenterology 18: 7175-83.

https://doi.org/10.3748/wjg.v18.i48.7175

Thomas, Jennifer J, Elizabeth A Lawson, Nadia Micali, Madhusmita Misra, Thilo Deckersbach, T Kamryn, Disorders Clinical, et al. 2017. "Avoidant/Restrictive Food Intake Disorder: A Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment." Curr Psychiatry Rep 19 (8): 1-15.

https://doi.org/10.1007/s11920-017-0795-5

Varney, Jane, Jacqueline Barrett, Kate Scarlata, Patsy Catsos, Peter R Gibson, and Jane G Muir. 2017. "FODMAPs : Food Composition, Defining Cutoff Values and International Application," 53-61.

https://doi.org/10.1111/jgh.13698

Yao, C. K., H. L. Tan, D. R. van Langenberg, J. S. Barrett, R. Rose, K. Liels, P. R. Gibson, and J. G. Muir. 2014. "Dietary Sorbitol and Mannitol: Food Content and Distinct Absorption Patterns between Healthy Individuals and Patients with Irritable Bowel Syndrome." Journal of Human Nutrition and Dietetics 27 (SUPPL2): 263-75.

https://doi.org/10.1111/jhn.12144

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