NMT150 NUT WK 10 (1).pdf

FUNCTIONAL GI (IBS) AUTHOR: DR. MARYAM YAVARI, MD, PH.D., ND NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Diet Microbiome balance TREATMENT GOALS Address presenting symptoms and improve patient...

FUNCTIONAL GI (IBS) AUTHOR: DR. MARYAM YAVARI, MD, PH.D., ND NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Diet Microbiome balance TREATMENT GOALS Address presenting symptoms and improve patient comfort Support full and speedy recovery to return to regular activities Patient education Monitor and Prevent sequelae  SIBO Common in people with irritable bowel syndrome (IBS). Some studies suggest that up to 80% of people with IBS may also have SIBO. Treatment for SIBO often involves antibiotics to eliminate the overgrowth of bacteria + dietary changes to support healthy microbiome and prevent future overgrowth. https://my.clevelandclinic.org/health/diseases/21820-small-intestinal-bacterial-overgrowth-sibo ROLE OF NUTRIENTS AND FOOD  Low FODMAP Diet - Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols - Can be effective in managing symptoms of SIBO in patients with IBS. - This diet eliminates certain types of carbohydrates that are poorly absorbed in the small intestine and can be fermented by bacteria, leading to symptoms like bloating, gas, and diarrhea. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and a probiotic restores Bifidobacterium species: a randomized controlled trial. Gastroenterology. 2014;146(1):67-75.e5. 2 Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016;55(3):897-906. https://charlestongi.com/news&events/the-low-fodmap-diet-for-irritable-bowel-syndrome/  Low FODMAP Diet - Several randomized controlled trials have shown that a low FODMAP diet can improve IBS symptoms in up to 75% of patients. - A systematic review and meta-analysis of 22 studies found that a low FODMAP diet was effective in reducing IBS symptoms, specially bloating and abdominal pain. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010;25(2):252-258. Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016;55(3):897-906 Alcohol If alcohol exacerbates the symptoms it should be reduced. IBS patients should be advised to consume alcohol in compliance with recommended safe limits. McKenzie YA, Bowyer RK, Leach H, Gulia P, Horobin J, O’Sullivan NA, Pettitt C, Reeves LB, Seamark L, Williams M, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update) J Hum Nutr Diet. 2016;29:549–575. Caffeine intake Caffeine intake should be assessed in IBS patients. If related to symptoms, daily intake should be less than 400 mg caffeine, which is the safe limit for most adults McKenzie YA, Bowyer RK, Leach H, Gulia P, Horobin J, O’Sullivan NA, Pettitt C, Reeves LB, Seamark L, Williams M, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update) J Hum Nutr Diet. 2016;29:549–575. Spicy foods intake If the IBS symptoms are triggered by spicy foods, the intake should be restricted. IBS triggers in spicy foods other than hot spices (e.g., fructans in onion and garlic) should also be assessed. McKenzie YA, Bowyer RK, Leach H, Gulia P, Horobin J, O’Sullivan NA, Pettitt C, Reeves LB, Seamark L, Williams M, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update) J Hum Nutr Diet. 2016;29:549–575.  Fiber intake Some studies have suggested that increasing fiber intake may improve IBS symptoms, especially constipation. However, the evidence is mixed, and some people with IBS may find that high fiber diets exacerbate their symptoms. El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (Review). Int J Mol Med. 2017;40(3):607-613. 4 Bijkerk CJ, de Wit NJ, Muris JW, Whorwell PJ, Knottnerus JA, Hoes AW. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ. 2009;339:b3154.  Fat intake If related to IBS symptoms during or after eating, fat intake should be assessed. According to FAO/WHO dietary recommendations, the total fat intake for an adult should range from 30% to 35% of total energy, without being under 15% of total energy. Patients with IBS should be advised to limit fat intake to no more than 40-50 g/d. Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204–1214. Dairy intake Low-lactose diet only if they have a positive lactose hydrogen breath test. Gluten-free Diet Conflicting evidence Consider nutritional deficiencies Summary Diet and microbiome balance: Low FODMAP Avoiding the triggers: spicy foods, coffee, alcohol,... Fiber intake Fat intake Dairy intake Gluten intake Case Tina, a 26 year old woman is concerned about abdominal discomfort, bloating and constipation. She was diagnosed with IBS 2 years ago. You recommend Tina to: Increase fiber intake in her diet Decrease fiber intake in her diet Have a FODMAP rich diet Monitor her response to fiber intake  REFERENCES CDC: https://www.cdc.gov/ Online source Center for Disease Control and Prevention Updates 2022 Prousky J. Textbook of Integrative Clinical Nutrition. CCNM Press Inc.; 2012. Katz D. Nutrition in Clinical Practice. 2nd Edition. Lippincott Williams & Wilkins; 2008. Katsilambros N. Clinical Nutrition in Practice. WileyBlackwell; 2010. Pizzorno J and Katzinger J. Clinical Pathophysiology. Mind Publishing; 2012. Marz RB. Medical Nutrition from Marz. 2nd edition. Quiet Lion Press; 1999. Ducrotté P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol. 2012;18(30):4012- 4018. Moayyedi P, Ford AC, Talley NJ, et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010;59(3):325-332. Murray MT. Encyclopedia of Nutritional Supplements. Prima Health; 1996. Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 7th Ed. Cengage Learning; 2018.  Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015 Mar 3;313(9):949-58. doi: 10.1001/jama.2015.0954. PMID: 25734736. McKenzie YA, Bowyer RK, Leach H, Gulia P, Horobin J. British dietetic association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016 Oct;29(5):549-75. doi: 10.1111/jhn.12385. PMID: 27170209. Barbara G, Grover M, Bercik P, et al. Rome Foundation Working Team Report on Post-Infection Irritable Bowel Syndrome. Gastroenterology. 2019 Jun;156(8):e3-e14. doi: 10.1053/j.gastro.2019.02.014. PMID: 31071323. Zoppi G, Cinquetti M, Luciano A, Benini A, Muner A, Bertazzoni Minelli E. The intestinal ecosystem in chronic functional gastrointestinal disorders. J Clin Gastroenterol. 2014 Oct;48 Suppl 1:S70-2. doi: 10.1097/MCG.0000000000000192. PMID: 25291138. Muir JG, Gibson PR. The Low FODMAP Diet for Treatment of Irritable Bowel Syndrome and Other Gastrointestinal Disorders. Gastroenterol Hepatol (N Y). 2013 Sep;9(9):450-2. PMID: 24711715. Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double- blind randomized placebo-controlled trial. Am J Gastroenterol. 2011 Mar;106(3):508-14; quiz 515. doi: 10.1038/ajg.2010.487. PMID: 21224837. Carroccio A, Mansueto P, Iacono G, et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol. 2012 Dec;107(12):1898-906; quiz 1907. doi: 10.1038/ajg.2012.277. PMID: 23147521. Moayyedi P, Quigley EM, Lacy BE, et al. The effect of dietary intervention on irritable bowel syndrome: a systematic review. Clin Gastroenterol Hepatol. 2015 Apr;13(4):750-8.e2. Staudacher HM, Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut. 2017 Jan;66 THANK YOU!