🚨 The latest in #diet and supplements for #IBS!
In this 🧵 I'll summarize @APandT "Food supplements and diet as treatment options in irritable bowel syndrome" by @ProfWhelan and @EiriniDimidi!
#medicine #GITwitter #nutrition #microbiome
onlinelibrary.wiley.com
In this 🧵 I'll summarize @APandT "Food supplements and diet as treatment options in irritable bowel syndrome" by @ProfWhelan and @EiriniDimidi!
#medicine #GITwitter #nutrition #microbiome
onlinelibrary.wiley.com
ALOE VERA
🌱prebiotic (⬆️bifidobacteria, SCFA), immunomodulatory
🌱Recent trial:❌difference btwn aloe&placebo for IBS symptoms or stool frequency/quality;❌difference in microbiome (but responders had different microbiome)
onlinelibrary.wiley.com
🌱prebiotic (⬆️bifidobacteria, SCFA), immunomodulatory
🌱Recent trial:❌difference btwn aloe&placebo for IBS symptoms or stool frequency/quality;❌difference in microbiome (but responders had different microbiome)
onlinelibrary.wiley.com
While RCTs for aloe have been negative, meta-analysis shows overall improvement in #IBS symptoms (ncbi.nlm.nih.gov). But adding the newest study to this analysis shows no difference from placebo.
⚠️Conclusion: aloe is ❌ recommended for IBS.
⚠️Conclusion: aloe is ❌ recommended for IBS.
PEPPERMINT OIL
🍵mechanism: modulation of histaminergic&cholinergic receptors in the gut, k-opioid agonist activity, serotonergic antagonism, anti-inflammatory effects
🍵causes smooth muscle relaxation (can relax LES and worsen GERD, so enteric coated formulations are preferred)
🍵mechanism: modulation of histaminergic&cholinergic receptors in the gut, k-opioid agonist activity, serotonergic antagonism, anti-inflammatory effects
🍵causes smooth muscle relaxation (can relax LES and worsen GERD, so enteric coated formulations are preferred)
🍵Peppermint oil is safe and effective in improving #IBS symptoms (link.springer.com)
🍵May be superior in efficacy to soluble fiber, antispasmodic drugs, and neuromodulators (sciencedirect.com)
🍵small bowel release may be superior to ileocolonic release
🍵May be superior in efficacy to soluble fiber, antispasmodic drugs, and neuromodulators (sciencedirect.com)
🍵small bowel release may be superior to ileocolonic release
#PROBIOTICS
🦠mechanism: alter gut microbiota & metabolite production; interact with intestinal immune system and the central & enteric nervous system
🦠modulate gut motility, inflammation, and visceral hypersensitivity
🦠mechanism: alter gut microbiota & metabolite production; interact with intestinal immune system and the central & enteric nervous system
🦠modulate gut motility, inflammation, and visceral hypersensitivity
🦠Meta-analysis: probiotic combinations⬇️persistent IBS symptoms&⬇️flatulence but❌bloating&urgency (onlinelibrary.wiley.com)
🦠Lactobacillus plantarum DSM 9843 ✅; Saccharomyces cerevisiae❌
⚠️Publication bias and heterogeneity in studies limit clinical applicability of studies
🦠Lactobacillus plantarum DSM 9843 ✅; Saccharomyces cerevisiae❌
⚠️Publication bias and heterogeneity in studies limit clinical applicability of studies
❓Do #probiotics have to be alive? Study of inactive B. bifidum MIMBb75 improved #IBS symptoms
🦠Probiotics are likely safe in patients with IBS
⚠️Conclusion: *specific* probiotic strains/combos of strains are effective for IBS, but lots of❓remain
🦠Probiotics are likely safe in patients with IBS
⚠️Conclusion: *specific* probiotic strains/combos of strains are effective for IBS, but lots of❓remain
FIBER
🍠mechanism: modulates gut microbiota & metabolite production, ⬆️💩 bulk by⬆️microbial biomass or via water retention, regulates gut motility
🍠soluble fiber improves #IBS symptoms, while insoluble fiber does not (ingentaconnect.com)
🍠psyllium✅
🍠mechanism: modulates gut microbiota & metabolite production, ⬆️💩 bulk by⬆️microbial biomass or via water retention, regulates gut motility
🍠soluble fiber improves #IBS symptoms, while insoluble fiber does not (ingentaconnect.com)
🍠psyllium✅
PREBIOTICS
💊do ⬆️bifidobacteria, but❌difference from placebo in response to treatment, abdominal pain, bloating, flatulence (academic.oup.com)
💊💨 may improve with <6 g/d and with non-inulin type fructans, but 💨 may worsen with inulin-type fructans
💊do ⬆️bifidobacteria, but❌difference from placebo in response to treatment, abdominal pain, bloating, flatulence (academic.oup.com)
💊💨 may improve with <6 g/d and with non-inulin type fructans, but 💨 may worsen with inulin-type fructans
HEALTHY EATING
🥑❌evidence for Mediterranean diet
🥑healthy eating, fiber modification, and avoidance of trigger foods shows some improvement, but not nearly as much as low-FODMAP diet
🥑❌evidence for Mediterranean diet
🥑healthy eating, fiber modification, and avoidance of trigger foods shows some improvement, but not nearly as much as low-FODMAP diet
LOW-FODMAP DIET
🫐Fermentable oligosaccharides, disaccharides, monosaccharides and polyols⬆️small bowel💧content & microbiota-mediated colonic💨production, inducing symptoms in people with #IBS
🫐Phases
1⃣elimination of ⬆️FODMAP foods
2⃣systematic reintroduction
3⃣personalization
🫐Fermentable oligosaccharides, disaccharides, monosaccharides and polyols⬆️small bowel💧content & microbiota-mediated colonic💨production, inducing symptoms in people with #IBS
🫐Phases
1⃣elimination of ⬆️FODMAP foods
2⃣systematic reintroduction
3⃣personalization
🫐LFD ⬇️ #IBS symptoms in up to 57% of patients
🫐⚠️concern that the LFD⬇️beneficial bifidobacteria (should we supplement with multistrain #probiotic?)
🫐⚠️restrictive , difficult to follow, and can▶️⬇️fiber, iron, calcium
🫐when considering LFD, refer to RD
🫐⚠️concern that the LFD⬇️beneficial bifidobacteria (should we supplement with multistrain #probiotic?)
🫐⚠️restrictive , difficult to follow, and can▶️⬇️fiber, iron, calcium
🫐when considering LFD, refer to RD
GLUTEN FREE DIET
🍞wheat is a known #IBS trigger, but mechanism❓
🍞studies on GFD for IBS conflicting– meta-analysis: ❌benefit compared to placebo
🍞FRUCTANS (a FODMAP), not gluten may actually be the problem in IBS
🍞wheat is a known #IBS trigger, but mechanism❓
🍞studies on GFD for IBS conflicting– meta-analysis: ❌benefit compared to placebo
🍞FRUCTANS (a FODMAP), not gluten may actually be the problem in IBS
SUMMARY
❌prebiotics, gluten-free diet, aloe vera
✅pepermint oil, certain probiotic strains (and combinations of strains), psyllium (soluble fibers), healthy eating, and low-FODMAP diet
Need to tailor therapy to the individual!
#IBS #GITwitter #GI #gut #microbiome
❌prebiotics, gluten-free diet, aloe vera
✅pepermint oil, certain probiotic strains (and combinations of strains), psyllium (soluble fibers), healthy eating, and low-FODMAP diet
Need to tailor therapy to the individual!
#IBS #GITwitter #GI #gut #microbiome
What dietary therapy/supplements do I recommend in #IBS?
✅healthy #diet🥦
✅⬆️soluble fiber 🥑
✅#probiotics (evidence-based strains!) 🦠
✅peppermint oil 🍵
Thoughts #GITwitter⁉️
#IBS #nutrition #microbiome
✅healthy #diet🥦
✅⬆️soluble fiber 🥑
✅#probiotics (evidence-based strains!) 🦠
✅peppermint oil 🍵
Thoughts #GITwitter⁉️
#IBS #nutrition #microbiome
P.S. Where do I get my #probiotics recommendations?
🦠 💊 🦠 💊 🦠
@aeprobio Clinical Guide to Probiotic Products Available in USA ⬇️⬇️⬇️
usprobioticguide.com
🦠 💊 🦠 💊 🦠
@aeprobio Clinical Guide to Probiotic Products Available in USA ⬇️⬇️⬇️
usprobioticguide.com
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