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Short-chain carbohydrates and functional gastrointestinal disorders.

Abstract

Carbohydrates occur across a range of foods regularly consumed including grains such as wheat and rye, vegetables, fruits, and legumes. Short-chain carbohydrates with chains of up to 10 sugars vary in their digestibility and subsequent absorption. Those that are poorly absorbed exert osmotic effects in the intestinal lumen increasing its water volume, and are rapidly fermented by bacteria with consequent gas production. These two effects alone may underlie most of the induction of gastrointestinal symptoms after they are ingested in moderate amounts via luminal distension in patients with visceral hypersensitivity. This has been the basis of the use of lactose-free diets in those with lactose malabsorption and of fructose-reduced diets for fructose malabsorption. However, application of such dietary approaches in patients with functional bowel disorders has been restricted to observational studies with uncertain efficacy. As all dietary poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, a concept has been developed to regard them collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and to evaluate a dietary approach that restricts them all. In patients with irritable bowel syndrome, there is now an accumulating body of evidence, based on observational and comparative studies, and on randomized-controlled trials that supports the notion that FODMAPs trigger gastrointestinal symptoms in patients with functional bowel disorders, and that a diet low in FODMAPs offers considerable symptom relief in the majority of patients who use it.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Dietetics and Human Nutrition, La Trobe University, Bundoora, Victoria, Australia. s.shepherd@latrobe.edu.au

    ,

    Source

    MeSH

    Dietary Carbohydrates
    Edible Grain
    Feeding Behavior
    Fermentation
    Fructose
    Fruit
    Gastrointestinal Diseases
    Humans
    Hydrolysis
    Intestinal Absorption
    Intestine, Small
    Irritable Bowel Syndrome
    Lactose
    Monosaccharides
    Oligosaccharides
    Patient Education as Topic
    Programmed Instruction as Topic
    Vegetables

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    23588241

    Citation

    Shepherd, Susan J., et al. "Short-chain Carbohydrates and Functional Gastrointestinal Disorders." The American Journal of Gastroenterology, vol. 108, no. 5, 2013, pp. 707-17.
    Shepherd SJ, Lomer MC, Gibson PR. Short-chain carbohydrates and functional gastrointestinal disorders. Am J Gastroenterol. 2013;108(5):707-17.
    Shepherd, S. J., Lomer, M. C., & Gibson, P. R. (2013). Short-chain carbohydrates and functional gastrointestinal disorders. The American Journal of Gastroenterology, 108(5), pp. 707-17. doi:10.1038/ajg.2013.96.
    Shepherd SJ, Lomer MC, Gibson PR. Short-chain Carbohydrates and Functional Gastrointestinal Disorders. Am J Gastroenterol. 2013;108(5):707-17. PubMed PMID: 23588241.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Short-chain carbohydrates and functional gastrointestinal disorders. AU - Shepherd,Susan J, AU - Lomer,Miranda C E, AU - Gibson,Peter R, Y1 - 2013/04/16/ PY - 2013/4/17/entrez PY - 2013/4/17/pubmed PY - 2013/6/26/medline SP - 707 EP - 17 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 108 IS - 5 N2 - Carbohydrates occur across a range of foods regularly consumed including grains such as wheat and rye, vegetables, fruits, and legumes. Short-chain carbohydrates with chains of up to 10 sugars vary in their digestibility and subsequent absorption. Those that are poorly absorbed exert osmotic effects in the intestinal lumen increasing its water volume, and are rapidly fermented by bacteria with consequent gas production. These two effects alone may underlie most of the induction of gastrointestinal symptoms after they are ingested in moderate amounts via luminal distension in patients with visceral hypersensitivity. This has been the basis of the use of lactose-free diets in those with lactose malabsorption and of fructose-reduced diets for fructose malabsorption. However, application of such dietary approaches in patients with functional bowel disorders has been restricted to observational studies with uncertain efficacy. As all dietary poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, a concept has been developed to regard them collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and to evaluate a dietary approach that restricts them all. In patients with irritable bowel syndrome, there is now an accumulating body of evidence, based on observational and comparative studies, and on randomized-controlled trials that supports the notion that FODMAPs trigger gastrointestinal symptoms in patients with functional bowel disorders, and that a diet low in FODMAPs offers considerable symptom relief in the majority of patients who use it. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/23588241/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=23588241 DB - PRIME DP - Unbound Medicine ER -