FODMAPS: Presenta(on Overview

Transcription

1 FODMAPS: Prac%cal Applica%on in Paediatrics Stephanie Brown, NZRD Paediatric Gastroenterology DieFFan Christchurch Public Hospital Presenta(on Overview What are FODMAPs? FODMAP diet and IBS? Foods high in FODMAPs ApplicaFon in Paediatrics Frequent challenges experienced by pafents and how these are overcome Monash University Smartphone app 1

2 FODMAPs Fermentable rapidly broken down by bacteria in the bowel Oligosaccharides fructans and galacto- oligosaccharides (GOS) Disaccharides lactose Monosaccharides fructose And Polyols sorbitol, mannitol, xylitol and malftol What are FODMAPs? Short- chain carbohydrates that provide fast food for bacteria. Cause the bowel to distend by drawing in more fluid and rapidly generafng gas when they are fermented by bowel bacteria. For some people FODMAPs can cause: diarrhoea, abdominal bloa.ng, abdominal pain, abdominal cramps, cons.pa.on and reflux. A low FODMAP diet can result in an improvement in symptoms. Foods that are not well tolerated and need to be eliminated / eaten in small quanffes can be idenffied. 2

3 How does food affect Irritable Bowel Syndrome (IBS)? People with IBS o_en know that certain foods will trigger their symptoms. Sufferers of IBS aaempt to help themselves. A low- FODMAP diet - cornerstone of treatment for people with IBS. The majority of IBS sufferers who have tried the diet have experienced greatly improved symptoms. It s important to get a confirmed diagnosis from a health professional. A low- FODMAP diet is not suitable for everyone with IBS, can be difficult to do without help and can be very restric.ve nutri.onally if care is not taken. How do FODMAPs contribute to IBS? The large bowel (and the lower part of the small bowel) contain billions of bacteria. If FODMAPs are not absorbed in the small bowel, they confnue the journey to the large bowel. Bacteria quickly break them down, which produces hydrogen, carbon dioxide and methane gases. The effects of FODMAPs can be cumula%ve. We consider all FODMAPs in food when modifying our diet. 3

4 What happens when FODMAPs are mal- absorbed by the small intesfne? Which foods are high in FODMAPs? Oligosaccharides Fructans & Galactooligosaccharides Some vegetables: Beetroot, asparagus, cabbage, garlic, onion and fruits: Grapefruit, nectarine, peach, plum, watermelon, dried cranberries, raisins Legumes, chickpeas Wheat, barley and rye (fructans) Di-saccharides Lactose Dairy products: Cow s/ sheep and goat milk, yoghurt, soft cheeses, custard, ice cream, milk powder Monosaccharides Fructose Some fruits: Apples, figs, mango, pear and vegetables: Peas Other: Honey, processed baking, sports drinks Polyols Sorbitol Mannitol Some fruits: apricots, avocado, blackberries, nectarine, peach, pear and vegetables: Cauliflower, corn, mushroom, kumara, Some artificial sweeteners Chewing gum 4

5 The role of Probio(cs in IBS ProbioFcs are live micro- organisms that confer some health benefits in the gut (supplements and yoghurts) generally safe and well tolerated Lactobacillus and Bifidobacterium are most commonly used Relief of symptoms such as bloafng and flatus in adults We recommend one management strategy at a Fme ProbioFcs may be commenced post- FODMAP diet MarkeFng has preceded scienffic evidence of benefits Label Reading Processed foods (muesli bars, snack foods) Just because it is wheat- free, does not ensure it is low FODMAP Store bought baking Sauces and condiments 5

6 Applica(on in Paediatrics: NutriFon for growth 2-6 weeks in durafon for eliminafon 5 weeks to re- introduce FODMAPs Dietary assessment via 4 day food diary prior to consult Height, weight and BMI Appropriate dietary subsftufons for individual tastes, socioeconomic status, social/home condifons, sport/physical acfvity Food and symptom diary Follow- up appointment for a_er the 6 week eliminafon phase to discuss and implement the re- introducfon of FODMAPs Frequent Challenges Milk in schools (must be lactose free) Fruit in schools (are there appropriate choices?) Peer pressure and compliance (kids will be kids) Managing parental expectafons PotenFal increase in food costs (gluten free & lactose free products can be more costly) Unnecessary over- restricfon of foods / long- term FODMAP diet (=? nutrient deficiencies & potenfal weight loss) 6

7 Case Study Twin girls, aged 8 years Weight 75 th + Height 50 th Diagnosed IBS by Paediatrician Longstanding history of swinging from diarrhoea to consfpafon Abdominal pain and bloafng No allergies, good health, twin x has occasional wheeze with weather change No familial history of IBS or IBD Interven(on Both girls consume 4-5 pieces of fruit daily up to 3 apples Healthy, balanced diets, meefng all nutrifonal requirements Low FODMAP diet 4-6 weeks Follow- up occurred at week six Symptoms greatly improved including no bloat or abdominal pain, more normal stools Commenced the reintroducfon phase 7

8 The Culprit? Apples! Smartphone Apps Variety of apps - can be downloaded via Android or Apple Useful to track intake and symptoms Recipes, food guides, meal plans, diary Some are free and some cost 8

9 Monash University Smartphone App Cost = $9.99 (automafc updates for Apple and Android) User- friendly: Traffic light system Red = High FODMAP (avoid) Amber = Medium FODMAP (limit/porfon dependent) Green = Low FODMAP (eat freely) Contains: Food guide, recipes, frequently asked quesfons, shopping guide and diary Science- based evidence FODMAP App Food Categories Traffic light system Recipes for convenience 9

10 Take home message 1. FODMAPs are short- chained sugars naturally found in certain foods that can exacerbate IBS symptoms 2. The low FODMAP diet is the new gold standard of dietary intervenfon for IBS 3. Currently only accept referrals from Paediatricians / Gastroenterologists 4. It is important that a DieFFan is in involved in the implementafon of a low FODMAP diet to ensure nutrifonal adequacy and appropriate monitoring 5. Follow- up is necessary as this is not meant to be a life- long diet! References: hap:// Waitemata DHB 2013 Canterbury DHB 2015 Evidence- based Dietary Management of FuncFonal GastrointesFnal Symptoms: The FODMAP approach - Journal of Gastroenterology and Hepatology 25 (2010) Pham M, Lemberg DA and Day AS. ProbioFcs: SorFng the Evidence From the Myths MJA vol 188 (2008); A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome - Gastroenterology 2014;146(1)

11 Thank you! QuesFons? 11