The Impact of Almonds and Almond Processing On Gastrointestinal Physiology, Luminal Microbiology and Gastrointestinal Symptoms: a Randomized Controlled Trial and Mastication Study.

BACKGROUND: Almonds contain lipid, fiber and polyphenols and possess physicochemical properties that impact nutrient bioaccessibility, which are hypothesized to impact gut physiology and microbiota. OBJECTIVES: Investigate the impact of whole almonds and ground almonds (almond flour) on fecal bifidobacteria (primary outcome), gut microbiota composition and transit time. DESIGN: Healthy adults (n = 87) participated in a parallel, 3-arm randomized controlled trial. Participants received whole almonds (56 g/d), ground almonds (56 g/d) or an isocaloric control muffin in place of habitual snacks for 4 weeks. Gut microbiota composition and diversity (16S rRNA gene sequencing), short-chain fatty acids (gas-chromatography), volatile organic compounds (gas-chromatography mass-spectrometry), gut transit time (wireless motility capsule), stool output and gut symptoms (7-day diary) were measured at baseline and endpoint. The impact of almond form on particle size distribution (PSD) and predicted lipid release was measured in a subgroup (n = 31). RESULTS: Modified intention-to-treat analysis was performed on 79 participants. There were no significant differences in abundance of fecal bifidobacteria following consumption of whole almonds (8.7%, SD 7.7%), ground almonds (7.8%, SD 6.9%) or control (13.0%, SD 10.2%; q = 0.613). Consumption of almonds (whole and ground pooled) resulted in higher butyrate (24.1 μmol/g, SD 15.0 μmol/g) in comparison to control (18.2 μmol/g, SD 9.1 μmol/g; p = 0.046). There was no effect of almonds on gut microbiota at the phylum level or diversity, gut transit time, stool consistency or gut symptoms. Almond form (whole versus ground) had no effect on study outcomes. Ground almonds resulted in significantly smaller PSD and higher predicted lipid release (10.4%, SD 1.8%) in comparison to whole almonds (9.3%, SD 2.0%; p = 0.017). CONCLUSIONS: Almond consumption has limited impact on gut microbiota composition but increases butyrate concentrations in adults, suggesting positive alterations to microbiota functionality. Almonds can be incorporated into the diet to increase fiber consumption without triggering gut symptoms. Clinical trial registry: ClinicalTrials.gov identifier - NCT03581812

Chronic constipation in adults: Contemporary perspectives and clinical challenges. 2: Conservative, behavioural, medical and surgical treatment

BACKGROUND: Chronic constipation is a prevalent disorder that affects quality of life of patients and consumes resources in healthcare systems worldwide. In clinical practice, it is still considered a challenge as clinicians frequently are unsure as to which treatments to use and when. Over a decade ago, a Neurogastroenterology and Motility journal supplement devoted to the investigation and management of constipation was published (Neurogastroenterol Motil 2009;21(Suppl 2):1). In October 2018, the 3rd London Masterclass, entitled "Contemporary management of constipation" was held. The faculty members of this symposium were invited to write two reviews to present a collective synthesis of talks presented and discussions held during this meeting. The first review addresses epidemiology, diagnosis, clinical associations, pathophysiology, and investigation. PURPOSE: The present is the second of these reviews, providing contemporary perspectives and clinical challenges regarding behavioral, conservative, medical, and surgical treatments for patients presenting with constipation. It includes a management algorithm to guide clinical practice

Probiotics and constipation: mechanisms of action, evidence for effectiveness and utilisation by patients and healthcare professionals

This article has been published in a revised form in Proceedings of the Nutrition Society https://doi.org/10.1017/S0029665119000934. This version is free to view and download for private research and study only. Not for re-distribution or re-use. © copyright holder

Gut Symptoms during FODMAP Restriction and Symptom Response to Food Challenges during FODMAP Reintroduction: A Real-World Evaluation in 21,462 Participants Using a Mobile Application

Background: There is limited evidence regarding the use of low FODMAP diet apps. This study aimed to evaluate the effectiveness of an app intended to reduce symptoms in FODMAP restriction and symptoms and tolerance of high FODMAP food challenges during FODMAP reintroduction and personalisation. Methods: Data were collected from 21,462 users of a low FODMAP diet app. Self-reported gut symptoms during FODMAP restriction, reintroduction, and personalisation and dietary triggers were identified from symptom response data for FODMAP food challenges. Results: Compared with baseline, at the end of FODMAP restriction, participants (n = 20,553) reported significantly less overall symptoms (11,689 (57%) versus 9105 (44%)), abdominal pain (8196 (40%) versus 6822 (33%)), bloating (11,265 (55%) versus 9146 (44%)), flatulence (10,318 (50%) 8272 (40%)), and diarrhoea (6284 (31%) versus 4961 (24%)) and significantly more constipation (5448 (27%) versus 5923 (29%)) (p n = 2053) completed 8760 food challenges; the five most frequent challenges and n/N (%) of dietary triggers identified were wheat bread 474/1146 (41%), onion 359/918 (39%), garlic 245/699 (35%), milk 274/687 (40%), and wheat pasta 222/548 (41%). The most frequently reported symptoms during food challenges were overall symptoms, abdominal pain, bloating, and flatulence. Conclusions: In a real-world setting, a low FODMAP diet app can help users improve gut symptoms and detect dietary triggers for long-term self-management

Perceptions of Constipation Among the General Public and People With Constipation Differ Strikingly From Those of General and Specialist Doctors and the Rome IV Criteria

This is the accepted manuscript of an article published in American Journal of Gastroenterology. The final version is available online: https://doi.org/10.14309/ajg.0000000000000267Neste

Almonds and their impact on gastrointestinal physiology, luminal microbiology and gastrointestinal function: a randomised controlled trial

OBJECTIVES: The objective of this study was to investigate the impact of almonds, and almond form (whole, ground) on fecal Bifidobacteria (primary outcome) and gut microbiology, physiology, and symptoms in healthy adults. METHODS: Eighty-seven healthy adults with moderate fiber intake (<22g/d) were randomized to receive whole almonds (56 g/d), ground almonds (56 g/d) or a control muffin (2/d) in place of their habitual snacks for 4 weeks. Fecal Bifidobacteria, gut microbiota composition and diversity (16S rRNA sequencing), short-chain fatty acids (SCFA; gas-chromatography), volatile organic compounds (gas-chromatography mass-spectrometry), gut transit time (wireless motility capsule), and stool output and symptoms (7-day diary) were measured at baseline and at end of intervention. Differences between groups were assessed by analysis of covariance (ANCOVA) or a non-parametric equivalent and corrected for multiple testing (Bonferroni (p) or Benjamini-Hochberg FDR (q)) where appropriate. RESULTS: There were no differences in relative abundance of fecal bifidobacteria following 4-weeks consumption of whole almonds (8.7%, SD 7.7), ground almonds (7.8%, SD 6.9) or control (13.0%, SD 10.2; q = 0.613). There was no effect of almonds on gut microbiota at the phylum level or on diversity. At the genus level, almonds (whole and ground pooled) increased relative abundance of Lachnospiraceae_NK4A136_group, Phascolarctobacterium and decreased Tyzerella (all p < 0.05), however these were no longer significant following FDR adjustment. Pre-specified analysis comparing almonds (whole and ground pooled) demonstrated higher concentrations of butyrate (24.1 μmol/g, SD 15.0) versus control (18.2, SD 9.1; p = 0.046). There was no effect of almonds on gut transit time, stool consistency or gut symptoms. Almond form as either whole (low nutrient bioaccessibility) or ground (higher nutrient bioaccessibility) did not affect any outcome. CONCLUSIONS: Almonds are a high fibre snack that can be incorporated into the diet of moderate fibre consumers with no adverse gastrointestinal symptoms. Almonds do not have major impact on global microbiota composition but may exert a prebiotic effect on microbial metabolism in healthy adults. FUNDING SOURCES: The Almond Board of California