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

Fructan content of commonly consumed wheat, rye and gluten-free breads

Fructans are non-digestible carbohydrates with various nutritional properties including effects on microbial metabolism, mineral absorption and satiety. They are present in a range of plant foods, with wheat being an important source. The aim of the present study was to measure the fructan content of a range of wheat, rye and gluten-free breads consumed in the United Kingdom. Fructans were measured in a range of breads using selective enzymic hydrolysis and spectrophotometry based on the AOAC 999.03 method. The breads generally contained low quantities of fructan (0.611.94 g/100 g), with rye bread being the richest source (1.94 g/100 g). Surprisingly, gluten-free bread contained similar quantities of fructan (1.00 g/100 g) as other breads. There was wide variation in fructan content between individual brands of granary (0.761.09 g/100 g) and gluten-free breads (0.361.79 g/100 g). Although they contain only low quantities of fructan, the widespread consumption of bread may make a significant contribution to fructan intakes

Erythrocyte folate and 5-methyltetrahydrofolate levels decline during 6 months of oral anticoagulation with warfarin

Dietary fluctuations of vitamin K are detrimental to oral anticoagulant control. Attempts to improve control through the avoidance of vitamin K-rich foods (mainly green vegetables) may inadvertently compromise folate status, itself a risk factor for thromboembolism. We evaluated the effect of a 6-month period of warfarin therapy on folate status in 114 patients using measurements of red-cell folate and 5-methyltetrahydrofolate and plasma folate and total homocysteine. Circulatory levels of phylloquinone, vitamin B12 and methylmalonic acid were also determined. A subset of 45 patients completed 7-day food diaries at the beginning and end of their treatment. There was a significant decrease in total erythrocyte folate (P = 0.005) and 5-methyltetrahydrofolate (P = 0.002) during the study. A concurrent increase in plasma phylloquinone (P = 0.003) was attributed to warfarin-induced perturbation of vitamin K metabolism. No other longitudinal changes were observed. Folate and phylloquinone intakes correlated with each other at baseline (P = 0.024) and after treatment (P = 0.011). Based on robust measurements of erythrocyte folates, patients showed a significant impairment in folate status after 6-month therapy with warfarin. The majority of patients had intakes of folate and phylloquinone below the national average or UK guidelines. The study highlights the need for improved dietary management of patients taking oral anticoagulants.</p

Iron requirements based upon iron absorption tests are poorly predicted by haematological indices in patients with inactive inflammatory bowel disease

Iron deficiency (ID) and iron deficiency anaemia (IDA) are common in patients with inflammatory bowel disease (IBD). Traditional clinical markers of iron status can be skewed in the presence of inflammation meaning that a patient’s iron status can be misinterpreted. Additionally, iron absorption is known to be down-regulated in patients with active IBD. However, whether this is the case for quiescent or mildly active disease has not been formally assessed. This study aimed to investigate the relationship between iron absorption, iron requirements and standard haematological indices in IBD patients without active disease. Twenty nine patients with quiescent or mildly active IBD and 28 control subjects undertook an iron absorption test which measured sequential rises in serum iron over four hours following ingestion of 200 mg ferrous sulphate. At baseline, serum iron, transferrin saturation, non-transferrin bound iron (NTBI), ferritin and soluble transferrin receptor were all measured. Thereafter (30-240 minutes) only serum iron and NTBI were measured. Iron absorption did not differ between the two groups (P=0.9; RM-ANOVA). In control subjects baseline haematological parameters predicted iron absorption (i.e. iron requirements) but this was not the case for patients with IBD. Iron absorption is normal in quiescent or mildly active IBD patients but standard haematological parameters do not accurately predict iron requirements