Functional dyspepsia (FD) is a prevalent functional gastrointestinal disorder affecting up to 20% of the population. It is characterized by bothersome postprandial fullness, early satiation, epigastric pain, and/or epigastric burning. These symptoms significantly impact daily activities and overall quality of life. As meal ingestion is a key factor in triggering symptoms, dietary modifications are often the first-line management strategy. However, the relationship between specific foods and FD symptoms is complex and often misunderstood. This article aims to provide an evidence-based review of the role of diet in FD, offering practical guidance for managing symptoms through dietary adjustments.
Understanding Functional Dyspepsia
According to the Rome IV criteria, functional dyspepsia is defined by the presence of one or more of the following symptoms:
- Bothersome postprandial fullness
- Bothersome early satiation
- Bothersome epigastric pain
- Bothersome epigastric burning
These symptoms must be present for at least 3 days a week during the last 3 months and must be chronic, with an onset of at least 6 months before diagnosis. It is important to note that these symptoms occur in the absence of any structural diseases, as confirmed by upper endoscopy if necessary.
Subtypes of Functional Dyspepsia
Two primary subtypes of FD have been identified:
- Postprandial Distress Syndrome (PDS): Characterized by bothersome postprandial fullness and/or bothersome early satiation, severe enough to impact typical activities.
- Epigastric Pain Syndrome (EPS): Defined by bothersome epigastric pain and/or burning, also severe enough to impact usual activities.
While meal ingestion clearly triggers symptoms in dyspeptic patients, the time course of symptom development varies. Studies have shown that dyspeptic symptoms can occur rapidly (within 15 minutes) after eating and remain elevated for several hours. Early peaks are common for fullness and bloating, intermediate peaks for nausea and belching, and late peaks for pain and burning.
Read also: The Hoxsey Diet
Pathophysiological Factors
Several factors contribute to the development of FD symptoms:
- Gastric Distension: Hypersensitivity to gastric distension is a key factor, with patients experiencing more intense symptoms than healthy individuals during both fasting and postprandial periods. Gastric distension is also associated with impaired gastric accommodation to meals.
- Impaired Gastric Accommodation: In normal conditions, meal ingestion induces fundic accommodation, followed by slow contractions, antral contractions, and gastric emptying. Patients with FD often have impaired gastric fundic accommodation, leading to symptoms.
- Abnormal Eating Behaviors: Rapid or large volume meal ingestion can overload the gastric accommodation process, generating symptoms. Irregular meal patterns and moderate-to-fast eating rates have been significantly associated with dyspepsia.
- Meal Temperature: Meal temperature may modify gastric perception, with cold temperatures potentially inducing smooth muscle contraction.
The Role of Macronutrients
The spread on the internet of indiscriminate exclusion diets and food intolerance tests often reinforces in patients with functional dyspepsia (FD) the idea of being allergic or intolerant to foods. Physicians are often uncertain regarding the contribution of specific foods in FD and the lack of guidelines and dedicated dietitians, ultimately, leads to conflicting and uneven dietary advises. Here, we provide a pathophysiological-based review of the putative causal relationship between specific foods and symptoms generation in FD and then provide an evidence-based standardized dietary approach, applicable in clinical practice.
Dietary Fat
Dietary fat is a significant factor in triggering symptoms in dyspeptic patients. A high-fat meal is typically associated with a decrease in the gastric emptying rate. Studies have shown that a low-fat, low-calorie dinner induces significantly fewer symptoms than a high-calorie dinner. In experimental conditions, a high-fat meal induced more symptoms than a high-carbohydrate meal, including nausea, bloating, postprandial fullness, and epigastric pain. Cognitive factors also play a role, as high-fat foods elicit more symptoms than low-fat foods. Low-fat foods elicit similar symptoms if patients perceive them as high-fat foods.
It is likely that dyspeptic patients, especially patients with severe symptoms, have determined for themselves that lipids can increase their typical symptoms. No study has reported a relationship between symptoms and the intake of proteins.
Carbohydrates
Data on the role of carbohydrates in FD are conflicting. Some studies report a lower carbohydrate intake associated with the occurrence of symptoms, possibly related to lower energy intake. Other studies report a higher daily intake of carbohydrates in dyspeptic patients compared to controls, though the difference may not be significant.
Read also: Walnut Keto Guide
FODMAPs (Fructo, Oligo, Di-, Monosaccharides And Polyols) are poorly absorbable and highly fermentable substances that may induce bloating and gas sensations. Dyspepsia is associated with grain/pasta/wheat products, soft drinks/carbonated drinks, fruit/fruit juice/watermelon, milk, and takeout/processed foods, most of which contain a large proportion of FODMAPs. A low-FODMAPs diet significantly decreases symptoms in IBS patients. In daily clinical settings, the overlap of both of these syndromes has occurred in 64% in patient questionnaires vs. 23% in routine clinical documentations. Indeed, further randomized studies that are specifically performed with dyspeptic patients are needed to recommend a low-FODMAPs diet in dyspeptic patients as during IBS.
Gluten and Wheat
Functional symptoms, irritable bowel syndrome (IBS), and dyspepsia are frequent occurrences in patients with celiac disease. However, the risk of celiac disease in patients with functional dyspepsia does not seem to be increased. Conversely, a significant percentage of patients diagnosed with celiac disease also fulfill the criteria for functional dyspepsia.
Nonceliac gluten/wheat sensitivity is a syndrome characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, occurring in subjects not affected by either celiac disease or wheat allergies. Dyspeptic symptoms are frequent in patients with nonceliac gluten/wheat sensitivity, with many patients reporting nausea or epigastric pain. Gluten-free diets induce a significant decrease in postprandial fullness, early satiety, and epigastric pain in these patients.
Results of well-conducted, randomized, controlled clinical trials testing the effects of gluten-free diet in dyspeptic patients are still lacking to clearly recommend such diet in patients. Only three studies have examined the relationships between carbohydrates and dyspeptic symptoms, with conflicting results.
Specific Foods and Dietary Habits
Although the contribution of specific foods identified as triggers from FD patients is empirical and diversified, some causal relationships between specific culprit foods and symptoms have been demonstrated. The retrospective nature of most studies and the lack of a standardized method to verify the food-symptom association accounts for the difficulty in drawing up an ultimate list of culprit or beneficial foods. Some of the most frequently reported triggering foods are fatty and acidic foods, wheat products and several types of fruit such as watermelon and fruit juices.
Read also: Weight Loss with Low-FODMAP
Trigger Foods
Certain foods are commonly reported to trigger or worsen dyspeptic symptoms:
- Fatty foods
- Acidic foods (citrus fruits, tomatoes)
- Wheat products
- Carbonated drinks
- Alcohol
- Spicy foods
- Coffee
Eating Habits
Abnormal eating behaviors, such as rapid or large volume meal ingestion, may overload the gastric accommodation process, thus generating symptoms. In a large cohort, irregular meal patterns and moderate-to-fast eating rates were significantly associated with chronic uninvestigated dyspepsia.
Dietary Recommendations for Functional Dyspepsia
Taking into account the above considerations, it is vital to pursue a uniform and evidence-based nutritional approach in the management of FD patients and to design high-quality studies evaluating the impact of nutritional intervention.
General Guidelines
- Eat Smaller, More Frequent Meals: Consuming smaller meals more frequently throughout the day can help reduce gastric distension and improve gastric emptying.
- Avoid Skipping Meals: Having an empty stomach sometimes contributes to functional dyspepsia. Nothing but acid in your stomach may make you feel sick.
- Chew Food Slowly and Completely: This aids digestion and reduces the burden on the stomach.
- Stay Away from Trigger Foods: Identify and avoid foods that trigger your symptoms.
- Maintain a Food Diary: Keep a record of what you eat and how it affects your symptoms to identify personal trigger foods.
- Avoid Overeating: Portion control is crucial to functional dyspepsia management.
Specific Dietary Modifications
- Low-Fat Diet: Reducing fat intake can help alleviate symptoms such as nausea, bloating, and epigastric pain.
- Gluten-Free Diet: If you suspect nonceliac gluten/wheat sensitivity, a gluten-free diet may be beneficial.
- Low-FODMAP Diet: Consider a low-FODMAP diet to reduce bloating and gas sensations.
- Limit Alcohol and Caffeine: Both can irritate the stomach lining and worsen symptoms.
- Probiotics: Probiotic supplements may help reduce symptoms of bloating, nausea, and abdominal pain and normalize bowel habits.
Potential Beneficial Foods
- Ginger: Thanks to its anti-inflammatory and antiemetic properties and its action on gastrointestinal motility, ginger may be helpful.
- Rice: The consumption of rice seems to be safe and well tolerated by FD patients.
- Peppermint and Caraway Oils: A combination of peppermint and caraway oils can effectively relieve gastrointestinal distress.
Other Lifestyle Modifications
- Reduce Stress: Stress-reduction techniques or relaxation therapy may help you manage your symptoms.
- Maintain a Healthy Weight: Weight gain increases the pressure on the abdomen and pushes the stomach up. This can cause the stomach acid to regurgitate into the esophagus.
- Elevate Your Head While Sleeping: At night, elevate your head approximately six inches. This encourages digestive juices to flow down to your intestines rather than backing up into your esophagus.
- Wear Loose Clothing: Loose clothing is kind to your digestive tract.
- Improve Posture: Poor posture is also responsible for compressing the stomach and hampering the proper flow of digestive juices.
Medical Treatments
Functional dyspepsia that can't be managed with lifestyle changes may need treatment. Treatment depends on symptoms.
Medicines
Some medicines may help manage symptoms of functional dyspepsia.
- Gas remedies: An ingredient called simethicone may provide some relief by reducing intestinal gas.
- Medicines to reduce acid production: These medicines are called H-2-receptor blockers and are available without a prescription. They include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid AR). Proton pump inhibitors available without a prescription include lansoprazole (Prevacid 24HR), omeprazole (Prilosec OTC) and esomeprazole (Nexium 24HR).
- Antibiotics: If tests find H. pylori, antibiotics may be prescribed to kill the bacteria.
- Low-dose antidepressants: Low doses of tricyclic antidepressants and antidepressants known as selective serotonin reuptake inhibitors may be recommended.
- Prokinetics: These medicines help the stomach empty faster and tighten the valve between the stomach and esophagus.
- Medicines to relieve nausea: These medicines are called anti-emetics. If you feel like throwing up after eating, anti-emetics may help.
Behavior Therapy
Working with a counselor or therapist may relieve symptoms that aren't helped by medicines. A counselor or therapist can show you relaxation techniques to help you cope with your symptoms.
tags: #diet #for #functional #dyspepsia