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Diet, lifestyle outweigh genetic impact on gut microbiome
Rothschild D, et al. Nature. 2018;doi:10.1038/nature25973.
March 16, 2018
Genetics play a surprisingly minor role in shaping the gut microbiome, while environmental factors like diet and lifestyle appear to have the greatest impact, according to new research published in Nature.
These findings provide strong new evidence supporting the concept of modifying the gut microbiota to improve human health, investigators from the Weizmann Institute of Science in Israel concluded.
"We cannot change our genes, but we now know that we can affect — and even reshape — the composition of the different kinds of bacteria we host in our bodies," study investigator Eran Segal, PhD, of the departments of computer science and applied mathematics, and molecular cell biology at Weizmann, said in a press release. "So, the findings of our research are quite hopeful; they suggest that our microbiome could be a powerful means for improving our health."
To test the hypothesis that differences in gut microbiota composition between individuals is largely determined by their genes, Segal and colleagues analyzed genotype and microbiome data from 1,046 healthy Israelis who participated in a longitudinal nutrition study. As the Israeli population is highly diverse, the study included participants with varied genetic ancestry, making this setting ideal for the genetic aspect of the study, investigators noted.
They found that the gut microbiome did not significantly correlate with genetic ancestry, and that an individual's genes play only a minor role in determining their gut microbiota composition, accounting for just about 2% of the variation observed between populations.
Further, they found genetically unrelated people who lived in the same household showed significant similarities in gut microbiota composition, while relatives with no history of living together shared no significant similarities in their microbiomes.
In contrast, they found that environmental factors like diet, drugs and anthropometric measurements accounted for more than 20% of the gut microbiota variation observed between individuals. They also showed that gut microbiome composition was as good or superior to genetics for predicting clinical measures like BMI, fasting glucose levels, glycemic status, high-density lipoprotein levels, cholesterol, waist and hip circumference, waist-hip ratio and lactose consumption.
"Our results demonstrate that the gut microbiome is predominantly shaped by environmental factors, and is strongly correlated with many human phenotypes after accounting for host genetics," Segal and colleagues concluded. This suggests that modulating the microbiome to improve clinical outcomes should work across diverse genetic backgrounds, they added. – by Adam Leitenberger
https://www.healio.com/gastroenterology/nutrition/news/online/%7Bf8eaf908-ecc4-47bb-81d3-0df8edf7423b%7D/diet-lifestyle-outweigh-genetic-impact-on-gut-microbiome?utm_source=selligent&utm_medium=email&utm_campaign=gastroenterology%20news&m_bt=428850516595
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Prebiotics vs a Diet Low in Fodmaps in Patients with Functional Gut Disorder
Quick Summary:
Prebiotic supplementation could replace the low FODMAPs diet as a treatment for functional gut disorders (IBS, constipation, functional dyspepsia, etc.). A 4-week study compared the effects of a prebiotic supplement plus Mediterranean-type diet, versus a placebo supplement plus low FODMAP diet for 2 weeks. Fecal microbiota composition, intestinal gas production, and digestive sensations were measured outcomes. After 4 weeks, both groups showed improvements in GI symptoms but only the prebiotic group showed significant improvements in microbial composition. (The FODMAP group actually showed an increase in pathogenic-associated bacteria). Two weeks after the intervention, improvement persisted in the prebiotic group but not in the FODMAP group.
The low FODMAP diet was created as a diagnostic tool for IBS, not as a therapeutic diet. While it may alleviate symptoms, it does not treat the condition at its root and may deplete the gut microbiome of beneficial gut bacteria – the very thing we want to increase in those with functional GI disorders. This study illustrates that well.
Quote
Formal Abstract
Prebiotics and diets low in fermentable residues (low-FODMAP diet) might reduce symptoms in patients with functional gastrointestinal disorders, despite reports that some non-absorbable, fermentable meal products (prebiotics) provide substrates for colonic bacteria and thereby increase gas production. We performed a randomized, parallel, double-blind study of patients with functional gastrointestinal disorders with flatulence.
We compared the effects of a prebiotic supplement (2.8 g/day Bimuno containing 1.37g B-GOS) plus a placebo (Mediterranean-type diet; prebiotic group, n=19) vs a placebo supplement (2.8 g glucose) plus a diet low in fermentable oligo-, di-, mono-saccharides and polyols (low-FODMAP group, n=21) for 4 weeks; patients were then followed for 2 weeks. The primary outcome was effects on composition of the fecal microbiota, analyzed by 16S sequencing. Secondary outcomes were intestinal gas production and digestive sensations. After 4 weeks, we observed opposite effects on microbiota in each group—particularly in relation to the abundance of Bifidobacterium sequences (increase in the prebiotic group and decrease in the low-FODMAP group; P=.042), and Bilophila wadsworthia (decrease in the prebiotic group and increase in the low-FODMAP group; P=.050).
After 4 weeks, both groups had statistically significant reductions in all symptom scores, except reductions in flatulence and borborygmi were not significant in the prebiotic group. Although the decrease in symptoms persisted for 2 weeks after patients discontinued prebiotic supplementation, symptoms reappeared immediately after patients discontinued the low-FODMAP diet. Intermittent prebiotic administration might therefore be an alternative to dietary restrictions for patients with functional gut symptoms. ClinicalTrials.gov no: NCT02210572.
Key words
intestinal gas
microbiota
functional intestinal disorders
https://www.sciencedirect.com/science/article/pii/S0016508518346870
Study Source:
Effects of Prebiotics vs a Diet Low in Fodmaps in Patients with Functional Gut Disorder
Author links-
WalterHuaman12MarianelaMego1ChaysavanhManichanh1NicolauCańellas34DanielCańueto3HegoiSegurola5MartaJansana6CarolinaMalagelada1AnnaAccarino1JelenaVulevic7GeorgeTzortzis7GlennGibson8EstebanSaperas2FranciscoGuarner1FernandoAzpiroz1
1
Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Universitat Autňnoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallčs), Spain
2
Department of Gastroenterology, University Hospital General of Catalonia, San Cugat del Valles, Barcelona, Spain
3
Metabolomics Platform, Universitat Rovira i Virgili, Campus Sescelades; Tarragona, Spain
4
Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (Ciberdem)
5
Nutritional Support Unit, University Hospital Vall d'Hebron, Barcelona, Spain
6
Department of Endocrinology and Nutrition, University Hospital General of Catalonia, San Cugat del Valles, Barcelona, Spain
7
Clasado Research Services Ltd, Science and Technology Centre, University of Reading, Early Gate, Reading, UK
8
Food Microbial Sciences Unit, Department of Food and Nutritional Sciences, The University of Reading, Whiteknights, Reading, UK
Received 27 February 2018, Revised 19 June 2018, Accepted 22 June 2018, Available online 30 June 2018.
https://doi.org/10.1053/j.gastro.2018.06.045
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Insufficient evidence to support gluten-free diet for IBS
Dionne J, et al. Am J Gastroenterol. 2018:doi:10.1038/s41395-018-0195-4.
August 7, 2018
New research revealed a lack of evidence to support initiating a gluten-free diet to alleviate symptoms of irritable bowel syndrome.
However, Joanna Dionne, MD, MSc, FRCP, PhD, of the division of gastroenterology at McMaster University in Hamilton, Ontario, and colleagues found that a diet low in fermentable oligo-, di- and monosaccharides and polyols (FODMAPs) did help reduce symptoms in patients with IBS.
Because of the dietary triggers of IBS, Dionne and colleagues wrote that many patients turn to dietary approaches to treat their symptoms.
“It is important to give patients evidence-based advice on which diets may be effective in reducing their symptoms,” they wrote. “Initial approaches that based dietary recommendations for food sensitivities had disappointing efficacy in randomized trials, but recent dietary approaches have shown more promise.”
Dionne and colleagues conducted a systematic review and meta-analysis of the literature and searched for randomized controlled trials that evaluated an exclusion diet vs. an alternative or usual diet. Inclusion required that the trials had to assess improvement in either global IBS symptoms or abdominal pain.
Nine studies that fit their criteria: two centered on a gluten-free diet (n = 111) and seven assessed a low-FODMAP diet (n = 397).
Dionne and colleagues found that a gluten-free diet was associated with reduced global symptoms compared with a control diet (RR = 0.42; 95% CI, 0.11-1.55). However, the link was not statistically significant.
Additionally, they found that a low-FODMAP diet was associated with reduced symptoms compared with control diets (RR = 0.69; 95% CI, 0.54-0.88).
Although they found evidence to support the use of a low-FODMAP diet for IBS, Dionne and colleagues wrote that the quality of data was not strong because the trials used different comparator groups and included a relatively low number of patients.
“The findings of this review demonstrate that, at present, there is insufficient evidence to recommend a [gluten-free diet] to reduce global IBS symptoms,” the researchers wrote. “There is very low-quality evidence that a low-FODMAP diet is effective in reducing global symptoms in IBS patients. More data are needed, but of the available dietary interventions, a low-FODMAP diet currently has the greatest evidence for efficacy in IBS.” â€" by Alex Young
https://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7Be0111ecd-2409-42da-89af-70133e78f21b%7D/insufficient-evidence-to-support-gluten-free-diet-for-ibs
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American College of Physicians Internal Medicine Meeting
'Complicated' relationship exists between irritable bowel syndrome, low FODMAP diet
April 17, 2019
PHILADELPHIA — The FODMAP diet may offer benefits for some patients with irritable bowel syndrome, but is not a fit for all patients, a speaker at the American College of Physicians Internal Medicine Meeting suggested.
Patients following the low-FODMAP eating pattern (fermentable oligo, disaccharides, monosaccharaides and polyols) can consume certain fruits, vegetables, meats and nuts; most gluten-free pasta products and lactose-free dairy products; certain cheeses; and artificial sweeteners that do not end in -ol, according to the U.S. Department of Agriculture website.
Though pharmaceutical options such as Amitiza (lubiprostone, Takeda), Linzess (linaclotide, Allergan) and Trulance (plecanatide, Synergy Pharmaceuticals) have strong recommendations and high or moderate levels of evidence to support their use as IBS treatment, "low FODMAP ... is becoming increasing popular for patients with IBS. Though there are certainly patient subsets who would absolutely benefit from it, we don't know how to pre-emptively identify them yet," Brooks D. Cash, MD, FACP, chief of gastroenterology, hepatology and nutrition at McGovern Medical School at the University of Texas Health Science Center, told attendees.
"The theory behind the low FODMAP diet is both somewhat complicated and also pretty simple," Cash continued. "The low FODMAP diet produces an osmotic effect from poorly digested carbohydrates that impacts motility, biomass and the microbiome, and perhaps leads to gastrointestinal symptoms such as bloating, flatulating, visceral sensations and cognitive symptoms. Our microbiome loves these types of foods and that's where the foods make a lot of gas as they digest or metabolize these poorly digested carbohydrates."
Cash discussed the limited research examining the link between low FODMAP and IBS.
In a study of approximately 80 participants, where about half ate a low FODMAP diet and the others ate a modified NICE diet (eating healthy foods, decreasing or eliminating alcohol and fats and avoiding huge portions and eating late at night), more of those following low FODMAP saw significant improvements in their abdominal pain, bloating and scores on quality of life questionnaire, but global IBS outcomes between the groups were not significantly different. In a second study, 19 in the low-FODMAP group had a 50% or greater reduction in their IBS severity vs. 17 in the modified NICE group.
"These studies are hard to recruit for, and it can be hard to mask the foods. ... This data is somewhat waffly in terms of significance, but it shows how low FODMAP can play an important role in these patients," he said.
The long-standing philosophy of healthy eating occasionally gets detoured when it comes to irritable bowel syndrome and the low fermentable oligo, disaccharides, monosaccharaides and polyols, or FODMAP, diet, a speaker at the American College of Physicians Internal Medicine Meeting suggested.
"But that's not to say there are not issues with low FODMAP," Cash continued. "What is the cutoff for FODMAP content? Resources differ on low FODMAP diets, most patients can't stick to the diet, there are theoretical nutritional issues with its longterm use, and it can be time-consuming to counsel patients."
The complexity and improved understanding of how diet affects health shows the need for consultation when suggesting such a diet, he said.
"When I was a fledging gastroenterologist I used to [show the patient] Google and say, 'here try this.' I know now that is not fair to our patients and I no longer do this. I would urge you all to do what I do: use a dietician or nutritionist to help with these patients," Cash said. – by Janel Miller
References: Cash BD. "Irritable bowel syndrome: New hope for an old problem." Presented at: American College of Physicians Internal Medicine Meeting; April 11-13, 2019; Philadelphia.
U.S. Department of Agriculture. "Digestive diseases and disorders." https://www.nal.usda.gov/fnic/digestive-diseases-and-disorders. Accessed April 15, 2019.
https://www.healio.com/family-medicine/gastroenterology/news/online/%7B97a61530-8392-41b5-91df-8b356ba2f2dd%7D/lsquocomplicatedrsquo-relationship-between-irritable-bowel-syndrome-low-fodmap-diet-
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When chronic illness leads to eating disorders in young people
By Naveed Saleh, MD, MS ' Medically reviewed by Amanda Zeglis, DO, MBA '
Published June 27, 2022
Diseases that require patients to follow lifelong diets can warp a child’s relationship with food, which could result in disordered eating and eating disorders.
Disordered eating can impair a young person’s health-related quality of life and lower their psychosocial health.
To combat the risk of eating disorders, physicians should screen to combat negative body image and disordered eating early, and learn more about how to treat disordered eating.
Here’s a sad thought: Not every child can enjoy the occasional ice cream cone or candy bar with reckless abandon.
For those with type 1 diabetes or chronic gastrointestinal disease, diets have to be closely monitored.
Strict diets, however, can place young patients down a path that begins with altered perceptions about food and possibly ends with a life-altering eating disorder.
It’s important for physicians to be aware of these outcomes and work to optimally manage food perceptions.
Proposed mechanism
Authors of a review published in Advances in Nutrition hypothesized how treatment of diet-related chronic health conditions (DRCHCs) such as inflammatory bowel disease (IBD), type 1 diabetes mellitus (T1DM), cystic fibrosis (CF), and irritable bowel syndrome can eventually result in eating disorders.
These diseases require patients to follow a lifelong diet. The diets place pressure on kids that can result in destructive perceptions of food and body weight, as well as unhealthy eating habits.
Increased concern over body weight and diet in children with DRHCs compared with their healthy cohorts could then lead to disordered eating such as binging, purging, or extreme dieting, which could lead to eating disorders.
“Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population,” the authors wrote, “overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment.”
In a review published in the International Journal of Eating Disorders, researchers found that diet-treated chronic illness was related to disordered eating as well as eating disorders.
Treating chronic illness with diet preceded disordered eating in diabetes, celiac disease, and GI disordersâ€"but not IBD.
The researchers found that disordered eating alongside unhealthy weight management increased the risk that children would experience poor clinical outcomes.
Repercussions
Results of a systematic review and meta-analysis published in PLOS ONE showed that disordered eating attitudes and behaviors predicted lower health-related quality of life (HRQOL) in children and teens compared with their healthy peers.
Similarly, disordered eating correlated with diminished psychosocial health.
The authors suggested that “health programs for promoting healthy eating and reducing disordered eating behaviors among school children and adolescents may help to enhance the HRQOL and overall health status of these individuals.”
What can be done
Authors of the review published in Advances in Nutrition mentioned interventions intended to curb the risk of eating disorders in children with DRHCs.
At routine visits, children can be screened early to combat negative body image and disordered eating. When identified, providers can intervene before harmful attitudes and behaviors change into eating disorders.
“Healthcare providers should be aware that young people with DRCHCs may be at risk of eating disorders, and carefully monitor psychological changes and the use of unhealthy weight control methods.”
â€" Quick, et al.
Clinicians can also be better trained on how to detect and treat disordered eating. Previous research has demonstrated that physicians who treat T1DM, for instance, have limited training in eating disorder management.
The authors stressed that it’s imperative to develop effective intervention and screening tools. These could cease the progression to eating disorders and mitigate detrimental health outcomes in younger people with DRCHCs.
Authors of the review published in International Journal of Eating Disorders pointed out the conundrum that clinicians face. Diet-treated chronic illness needs young people to closely consider diet and weight, but doing so may increase the odds of disordered eating.
“Future research is needed to elucidate the mechanisms that transform standard treatment practices into pathological eating, including characteristics and behaviors of the child, parents/care providers, family, and treatment providers.”
â€" Conviser, et al.
What this means for you
It’s tough when your younger patients have to deal with DRHCs. While their peers are enjoying sugary, salty, or high-calorie treats, kids with illnesses such as diabetes or CF cannot partake. This can lead to distorted perceptions of food, disordered eating or even eating disorders. As a physician, it’s important to screen them for disordered eating and remain informed of appropriate interventions to decrease the risk of future eating disorders.
https://www.mdlinx.com/article/when-chronic-illness-leads-to-eating-disorders-in-young-people/6rg4upMtkLWZpM7hSzmI2l
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