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Low-FODMAP diet NOT superior to traditional diet for reducing IBS symptoms new
      #371674 - 11/24/14 10:17 AM
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Low-FODMAP diet not superior to traditional diet for reducing GI symptoms of IBS
November 24, 2014

Traditional dietary advice for irritable bowel syndrome had comparable efficacy to a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols — or FODMAP — in improving gastrointestinal symptoms, according to data presented at UEG Week.

"The aim of the study was to perform a randomized controlled trial to compare the effect on IBS symptoms of a low-FODMAP diet compared with traditional dietary advice in outpatients with IBS in a setting resembling standard clinical practice, and to perform this study in a single-blinded design," Lena Böhn, PhD student in the department of internal medicine and clinical nutrition, Center for Person-Centered Care at Sahlgrenska Academy, Sweden, told Healio Gastroenterology.


Sixty-five patients with IBS (54 women; median age, 43 years [range, 19-68]) from three hospitals in Sweden were assigned to traditional dietary advice for IBS (n=33) or low-FODMAP dietary instructions (n=32), to which they were masked. Symptom intensity was measured using the IBS Severity Scoring System (IBS-SSS) at baseline and at the end of the 4-week treatment period.

At the end of the treatment period, 56% of the low-FODMAP group responded to treatment compared with 52% of the traditional diet group, and comparable response was consistent in analysis of patients with moderate and severe IBS. Both low-FODMAP (P=.001) and traditional diet (P<.001) reduced IBS-SSS scores with comparable efficacy overall, and in abdominal pain severity and frequency, dissatisfaction with bowel habits and quality of life. However, there was a trend for greater reduction in abdominal distension with traditional diet (P=.08).

"Providing dietary advice to patients with IBS is efficient in reducing gastrointestinal symptoms," Böhn said. "However, both a low-FODMAP diet and traditional IBS diet improved IBS symptoms, without any clear differences between the two strategies. This means that a combination of the two diets is [preferable], on an individual basis."



For more information:

Böhn L. Abstract OP007. Presented at: UEG Week; Oct. 18-22, 2014; Vienna.

Disclosure: The researchers report no relevant financial disclosures.

http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B82469680-7ac4-480d-9710-c65c7b83842b%7D/low-fodmap-diet-not-superior-to-traditional-diet-for-reducing-gi-symptoms-of-ibs

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Intestinal Microbiota And Diet in IBS new
      #371858 - 01/27/15 11:50 AM
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Review

Am J Gastroenterol advance online publication 27 January 2015; doi: 10.1038/ajg.2014.427

Intestinal Microbiota And Diet in IBS: Causes, Consequences, or Epiphenomena?

Open

Mirjana Rajili&#263;-Stojanovi&#263; PhD1, Daisy M Jonkers PhD2, Anne Salonen PhD3, Kurt Hanevik MD, PhD4, Jeroen Raes PhD5, Jonna Jalanka PhD6, Willem M de Vos PhD3,6,7, Chaysavanh Manichanh PhD8, Natasa Golic PhD9, Paul Enck PhD10, Elena Philippou PhD11, Fuad A Iraqi PhD12, Gerard Clarke PhD13, Robin C Spiller MD, PhD14 and John Penders PhD15

Abstract

Irritable bowel syndrome (IBS) is a heterogeneous functional disorder with a multifactorial etiology that involves the interplay of both host and environmental factors. Among environmental factors relevant for IBS etiology, the diet stands out given that the majority of IBS patients report their symptoms to be triggered by meals or specific foods. The diet provides substrates for microbial fermentation, and, as the composition of the intestinal microbiota is disturbed in IBS patients, the link between diet, microbiota composition, and microbial fermentation products might have an essential role in IBS etiology. In this review, we summarize current evidence regarding the impact of diet and the intestinal microbiota on IBS symptoms, as well as the reported interactions between diet and the microbiota composition. On the basis of the existing data, we suggest pathways (mechanisms) by which diet components, via the microbial fermentation, could trigger IBS symptoms. Finally, this review provides recommendations for future studies that would enable elucidation of the role of diet and microbiota and how these factors may be (inter)related in the pathophysiology of IBS.

Continue to full article: http://www.nature.com/ajg/journal/vaop/ncurrent/full/ajg2014427a.html

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'Very limited evidence' to show FODMAPS diet helps IBS new
      #372336 - 08/07/15 11:56 AM
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Research finds little evidence to support FODMAPS elimination diet's use


FRIDAY, Aug. 7, 2015 (HealthDay News) -- There's little evidence that eliminating certain types of carbohydrates from their diet will benefit people with irritable bowel syndrome (IBS), a new study finds.

The researchers looked at the published studies on a specific diet called the low FODMAP diet. This diet is based on the theory that certain carbohydrates are poorly absorbed by the small intestine and that IBS symptoms worsen when people with the disorder eat these types of carbohydrates.

The types of carbohydrates eliminated in this diet are found in wheat, onions, legumes, milk, honey, apples, high-fructose corn syrup, and the artificial sweeteners sorbitol and mannitol.

Some guidelines suggest that a low FODMAP diet might be appropriate for IBS patients who have had no success with other treatments. But this should only be done under the supervision of a dietitian who specializes in this type of therapy, according to the review published online Aug. 6 in Drug and Therapeutics Bulletin.

"However, we believe that patients should be advised that there is very limited evidence for its use, the ideal duration of treatment has not been assessed in a clinical trial, and its place in the management of IBS has not been fully established," wrote Dr. James Cave, editor-in-chief of Drug and Therapeutics Bulletin.

The review did find some evidence that patients believe the diet reduces some IBS symptoms. And, one study indicated that the diet alters the bacteria population in the digestive tract, but the implications and long-term effects of that are unclear, the researchers said.

Overall, claims that the low FODMAP diet helps control IBS symptoms are "based on a few relatively small, short-term unblinded or single-blinded controlled trials of varying duration," wrote Cave.

IBS affects up to 20 percent of people, and women are twice as likely as men to have the disorder, which causes symptoms such as abdominal pain/discomfort, bloating and changes in bowel habits.

More information

The American Academy of Family Physicians has more about irritable bowel syndrome.

SOURCE: Drug and Therapeutics Bulletin, news release, Aug. 6, 2015

-- Robert Preidt

Last Updated: Aug 7, 2015

Copyright © 2015 HealthDay. All rights reserved.

http://consumer.healthday.com/gastrointestinal-information-15/digestion-health-news-200/cutting-certain-carbs-might-not-ease-irritable-bowel-syndrome-702120.html

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Fiber-Rich Diet May Boost Lung Function new
      #372677 - 01/27/16 02:52 PM
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Fiber-Rich Diet May Boost Lung Function

Authors note an association with intake of fruits and veggies

by Salynn Boyles
Contributing Writer

Action Points

Low dietary fiber intake was associated with reduced lung function, suggesting that eating a diet rich in fiber may protect against lung diseases like chronic obstructive pulmonary disease and asthma.
Note that fruit and vegetable consumption was more strongly associated with higher lung function than consumption of whole grains in the analysis, and this association was independent of antioxidant intake.

Low dietary fiber intake was associated with reduced lung function, suggesting that eating a diet rich in fiber may protect against lung diseases like chronic obstructive pulmonary disease (COPD) and even asthma, researchers said.

In an analysis of National Health and Nutrition Examination Surveys (NHANES) data, adults with the highest fiber consumption were more likely to have normal lung function and they were less likely to have airway restrictions compared with adults whose diets contained the least fiber, reported Corrine Hanson, PhD, RD, of the University of Nebraska Medical Center in Omaha, and colleagues.

These associations were found to be consistent, even when controlling for important covariates for poor lung function, including smoking and high body mass index (BMI), they wrote in the Annals of the American Thoracic Society.

Fruit and vegetable consumption was more strongly associated with higher lung function than consumption of whole grains in the analysis, and this association was independent of antioxidant intake, which has previously been shown to be positively associated with lung function.

"These findings are pretty consistent with several other [observational] studies examining fiber and lung function. The difference in the studies has been in the types of fiber that appear to be protective," Hanson told MedPage Today in a telephone interview. "We found an association with fruits and vegetables, but not cereal grains. Other studies suggest that cereal grains may be more important."

The researchers wrote that there is extensive research linking high fiber intake with a lower risk for heart disease and certain cancers, but less evidence linking fiber intake to lung health.

"Dietary fiber has been shown to exhibit both anti-inflammatory and anti-oxidant properties, which have been implicated in both the development and progression of lung disease," they wrote.

To test their hypothesis that lower fiber intake is associated with reduced lung function, the researchers examined data on adults surveyed for in NHANES cycle 2009-2010. In addition to information on dietary intake, the survey included spirometry measures.

The analysis included 1,921 adults, ages 40 to 79, with available pre-bronchodilator spirometry measurements. The Global Initiative for COPD (GOLD) classification was used to establish the presence and severity of airflow obstruction based on spirometry measures. Dietary intake was determined from two interviewer-administered, 24-hour recalls, developed by the U.S. Department of Agriculture.

All participants were asked about their smoking history, and smoking status was defined as: never, former (>100 cigarettes in a lifetime, not current), and current (>100 cigarettes, smoking currently).

The primary outcomes were lung function measurements, including FEV1, FVC, and percent predicted FEV1 and FVC. The researchers also conducted a categorical analysis of fiber intake and airflow restriction and obstruction based on GOLD and Spirometry Grade (SG) classifications.

Multivariable regression models were used to examine the association of lung function measurements with dietary fiber intake after adjustment for relevant confounders. All analyses accounted for the weighted data and complex design of the NHANES sample.

The analysis revealed that surveyed participants in the highest quartile intake of fiber had mean FEV1 and FVC measurements that were 82 mL and 129 mL higher that the lowest quartile of intake (P=0.05 and 0.01, respectively), and mean percent predicted FEV1 and FVC values that were 2.4 and 2.8 percentage points higher (P=0.07 and 0.02, respectively).

Also, in the categorical analysis, higher fiber intake was associated with a higher percentage of participants with normal lung function (P=0.001) and a significant decline in the proportion of participants with airflow restriction (P=0.001).

With increasing daily fiber intake, the percentage of those with normal lung function increased -- 50.1% versus 68.3% for quartile 1 (Q1) versus Q4 (P=0.001) -- although the effect was attenuated at quartiles 3 and 4. For increasing daily fiber intake, there was a significant decline in the proportion of participants with airflow restriction (29.8% versus 14.8% for Q1 versus Q4, P=0.001) which again was attenuated at the higher quartiles.

The authors also reported that participants with a higher fiber intake tended to have a lower BMI, and a higher intake of fruits, vegetables, and whole grains.

"Intake of fruits, vegetables and legumes were associated with lung function in our study independent of intake of antioxidants previously associated with lung function," they pointed out. "Several studies have found stronger associations with intakes of whole fruit when compared to individual fruit-related nutrients."

The association between high dietary intake and lung function was independent of antioxidant intake, intake of cured meat and other possible dietary risk factors, the authors noted.

The cross-sectional nature of the NHANES data was a study limitation, precluding the establishment of a causal relationship between higher fiber intake and better lung function.

"It could be proposed that fiber is a surrogate measure for overall healthy lifestyle," they wrote.

A study strength was the use of spirometry measurement to identify airflow limitations, "as opposed to the self-reported diagnosis of COPD used in many epidemiological studies," the researchers wrote.

Hanson told MedPage Today that the consistent finding in the observational data of a possible protective benefit for high-fiber intake in lung function could have important public health implications for the public at large and very high-risk groups, such as smokers.

"There are very few interventional strategies for the prevention of COPD, with the exception of not smoking or smoking cessation," she said. "This is a non-invasive, very inexpensive strategy that may be good for your lungs."

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

last updated 01.27.2016

Primary Source
Annals of the American Thoracic Society
Source Reference: Hanson C, et al "The relationship between dietary fiber intake and lung function in NHANES" Ann Am Thorac Soc 2016; DOI: 10.1513/AnnalsATS.201509-609OC.

http://www.medpagetoday.com/Pulmonology/SmokingCOPD/55857?xid=nl_mpt_DHE_2016-01-27&eun=g379602d0r

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Fructose malabsorption, symptom severity, IBS subtype predict response to low FODMAP diet new
      #372881 - 06/27/16 02:44 PM
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Fructose malabsorption, symptom severity, IBS subtype predict response to low FODMAP diet

Irritable bowel syndrome patients experienced greater benefits from a low FODMAP diet if they had a positive fructose breath test, greater symptom severity at baseline, and a mixed IBS subtype, according to data presented at the British Society of Gastroenterology Annual Meeting.


"Hydrogen breath testing can identify those with poor absorption of lactose or fructose, who may therefore benefit more from their dietary exclusion as part of the low FODMAP diet," Anna Cox, BSc, from University College Hospital in London, told Healio Gastroenterology.

Anna Cox

Cox and colleagues sought to determine whether a hydrogen breath test for lactose and fructose intolerance would identify responders to a low FODMAP diet, and also whether patients with diarrhea-predominant IBS (IBS-D) would experience greater improvement compared with constipation-predominant IBS (IBS-C) or mixed IBS (IBS-M) subtypes.

At baseline and a mean of 61 days after treatment, they evaluated IBS symptom severity scores ranging from 0 to 500 based on pain, bloating, constipation and diarrhea in 228 consecutive IBS patients who completed low FODMAP dietary education therapy. Forty-five percent had IBS-D, 33% had IBS-C and 22% had IBS-M, most of whom were women.

Moreover, patients underwent hydrogen breath testing with 30 g fructose and 30 g lactose and were blinded to breath test results until follow-up. Thirty-six percent had positive lactose breath tests, 35% had positive fructose breath tests, and 17% were positive for both.

All patients experienced improvement in symptom severity (–36; P < .001) and 31% were considered responders with more than 50-point improvements.

IBS-M patients experienced greater symptom improvement (–56; P < .001) compared with IBS-D (–37) and IBS-C patients (–29).

A positive fructose hydrogen breath test predicted the greatest response compared with a test negative for both fructose and lactose (–47 vs. –33; P = .008). There were no significant associations observed with tests positive for lactose or both lactose and fructose.

Finally, the researchers found that response mildly correlated with symptom severity at baseline (P = .002), but this relationship was not responsible for differences in response between breath test and IBS subtype groups.

"We found that a positive fructose [breath test], seen in about one-third of IBS patients, predicted a greater response to the low FODMAPs diet, while no association was found for lactose. This suggests that fructose intolerance is an important aspect of FODMAP sensitivity and that fructose breath testing may be useful clinically, both to identify potential responders and to inform re-introduction of fructose following the full low FODMAP elimination period," Cox said. "We also observed the greatest response in the mixed IBS subtype and in those with diarrhea more than constipation. This is likely due to a reduction in fiber intake with the low FODMAP diet and the subsequent lack of fiber's laxating effects." – by Adam Leitenberger

Reference:

Cox A, et al. Abstract #OC-022. Presented at: British Society of Gastroenterology Annual Meeting; June 20-23, 2016; Liverpool, UK.

Disclosures: The researchers report no relevant financial disclosures.

Editor's note: This article was updated on June 22 with additional data and comments from the presenter.


http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B7822de7a-a169-41d6-a9d1-e1851b0f76d9%7D/fructose-malabsorption-symptom-severity-ibs-subtype-predict-response-to-low-fodmap-diet

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Gut microbiome profiles predict response to low FODMAP diet in IBS
      #373391 - 11/02/16 02:45 PM
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Gut microbiome profiles predict response to low FODMAP diet in IBS
November 2, 2016

Gut microbiota profiles in stool samples of patients with irritable bowel syndrome predicted response to a low FODMAP diet, according to research presented at UEG Week 2016.

"Dietary intervention may reduce IBS symptoms and impact gut microbiota, but the degree to which diet affects gut microbiota is not fully elucidated. Furthermore, factors predicting response to dietary intervention are largely unknown," Sean M. P. Bennet, MSc, from the University of Gothenburg, Sweden, said during his presentation.

Bennet and colleagues analyzed data from a previous study in which 75 patients with at least moderately severe IBS symptoms were randomly assigned to follow a traditional IBS or low FODMAP diet for 4 weeks. Ultimately, significant improvements in IBS symptoms were reported in comparable proportions in both groups.

"However, there was an unknown impact and involvement of the gut microbiota," Bennet said. "We therefore wanted to investigate the fecal microbiota composition before and after a low FODMAP diet and traditional IBS dietary advice."

He and colleagues performed multivariate discrimination analysis relative to a healthy reference group to characterize patient bacterial profiles, which were created using a GA-Map 16S rRNA Dysbiosis Testing of stool samples collected before and after the intervention period.

They found that patients who followed a traditional IBS diet had similar fecal bacterial profiles before and after the intervention, while patients on a low FODMAP diet had different fecal bacterial profiles before and after the intervention.

Nonresponders in the low FODMAP group had more severe dysbiosis than responders, both at baseline (P = .007) and after the intervention (P = .03), but patients who followed a traditional IBS diet had comparable dysbiosis irrespective of responsiveness.

Dysbiosis improved after a traditional IBS diet compared with the low FODMAP diet; among the traditional diet group, 33% had improved dysbiosis, 47% had no change and 20% had worsened dysbiosis, and among the low FODMAP group, these figures were 13%, 45% and 42%, respectively.

"This might be because we saw a significant reduction in Bifidobacterium [P = .0005] after a low FODMAP diet, irrespective of responsiveness," Bennet said. "However, the traditional IBS diet intervention had no effect on the abundance of Bifidobacterium."

An evaluation of predictive models showed responders could be discriminated from nonresponders before the low FODMAP intervention, but not the traditional IBS diet, based on bacterial profiles.

"In conclusion, fecal bacterial profiles predict IBS patient responsiveness to a low FODMAP diet," Bennet said. "The ability of fecal bacteria composition to predict response to a low FODMAP diet in IBS may help in selection of which patients to give this dietary advice." – by Adam Leitenberger

References:

Bennet SMP, et al. Abstract #3474. Presented at: United European Gastroenterology Week; Oct. 15-19, 2016; Vienna.

Disclosures: The researchers report no relevant financial disclosures.

http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B865c905a-80be-4e2e-a98c-b667454086ab%7D/gut-microbiome-profiles-predict-response-to-low-fodmap-diet-in-ibs

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Gluten-free diet could increase cardiovascular risk in people without celiac disease
      #373593 - 05/09/17 01:35 PM
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Gluten-free diet could increase cardiovascular risk in people without celiac disease

Lebwohl B, et al. BMJ. 2017;doi:10.1136/bmj.j1892.
May 2, 2017

Researchers found that long-term consumption of gluten was not associated with coronary heart disease risk, and recommended against a gluten-free diet for people without celiac disease as it could limit their intake of "heart-healthy" whole grains.

"Gluten is clearly harmful for people with celiac disease, but popular diet books, based on anecdotal and circumstantial evidence, have pushed the notion that a low-gluten diet is healthy for everyone," Benjamin Lebwohl, MD, MS, assistant professor of medicine and epidemiology at Columbia University Medical Center, director of clinical research in the Celiac Disease Center at Columbia University, and gastroenterologist at NewYork-Presbyterian/Columbia University Medical Center, said in a press release. "Our findings show that gluten restriction has no benefit, at least in terms of heart health, for people without celiac disease. In fact, it may cause some harm if they follow a low-gluten diet that is particularly low in whole grains because those grains appear to have a protective effect against heart disease."
Benjamin Lebwohl, MD, MS

Benjamin Lebwohl

While the prevalence of celiac disease (affecting about 1 in 100 Americans) and non-celiac gluten sensitivity is relatively low, about a third of Americans are attempting to reduce their gluten intake by some estimates, Lebwohl added.

Therefore, he and colleagues evaluated the link between gluten consumption and coronary heart disease using data on 64,714 women enrolled in the Nurses' Health Study and 45,303 men enrolled in the Health Professionals Follow-up Study. All study participants had no history of coronary heart disease nor celiac disease, and completed food frequency questionnaires every 4 years from 1986 through 2010.

"We decided to look at heart disease because it's a leading killer, and because it's generally understood that heart health can be affected by diet," Lebwohl said in the press release.

Overall, 2,431 women and 4,098 men developed coronary heart disease — defined as a fatal or non-fatal myocardial infarction — over 26 years of follow-up. Participants in the lowest fifth of gluten consumption had a coronary heart disease incidence rate of 352 per 100,000 person-years, while those in the highest fifth had an incidence rate of 277 per 100,000 person-years. Adjusted analysis showed there was no significant association between gluten intake and coronary heart disease.

"Even those with the lowest amount of gluten consumption experienced the same rate of heart disease as those who were consuming the most gluten," Andrew T. Chan, MD, MPH, gastroenterologist and chief of the Clinical and Translational Epidemiology Unit in the Massachusetts General Hospital division of gastroenterology, and associate professor of medicine at Harvard Medical School, said in the press release.
Andrew T. Chan, MD, MPH

Andrew T. Chan

Additional analyses suggested that avoiding gluten could also limit consumption of whole grains, which have been linked to a lower cardiovascular risk.

"Based on our data, recommending a low-gluten diet solely for the promotion of hearth health does not appear warranted," Chan said.

The investigators plan to further study the effect of gluten consumption on other health outcomes like cancer and autoimmune disease, according to the press release. –by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.

http://www.healio.com/gastroenterology/malabsorption/news/online/%7B24378853-8326-46ed-8483-c9d611c98d6a%7D/gluten-free-diet-could-increase-cardiovascular-risk-in-people-without-celiac-disease?utm_source=selligent&utm_medium=email&utm_campaign=gastroenterology%20news&m_bt=428850516595



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High-fat diet leads to same intestinal inflammation as a virus new
      #373605 - 06/23/17 04:25 PM
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High-fat diet leads to same intestinal inflammation as a virus

UCLA Health System News

A new study by scientists at UCLA found that when mice eat a high–fat diet, the cells in their small intestines respond the same way they do to a viral infection, turning up production of certain immune molecules and causing inflammation throughout the body. The scientists also found that feeding the mice tomatoes containing a protein similar to that in HDL, or "good cholesterol," along with the generic cholesterol drug ezetimibe, reversed the inflammation.

The results could lead to new types of drugs, targeting the intestinal cells, to reduce people's risk of heart attacks and strokes, or to treat other conditions linked to inflammation, including cancer and inflammatory bowel disease.

Researchers already knew that prolonged obesity can cause inflammation of the liver and fat tissues, and that this inflammation contributes to the development of diabetes and heart disease. Studies have also shown that higher levels of high–density lipoprotein, or HDL, cholesterol, reduces a person's risk of heart disease.

The UCLA research team, led by Alan Fogelman, chair of the department of medicine at the David Geffen School of Medicine at UCLA, previously developed genetically engineered tomatoes that contained 6F, a protein resembling the main protein in high–density lipoprotein. In early experiments on 6F, they found that the compound was active in the small intestines of mice, and that it reduced inflammation. But exactly how it did this was unclear.

The scientists fed either a standard chow or a high–fat, high–cholesterol Western diet to mice that were especially prone to developing clogged arteries. They also treated some of the mice with either 6F, in the form of a tomato concentrate containing the protein, ezetimibe, or both. After two weeks, cells from the small intestines of the mice were collected and blood samples were taken. The researchers measured cholesterol levels as well as the levels of inflammatory and immune molecules in both the intestines and throughout the body.

The findings shed light on the molecular details of how high–fat diets cause inflammation in the body, by making the intestines activate the pathway normally triggered by a virus. This suggests that blocking this immune reaction – as 6F and Ezetimibe do – may treat inflammatory diseases and decrease people's risk of heart attack and stroke.

The authors of the study are all faculty and researchers at UCLA, affiliated with the Department of Medicine; Department of Molecular and Medical Pharmacology; Department of Human Genetics; Department of Microbiology, Immunology & Molecular Genetics; Department of Pathology and Laboratory Medicine; Department of Obstetrics and Gynecology; Semel Institute for Neuroscience and Human Behavior; and Department of Molecular, Cell and Developmental Biology. The first author is Pallavi Mukherjee; Fogelman is the senior author.

The study was published June 7, 2017, in the Journal of Lipid Research.

https://www.mdlinx.com/internal-medicine/top-medical-news/article/2017/06/23/7223355?utm_source=in-house&utm_medium=message&utm_campaign=mh-june17-im

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Can a Western diet permanently alter the immune system? new
      #373644 - 01/19/18 01:17 PM
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Can a Western diet permanently alter the immune system?

Healthline/Medical News Today

The immune system's response to the Western diet is similar to how it reacts to infection by dangerous bacteria, according to new research led by the University of Bonn in Germany and published in the journal Cell.

Another disturbing result of the study is that, in the longer-term, a Western diet can make the immune system become hyper-responsive to inflammation triggers.

According to the findings, even changing to a healthful diet does not seem to undo the damage.

The long-term changes may contribute to type 2 diabetes, arteriosclerosis, and several other conditions wherein inflammation is thought to play a part, and which have been linked to consumption of a Western diet.

For the study, the researchers fed atherosclerosis-prone mice on a Western diet, comprising high-calorie, high-fat, low-fiber, and fast food.
The Western diet altered gene expression

After just 1 month, the mice showed changes throughout their bodies that are similar to the strong inflammation reactions that occur in bacterial infections.

"The unhealthy diet," says lead study author Anette Christ, a postdoctoral fellow at the University of Bonn, "led to an unexpected increase in the number of certain immune cells in the blood of the mice, especially granulocytes and monocytes."

This led the team to explore what might be happening further upstream, in the bone marrow, where the precursors, or progenitors, of these particular types of immune cell are located.

The researchers compared major immune cell bone marrow progenitors from mice that had been fed on a Western diet with those of control mice that had been fed on a more healthful, normal cereal diet.

They found that the Western diet had switched on many genes in the progenitor cells, including some that increase proliferation and enhance responses from the innate immune system.

The innate immune system is a part of the immune system that reacts with a rapid, broad response to infection, which is later followed by a more specific reaction from the adaptive immune system.
Healthful diet did not reverse gene activation

The acute inflammation response died down in the Western diet mice after they were placed on their normal cereal diet for 4 weeks.

But, switching to the more healthful diet failed to reverse the fundamental alterations in the innate immune system, and many of the genes that had been activated by the Western diet stayed active.

"It has only recently been discovered," notes senior study author Professor Eicke Latz, the director of the Institute for Innate Immunity of the University of Bonn, "that the innate immune system has a form of memory."

There is a process called "innate immune training," he explains, which is normally triggered by bacterial infection, but in the case of the mice in the study, it was triggered by a Western diet.

Innate immune training ensures that after infection, the body remains "in a kind of alarm state," so its defenses can "respond more quickly to a new attack," Professor Latz adds.
Protein sees the Western diet as a pathogen

The team also discovered that a protein called NLR family pyrin domain containing 3 (NLRP3) is the immune system sensor that recognizes the Western diet as a pathogen and, therefore, triggers the inflammatory response.

In addition, it seems that as well as triggering inflammatory responses through NLRP3, the Western diet also causes long-term epigenetic changes in the packaging of genetic material, so that parts of DNA that are normally difficult to access are easier to read.

"The immune system consequently reacts even to small stimuli with stronger inflammatory responses," explains Professor Latz.

In a final set of tests, the team confirmed the role of NLRP3 by showing that mice bred to lack the protein did not develop systemic inflammation from a Western diet, and neither did they show some of the other longer-term changes involving the protein.

The researchers conclude that NLRP3 brokers the trained immunity that follows from a Western diet and "could thereby mediate the potentially deleterious effects of trained immunity in inflammatory diseases."

Professor Latz says that the findings highlight the dramatic impact that the wrong kind of food can have, and that they have important implications for society.

"Children have a choice of what they eat every day. We should enable them to make conscious decisions regarding their dietary habits," he adds.

"The foundations of a healthy diet need to become a much more prominent part of education than they are at present."

Professor Eicke Latz


https://www.mdlinx.com/gastroenterology/top-medical-news/article/2018/01/16/7500319/?utm_source=in-house&utm_medium=message&utm_campaign=epick-gastro-jan18

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Fecal Profiling May Predict Dietary Response in IBS to FODMAPS Diet
      #373674 - 03/15/18 11:51 AM
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Fecal Profiling May Predict Dietary Response in IBS
Baseline VOCs correlate with symptom relief in patients on low-FODMAP diet

by Diana Swift, Contributing Writer
March 15, 2018

Fecal profiling of volatile organic compounds may provide a low cost, non-invasive tool to predict the responses of irritable bowel syndrome (IBS) patients to probiotics and diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs).

Note that this approach can potentially shed light on the pathophysiology of IBS, and has the potential to advance its clinical management with more precisely personalized nutrition regimens.

Fecal profiling of volatile organic compounds (VOCs) may provide a low cost, non-invasive tool to predict the responses of irritable bowel syndrome (IBS) patients to probiotics and diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), according to British researchers.

Modeling baseline fecal VOCs, and using key features of VOC profiles, correctly predicted response to a low-FODMAP diet in 100% of patients and in 89% of patients receiving a probiotic, reported Megan Rossi, PhD, RD of King's College in London, and colleagues.

This approach can potentially shed light on the pathophysiology of IBS, and advance its clinical management with more precisely personalized nutrition regimens, they wrote in Clinical Gastroenterology and Hepatology.

Multiple randomized trials have indicated that the low-FODMAP diet is effective in 50%-80% of IBS patients. "However, predicting response is clinically important because the diet requires intensive dietary counselling and impacts on both the gut microbiota and nutrient intake, and, therefore, avoiding this intervention in the 20%-50% who are unlikely to respond would be an important clinical advance," Rossi's group noted.

New approaches are definitely needed, according to William D. Chey, MD, of the University of Michigan in Ann Arbor.

"Only about half [of patients] get better on the diet, which has associated shopping costs and inconvenience to the patient, plus input from a dietitian and an extended three-step period of time to work through its stages," Chey told MedPage Today. "This often gets glossed over but it's not a trivial thing."

Chey, who was not involved in the study, further explained that little is known about the long-term nutritional and microbiotic downsides of this restrictive diet. "By excluding prebiotic carbohydrates, you are very likely to have effects on the microbiome, so it's important to identify strategies that enrich the likelihood of response and maximize choosing the right treatment for the right patient," he said.

Rossi's group used data and samples from patients with IBS-diarrhea, IBS-mixed, and IBS-unsubtyped treated at two major London hospitals and participating in a previous clinical trial. A total of 95 patients (majority white), whose age ranged from early to late 30s, completed the study. Of these, 93 (63 women) provided sufficient fecal sample for analysis and were randomized for 4 weeks to a low-FODMAP diet (n=46) or a sham diet plus dietary advice (n=47).

In 2-by-2 factorial fashion, patients in both dietary groups also received either a multi-strain probiotic supplement (n=49) or a placebo supplement (n=44).

Gas chromatography assessed VOCs in fecal samples at baseline and at study completion. The clinical endpoint was the IBS Severity Scoring System (IBS-SSS), which records abdominal pain, distension, stool frequency and consistency, and interference with life over a 10-day period.

All 93 participants were deemed compliant with diet, and 86 were classified as compliant with supplementation. At the end of the study, those in the low-FODMAP arm had a significantly lower total FODMAP intake (20+8 g/day) compared with those on the sham diet (33+16 g/day, P<0.001).

In terms of response, more patients reacted clinically to the low-FODMAP diet (37/46, 80%) than the sham diet (21/47 45%, P<0 .001), with a mean change in IBS-SSS score of –130 and –49 (P<0.001), respectively.

There was no difference in clinical response between patients given the probiotic (31/49, 63%) versus placebo (27/44, 61%, P=0.850), with no synergistic or antagonistic effects observed with supplementation. In addition, there was no difference in the mean change in IBS-SSS score between recipients of probiotic (–88) and placebo (–90, P=0.921).

The researchers found that baseline VOC profiles contained 15 features that explained 25% of response variation to the low-FODMAP diet with a mean accuracy of 97% (95% CI 96%-99%), as well as 10 features that explained 30% of response variation to the probiotic, with a mean accuracy of 89% (95% CI 86%-92%). At end of treatment, nine observed compounds explained 31% of variation in response to low-FODMAP and 11 compounds explained 27% of variation with the probiotic.

As to how VOCs predict response, the authors pointed out that many of these compounds are created from indigestible food substrates in the colon through both microbial metabolic activity and diet. VOC patterns at baseline may reflect the pathophysiology of an individual's IBS and eating a high-FODMAP standard diet may, in the presence of IBS-associated dysbiosis, generate fermentation products that cause symptoms. Once the normal diet has been replaced, there is less substrate for bacterial metabolism and gas production and associated symptoms are reduced.

Study limitations included the relatively small sample size, its exploratory nature and the lack of data to inform a power calculation. Also, since the device that assessed fecal VOCs identified patterns of VOCs, not individual VOCs, detailed investigation of the potential mechanisms of individual VOCs could not be done. Finally, the 2-by-2 factorial design may have clouded the results.

Chey noted that, in his experience, about half of patients improve on the low-FODMAP diet, a remarkably high rate of success for a dietary therapy. Also, some of his patients have been following a reduced-FODMAP diet since his institution began introduced it in 2008.

"And up to 85% can move to a less restrictive diet after the phase of determining sensitivities," Chey said.

This study was funded by the National Institute of Health Research.

Rossi and Chey disclosed no relevant relationships with industry. Two co-authors disclosed being co-inventors of a mobile application for the low-FODMAP diet.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

last updated 03.15.2018

Primary Source
Clinical Gastroenterology and Hepatology
Source Reference: Rossi M, et al "Volatile Organic Compounds in Feces Associate With Response to Dietary Intervention in Patients With Irritable Bowel Syndrome" Clin Gastroenterol Hepatol 2018; DOI:10.1016/j.cgh.2017.09.055.


https://www.medpagetoday.com/gastroenterology/irritablebowelsyndrome/71777

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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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