Prebiotics vs a Diet Low in Fodmaps in Patients with Functional Gut Disorder
07/18/18 02:58 PM
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Heather
Reged: 12/09/02
Posts: 7798
Loc: Seattle, WA
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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-
WalterHuaman12MarianelaMego1ChaysavanhManichanh1NicolauCañellas34DanielCañueto3HegoiSegurola5MartaJansana6CarolinaMalagelada1AnnaAccarino1JelenaVulevic7GeorgeTzortzis7GlennGibson8EstebanSaperas2FranciscoGuarner1FernandoAzpiroz1
1
Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
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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
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Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (Ciberdem)
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Nutritional Support Unit, University Hospital Vall d'Hebron, Barcelona, Spain
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Department of Endocrinology and Nutrition, University Hospital General of Catalonia, San Cugat del Valles, Barcelona, Spain
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Clasado Research Services Ltd, Science and Technology Centre, University of Reading, Early Gate, Reading, UK
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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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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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