FODMAP diets and IBS: Distinct microbiome profile among people who see the biggest benefits
Researchers hope the findings could lead to the development of a microbiota signature as a biomarker to manage IBS cases with dietary recommendations, and provide bacterial targets for new therapies.
The microbiome has long been thought to play a major role in the development of IBS, and restricting fermentable carbs, which are found in a wide range of foods, including wheat, onions, and milk, is usually recommended to ease symptoms.
However, it’s not fully understood exactly how this diet works or if there are particular genes or molecules that will identify those in whom it will.
Therefore, researchers analysed the stool samples of 56 people with IBS and 56 people who lived with them, but without the condition.
They then assessed the clinical response in 41 of these pairs after 4 weeks on the low FODMAP diet by reviewing their stool samples again.
Before adoption of the low FODMAP diet, analysis of the stool samples of those with IBS revealed two distinct microbial ‘signatures’, which the researchers referred to as ‘pathogenic-like’ (IBSP) and as ‘health-like’ (IBSH).
The pathogenic microbial signature was abundant in harmful Firmicutes sp, including known disease causing bacteria, such as C. difficile, C. sordellii and C. perfringens, but very low in beneficial Bacteroidetes species.
The lactic acid bacteria Streptococcus parasanguinis and Streptococcus timonensis that are usually found in the mouth were also abundant. It was also discovered that bacterial genes for amino acid and carbohydrate metabolism were overexpressed, which may explain the excess of some metabolites that are linked to IBS symptoms, say the researchers.
After four weeks on the low FODMAP diet, the microbiome of the comparison group and those with the healthy microbial profile stayed the same.
But the microbiome of those with the pathogenic profile became healthier, with an increase in Bacteroidetes, and a fall in Firmicutes species. Also, the bacterial genes involved in the metabolism of amino acids and carbs were no longer overexpressed.
The symptoms improved in 3 out of 4 of the patients with IBS. But the clinical response to the low FODMAP diet was greater in those with IBS and a pathogenic microbial signature than it was in those with IBS and a healthy microbial signature in their gut.
The researchers cautioned that more studies were needed to prove a causal relationship: “The evidence associating diet, the microbiome and symptoms in [pathogenic IBS] is compelling, but studies following the introduction of candidate organisms into an animal model are needed.”
Nevertheless, they suggest their findings could pave the way for the development of a microbial signature to identify those who would respond best to a low FODMAP diet and better manage those who wouldn’t.
“If the bacteria represented in the [pathogenic] subtype are shown to play a pathogenic role in IBS, perhaps through their metabolic activity, this provides a target for new therapies and an intermediate [marker] by which to assess them,” they suggest.
Writing in the journal, Gut, they concluded: “50% of IBS cases manifested a ’pathogenic’ gut microbial signature. This shifted towards the healthy profile on the low FODMAP diet; and IBSP cases showed an enhanced clinical responsiveness to the dietary therapy. The effectiveness of FODMAP reduction in IBSP may result from the alterations in gut microbiota and metabolites produced. Microbiota signatures could be useful as biomarkers to guide IBS treatment; and investigating IBSP species and metabolic pathways might yield insights regarding IBS pathogenic mechanisms.”
In a linked editorial, Professor Peter Gibson and Dr Emma Halmos of Melbourne’s Monash University, describe the introduction and adoption of the FODMAP diet as “a major change” in the management of patients with irritable bowel syndrome (IBS) towards integrated care.
They point out some limitations of the research, including that FODMAP intake was poorly assessed, fibre intake,which can also influence the microbiome wasn’t reported and patient drop-out reduced the power of the study.
“Nevertheless, the beauty of [the study] is not in its definitive nature, but that it enables the creation of feasible innovative hypotheses that can be examined by focused studies. Perhaps the FODMAP diet is not just a symptomatic therapy,” they conclude.
"Two microbiota subtypes identified in irritable bowel syndrome with distinct responses to the low FODMAP diet"
Authors: Kevin Vervier, et al