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Research published online in the journal Gut shows that people who respond well to the recommended dietary therapy that restricts the intake of fermentable carbohydrates to treat irritable bowel syndrome (IBS) have a large number of specific types of bacteria in their intestines.

Researchers say this discovery opens up the potential for new treatments and better management of the disease, which affects up to 15% of people worldwide.

The composition of trillions of microorganisms (microbiome) in the gut is believed to play a major role in the development of IBS.

It is generally recommended to limit fermentable carbohydrates, including fermentable carbohydrates in many foods such as wheat, onions and milk, to relieve symptoms. This method is called low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides) And polyols) diet.

But it is not yet fully understood how this diet works, or whether there are specific genes or molecules that can identify who.

To fill this knowledge gap, the researchers analyzed in detail the stool samples of 56 IBS patients and 56 people who lived with them but did not have the disease to determine the microbial characteristics and genes involved in the conversion of food into active molecules. At the same time in their usual diet.

Then, they assessed the clinical response of 41 of them by rechecking their stool samples after 4 weeks of a low-FODMAP diet.

Before adopting a low-FODMAP diet, analysis of stool samples from IBS patients revealed two different microbial "features", which researchers call "pathogen-like" (IBSP) and "healthy-like" (IBSH).

The characteristics of pathogenic microorganisms are abundant in harmful Firmicutes, including known pathogenic bacteria such as Clostridium difficile, Clostridium perfringens, and Clostridium perfringens, but very low in beneficial Bacteroides species .

The lactic acid bacteria usually found in the oral cavity are also abundant. Researchers say that bacterial genes that metabolize amino acids and carbohydrates are overexpressed, which may explain the excesses of certain metabolites associated with IBS symptoms.

The healthy microbial characteristics of other IBS patients were similar to those found in the control group (family members).

After 4 weeks of a low FODMAP diet, the control group and the microbiome with healthy microbial characteristics remained unchanged.

But the microbiome with pathogenic characteristics became healthier, with the increase of Bacteroides and the decrease of Firmicutes. Bacterial genes involved in amino acid and carbohydrate metabolism are no longer overexpressed.

3 out of 4 patients with IBS showed improvement in symptoms. However, patients with IBS and pathogenic microbes have a greater clinical response to a low FODMAP diet than patients with IBS and gut-healthy microbes.

The researchers warned: “The evidence linking diet, microbiome, and symptoms in [pathogenic IBS] is compelling, but studies need to be conducted after the candidate organism is introduced into an animal model to prove that this relationship is causal. relation."

Nonetheless, they believe their findings could pave the way for the development of microbial characteristics, identify those who respond best to a low FODMAP diet, and better manage those who do not.

"If bacteria in the [pathogenic] subtype are proven to play a pathogenic role in IBS, perhaps through their metabolic activity, this provides a target for new therapies and provides an intermediate [marker] for evaluating them ," they suggested.

In a related editorial, Professor Peter Gibson and Dr. Emma Halmos of Monash University in Melbourne described the introduction and adoption of the FODMAP diet as "a major change from the management of irritable bowel syndrome (IBS) patients to integrated care."

But they added that although "an effective symptomatic treatment, [it] brings risks associated with exacerbating eating disorders, challenging nutritional adequacy, and presumed intestinal flora imbalance."

They pointed out some of the limitations of the study, including poor assessment of FODMAP intake, fiber intake may also affect the microbiome, unreported, and patient withdrawal reduced the effectiveness of the study.

"Nevertheless, the beauty of [this study] is not in its certainty, but in its ability to create feasible innovative hypotheses that can be tested by focused research. Maybe the FODMAP diet is more than just a symptomatic treatment. "They concluded.

Gibson, PR, etc. (2021) The two microbial subtypes found in irritable bowel syndrome respond differently to low FODMAP. Intestine. doi.org/10.1136/gutjnl-2021-326284.

Tags: amino acids, animal models, bacteria, carbohydrates, diet, FODMAP, food, genes, irritable bowel syndrome, metabolism, metabolites, microbiome, research, syndrome, wheat

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