Improved Symptom Profiles and Minimal Inflammation in IBS-D Patients Undergoing a Long-Term Low-FODMAP Diet: A Lipidomic Perspective

Abstract

Given the link between the minimal inflammation underlying irritable bowel syndrome (IBS) and dietary treatments, considerable attention has focused on diets low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). In this context, inflammatory patterns and lipidomic investigations may shed light on the pathophysiological mechanisms whereby a low-FODMAP diet (LFD) improves the IBS diarrhoea (IBS-D) variant. Thus, we investigated whether a long-term LFD induced changes in symptom profiles, anthropometric characteristics, inflammatory markers (C-reactive protein, cyclooxygenase-2, and prostaglandin E2) and erythrocyte-membrane fatty acid (FA) composition in IBS-D patients. Twenty IBS-D patients underwent a 90 day personalised LFD programme, and were regularly evaluated at scheduled visits. At the diet’s end, both IBS symptoms and anthropometric parameters were significantly improved. A significant decrease in prostaglandin E2 also accompanied these reductions. As for FAs, the putative inflammatory indicators, arachidonic acid (AA) levels and the AA/eicosapentaenoic acid ratio were significantly decreased. In conclusion, IBS-D patients following a controlled long-term LFD experienced improved symptom profiles and decreased inflammatory markers linked to FAs. Lipidomic data may be insightful for unravelling the molecular mechanisms associated with IBS-D pathophysiology.

The Relationship between Low Serum Vitamin D Levels and Altered Intestinal Barrier Function in Patients with IBS Diarrhoea Undergoing a Long-Term Low-FODMAP Diet: Novel Observations from a Clinical Trial

“…As regards the effect of the LFD on IBS, different data in the literature indicate that restricting FODMAP consumption could be beneficial for symptoms and intestinal barrier function [ 43 , 44 ], and a long-term LFD has shown to be more effective than a 30-day diet to control for symptoms fluctuations that occur naturally in all the IBS subtypes irrespective of drug or nutritional treatments. In agreement with this evidence, 12 weeks of LFD significantly reduced symptoms in our IBS-D patients, confirming ours and other previous results [ 23 , 45 ] about its efficacy.…”

“…The patients had to record a food diary at the start of the study and during the diet intervention to evaluate their energy intake and energy consumption. The diary included details of the quantities (expressed in grams) and the types of food consumed daily at breakfast, lunch, dinner, during snacks, and the type of physical activity and duration [ 23 ].…”

“…A dedicated software (Nutrigeo 8.6.0.0, Progeo Medical, Centobuchi di Monteprandone, AP, Italy) was used to evaluate the daily macronutrient intake (50% glucides, 30% lipids, and 20% proteins). The diets were developed as described elsewhere [ 23 ]. A detailed weekly menu structured on breakfast, lunch, and dinner, plus two light snacks (mid-morning and afternoon) was provided to each patient together with a brochure reporting detailed information on the permitted and forbidden foods, and which to reduce according to the indications of the Monash University [ 30 ].…”

“…Consequently, a low FODMAP diet (LFD) has been proven useful for treating IBS-D. In a recent study, IBS-D patients largely benefited from a long-lasting LFD in terms of symptoms by improving at the same time their inflammatory and lipidomic profiles [ 23 ].…”

Nutritional Interventions in the Management of Fibromyalgia Syndrome

“…FODMAPs (Fermentable Oligo-Di-Mono-saccharides And Polyols) are poorly absorbed short-chain carbohydrates including lactose, free fructose, polyols, fructans and galacto-oligosaccharides. The low-FODMAPS diet has shown significant benefits in the treatment of IBS [78]. Since 70% of FM patients suffer from IBS [79], it has been hypothesized that the low-FODMAPs diet could be beneficial for FM subjects [60,61].…”