Randomised clinical trial: effect of low-FODMAP rye bread versus regular rye bread on the intestinal microbiota of irritable bowel syndrome patients: association with individual symptom variation

Abstract

Background: A low intake of Fermentable, Oligo-, Di-, Mono-saccharides and Polyols (FODMAPs) is effective in the symptom control of irritable bowel syndrome (IBS) patients but may exert negative effects on the intestinal microbiota. The microbial effects of increasing regular or non-FODMAP fibre sources are largely unknown. Furthermore, it is not known if the baseline microbiota composition is associated with individual symptom control during the consumption of different rye products in IBS patients. Our objective was to evaluate whether increased consumption of low-FODMAP rye bread or regular rye bread for 4 weeks would alter the intestinal microbiota composition of IBS patients following their habitual diet, and whether these changes associate to symptoms and/or the baseline microbiota. Methods: The study was conducted as a randomized double blind controlled cross-over study (n = 50). Microbiota was analysed by 16S rRNA gene sequencing and associated with gastrointestinal symptoms. Both microbial changes and their associations to symptoms were secondary outcomes. Results: The consumption of the test breads did not alter microbiota diversity. Compared to baseline, consumption of the low FODMAP rye bread decreased the abundance of Bacteroides, Flavonifractor, Holdemania, Parasutterella and Klebsiella and showed a trend towards increased bifidobacteria, whereas the regular rye bread decreased the abundance of Flavonifractor. When comparing between the two test breads, Klebsiella was decreased after low-FODMAP rye bread intake. Patients whose symptoms decreased during the low-FODMAP rye bread displayed more Blautia and less Barnesiella at baseline.

Colonic Gene Expression and Fecal Microbiota in Diarrhea-predominant Irritable Bowel Syndrome: Increased Toll-like Receptor 4 but Minimal Inflammation and no Response to Mesalazine

“…Flavonifractor has been previously linked to IBS, being increased in children with IBS in whom the amount of Flavonifractor was negatively associated with abdominal pain. 67 Another study reported this taxon was decreased in patients with IBS after increased rye fiber consumption, 68 but similar to the current study, there was no association to pain. Interestingly elevated levels of Flavonifractor were also found in the rectal mucosa biopsies of autistic children with gastrointestinal disorders and pain.…”

Health benefits of whole grain: effects on dietary carbohydrate quality, the gut microbiome, and consequences of processing

“…Part of this was thought to be due to the high interindividual variation in gut microbiota composition, as there was no separation in clustering of the microbiota composition using principal coordinates analysis based on Bray–Curtis distance between the groups (Schutte et al., 2018), and samples before and after intervention of a particular individual seemed to cluster close together. In a randomized clinical trial, the effect of low‐FODMAP (fermentable oligo‐, di, and monosaccharides, and polyols) rye bread versus regular rye bread on the intestinal microbiota of irritable bowel syndrome patients was investigated (Laatikainen et al., 2019). Compared with baseline, consumption of the low‐FODMAP rye bread decreased the abundance of Bacteroides , Flavonifractor , Holdemania , Parasutterella , and Klebsiella , whereas the regular rye bread decreased the abundance of Flavonifractor .…”

“…Compared with baseline, consumption of the low‐FODMAP rye bread decreased the abundance of Bacteroides , Flavonifractor , Holdemania , Parasutterella , and Klebsiella , whereas the regular rye bread decreased the abundance of Flavonifractor . When comparing between the two test breads, Klebsiella was decreased after low‐FODMAP rye bread intake (Laatikainen et al., 2019).…”

“…Screening of different K. marxianus strains for their capacity to ferment well in whole‐grain dough and for their impact on fructan meant that low FODMAP, high dietary fiber whole‐grain breads could be prepared. A recent double‐blind study demonstrated that consumption of a high‐dietary fiber low‐FODMAP rye bread, produced by enzyme instead of yeast technology, had potential to support a healthy microbiota (Laatikainen et al., 2019).…”

Adults with Prader–Willi syndrome exhibit a unique microbiota profile

“…Of further interest is the relationship between Blautia abundance and gastrointestinal symptoms. IBS patients, whose gastrointestinal symptoms decreased with a low-FODMAP diet, had higher abundance of Blautia [ 51 ], suggesting visceral sensitivity in these individuals. In contrast, individuals with PWS exhibit a high tolerance to pain and discomfort [ 52 ].…”