β-Galactooligosaccharide in Conjunction With Low FODMAP Diet Improves Irritable Bowel Syndrome Symptoms but Reduces Fecal Bifidobacteria.
Study Goal
The researchers aimed to determine whether combining a low-FODMAP diet (LFD) with β-galactooligosaccharides (B-GOS) supplementation improves IBS symptoms while preventing the decline in bifidobacteria associated with LFD alone.
Results Summary
The LFD combined with B-GOS produced greater symptom relief (67%) compared to a sham diet (30%), but B-GOS did not prevent the reduction in bifidobacteria. The LFD also reduced fecal Actinobacteria and butyrate levels.
Population
69 adult IBS patients meeting Rome III criteria, recruited from secondary care in the UK.
Effective Dosage
1.4 g/d B-GOS
Duration
4 weeks
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
low FODMAP diet (LFD) | decrease | symptoms | irritable bowel syndrome (IBS) | - | reduces | #1 |
low FODMAP diet (LFD) | decrease | bifidobacteria | irritable bowel syndrome (IBS) | - | reduces | #2 |
β-galactooligosaccharides (B-GOS) | decrease | symptoms | irritable bowel syndrome (IBS) | - | may reduce | #3 |
β-galactooligosaccharides (B-GOS) | increase | bifidobacteria | irritable bowel syndrome (IBS) | - | may increase | #4 |
LFD supplemented with 1.4 g/d B-GOS (LFD/B-GOS) | increase | adequate symptom relief | Rome III adult patients with IBS from secondary care in the United Kingdom | 67% (16/24) | was higher | #5 |
sham diet with placebo supplement (control) | neutral | adequate symptom relief | Rome III adult patients with IBS from secondary care in the United Kingdom | 30% (7/23) | was | #6 |
LFD/B-GOS | no change | Bifidobacterium concentrations | Rome III adult patients with IBS from secondary care in the United Kingdom | - | were not different | #7 |
LFD/B-GOS | decrease | Bifidobacterium concentrations | Rome III adult patients with IBS from secondary care in the United Kingdom | 9.49 [0.73] log10 cells/g dry weight | were lower | #8 |
control | neutral | Bifidobacterium concentrations | Rome III adult patients with IBS from secondary care in the United Kingdom | 9.77 [0.41] log10 cells/g dry weight | were | #9 |
LFD | decrease | proportion of Actinobacteria | Rome III adult patients with IBS from secondary care in the United Kingdom | 1.9% | was lower | #10 |
LFD/B-GOS | decrease | proportion of Actinobacteria | Rome III adult patients with IBS from secondary care in the United Kingdom | 1.8% | was lower | #11 |
control | neutral | proportion of Actinobacteria | Rome III adult patients with IBS from secondary care in the United Kingdom | 4.2% | was | #12 |
LFD | decrease | fecal butyrate | Rome III adult patients with IBS from secondary care in the United Kingdom | 387.3 | was lower | #13 |
LFD/B-GOS | decrease | fecal butyrate | Rome III adult patients with IBS from secondary care in the United Kingdom | 346.0 | was lower | #14 |
control | neutral | fecal butyrate | Rome III adult patients with IBS from secondary care in the United Kingdom | 609.2 | was | #15 |
LFD combined with B-GOS prebiotic | increase | symptoms | Rome III adult patients with IBS from secondary care in the United Kingdom | - | produced a greater symptom response | #16 |
1.4 g/d B-GOS | no change | bifidobacteria | Rome III adult patients with IBS from secondary care in the United Kingdom | - | did not prevent the reduction | #17 |
LFD | decrease | fecal Actinobacteria | Rome III adult patients with IBS from secondary care in the United Kingdom | - | reduces | #18 |
LFD | decrease | fecal butyrate | Rome III adult patients with IBS from secondary care in the United Kingdom | - | reduces | #19 |
INTRODUCTION: The low FODMAP diet (LFD) reduces symptoms and bifidobacteria in irritable bowel syndrome (IBS). β-galactooligosaccharides (B-GOS) may reduce the symptoms and increase bifidobacteria in IBS. We investigated whether B-GOS supplementation alongside the LFD improves IBS symptoms while preventing the decline in bifidobacteria. METHODS: We performed a randomized, placebo-controlled, 3-arm trial of 69 Rome III adult patients with IBS from secondary care in the United Kingdom. Patients were randomized to a sham diet with placebo supplement (control) or LFD supplemented with either placebo (LFD) or 1.4 g/d B-GOS (LFD/B-GOS) for 4 weeks. Gastrointestinal symptoms, fecal microbiota (fluorescent in situ hybridization and 16S rRNA sequencing), fecal short-chain fatty acids (gas-liquid chromatography) and pH (probe), and urine metabolites (H NMR) were analyzed. RESULTS: At 4 weeks, adequate symptom relief was higher in the LFD/B-GOS group (16/24, 67%) than in the control group (7/23, 30%) (odds ratio 4.6, 95% confidence interval: 1.3-15.6; P = 0.015); Bifidobacterium concentrations (log10 cells/g dry weight) were not different between LFD and LFD/B-GOS but were lower in the LFD/B-GOS (9.49 [0.73]) than in the control (9.77 [0.41], P = 0.018). A proportion of Actinobacteria was lower in LFD (1.9%, P = 0.003) and LFD/B-GOS (1.8%, P < 0.001) groups than in the control group (4.2%). Fecal butyrate was lower in the LFD (387.3, P = 0.028) and LFD/B-GOS (346.0, P = 0.007) groups than in the control group (609.2). DISCUSSION: The LFD combined with B-GOS prebiotic produced a greater symptom response than the sham diet plus placebo, but addition of 1.4 g/d B-GOS did not prevent the reduction of bifidobacteria. The LFD reduces fecal Actinobacteria and butyrate thus strict long-term use should not be advised.