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β-galacto-oligosaccharide in conjunction with low FODMAP diet improves irritable bowel syndrome symptoms but reduces fecal bifidobacteria

Research output: Contribution to journalArticle

Bridgette Wilson, Megan Rossi, Tokuwa Kanno, Gareth Parkes, Simon Anderson, James Mason, Peter M. Irving, Miranda Lomer, Kevin Whelan

Original languageEnglish
JournalThe American Journal of Gastroenterology
Publication statusAccepted/In press - 30 Mar 2020

King's Authors

Abstract

Introduction: The low FODMAP diet (LFD) reduces symptoms and bifidobacteria in irritable bowel syndrome (IBS). Β-galacto-oligosaccharides (β-GOS) may reduce symptoms and increase bifidobacteria in IBS. We investigated whether β-GOS supplementation alongside the LFD improves IBS symptoms whilst preventing the decline in bifidobacteria. Methods: We performed a randomized, placebo-controlled, 3-arm, trial of 69 Rome III, adult, IBS patients from secondary care in the United Kingdom. Patients were randomized to; sham diet with placebo supplement (control) or LFD supplemented with either placebo (LFD) or 1.4 g/d β-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 (1H NMR) were analyzed. Results: At 4-weeks, adequate symptom relief was higher in the LFD/B-GOS group (16/24, 67%) than control (7/23, 30%) (OR 4.6, 95%CI: 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 control (9.77 (0.41), p=0.018). Proportion of Actinobacteria was lower in LFD (1.9%, p=0.003) and LFD/B-GOS (1.8%, p<0.001) groups than control (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 control (609.2). Conclusion: The LFD combined with β-GOS prebiotic produced a greater symptom response than the sham diet plus placebo but addition of 1.4 g/d β-GOS did not prevent the reduction of bifidobacteria. The LFD reduces fecal Actinobacteria, and butyrate thus strict long-term use should not be advised.

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