What role does the gastrointestinal microbiota play in IBS symptoms?

Video from the Canadian Digestive Health Foundation.

One of the most interesting yet unknown topics in IBS is how the gastrointestinal microbiota play a part in the symptoms. The research team at King’s where I work discovered that the low FODMAP diet reduced levels of bifidobacteria in people with IBS.  Bifidobacteria is a gut microbe that has many benefits for health. Whether the low FODMAP diet causes a continued decrease in bifidobacteria in the long term or if this decrease has any negative effects on the health of the gut long term will continue to be studied.  Because of this unknown factor it is also not known if following the low FODMAP diet is safe in the long term.  The low FODMAP diet is not currently recommended as a diet for life but rather as a short term diet to help control IBS symptoms and once this is achieved to start eating foods high in FODMAPs according to your own tolerance levels; as determined through the reintroduction phase.

I wanted to share this video as it gives a really nice overview of IBS and the Gastrointestinal Microbiota. FODMAPs are not mentioned until the last few minutes of the presentation, and then only briefly, but this presentation is really all about the potential for altering the gut microbiota to influence IBS symptoms.   This topic is going to an interesting one to watch develop……

You can read Stephen Collins’ (the chap presenting the video) recent review paper; A role for the gut microbiota in IBS. In Nature Reviews (if you have access).

You can read the original research article by the King’s College London (KCL) FODMAPs Research Team from the link below (it is now an open access paper).  Main conclusion from the study:

Restriction of fermentable short-chain carbohydrates (FODMAPs) is an effective management strategy for IBS, resulting in reductions in overall symptoms and bloating. However, this dietary therapy results in significant reductions in luminal bifidobacteria after 4 weeks. Whether this effect persists over time or has any detrimental effects on long-term colonic health is yet to be determined.

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11 thoughts on “What role does the gastrointestinal microbiota play in IBS symptoms?

  1. Unfortunately, re-introducing high FODMAP foods after a period of low FODMAP is practically impossible – only very few lucky people are able to do it, usually those with only low levels of sensitivity. For the majority, any high FODMAP food causes symptoms, and they’re usually worse than before starting the diet (we become more sensitive?). From my point of view, I’d rather eat solely rice, chicken and potatoes for the rest of my life, than be sick all the time.

    1. Hi Zaneta many thanks for your comment it is something that is really interesting. While I agree with you that for some people with IBS visceral hypersensitivity may prevent many high FODMAP foods from being reintroduced, in my experience this is the minority of people. The majority of people I have seen in clinic are able and very keen to reintroduce high FODMAP foods back into their diet to their own tolerance levels. Research is looking into this right now to ascertain whether people who have followed the low FODMAP diet do actually eat high FODMAP foods again. Certainly there will be some who do not and I do not think the low FODMAP diet is that restricted, it still allows a huge variety of foods. I think your right in saying that the symptoms may feel worse after an extended period on the low FODMAP diet. This may be due to the change in gastrointestinal microbiota, visceral hypersensitivity or a combination of this and / or other factors. The low FODMAP diet has never been thought of as a diet for life and there are long term questions of the safety and efficacy of the diet. By completely avoiding all high FODMAP foods you may inadvertently be making your IBS worse due to the known beneficial effects of the high FODMAP foods on the digestive system. There is an increasing amount of research that suggests avoidance of foods has led to an increase in allergies and intolerance’s. Perhaps this is where the manufactured prebitoics will prove most useful; in those who can’t consume prebiotics from high FODMAP foods due to IBS symptoms but need them for long term gastrointestinal health……

  2. Thank you for this, the video is excellent. So do you think that taking Bifidobacteria as a suppliment could be a good thing while on a low FODMAPS diet? And do you think taking the prebiotic Transgalacto-oligosaccharide, as shown towards the end of the talk, would be tolerated and advisable on a low FODMAPS diet?

    1. the product shown in the slide towards the end is Bimuno and looking at its ingredients, the pertinent ones seem to be lactose and galactose so things that we would normally avoid on the FODMAPS?

      1. Hi Hannah, I know a little about Bimuno. I think the lactose is a very minor ingredient so should be okay for most people. There is no problem with galactose it is fine on the FODMAP diet, however Bimuno does contain galacto-oligosacharides (GOS) which is the prebiotic in the product. It gets a bit confusing as galacto-oligosacharide (GOS) is a prebiotic and is high FODMAP. Although I believe the GOS Bimuno use is extracted from a source that makes it a low FODMAP GOS. The GOS should feed the bifidobacteria. Bimuno has been shown to help reduce bloating and wind in IBS although the dose is the important issue. Start with a quarter of the sachet for 4 days, then increase to half for 4 more days. Then take the full dose everyday. You have to keep taking it for any beneficial effect to continue. More research is needed to identify who and why products like Bimuno work best in and whether they compliment the low FODMAP diet and how it affects the levels of bifidobacteria and other gastrointestinal microbiota.

    2. Hi Hannah thanks for your comment. What benefit there may be from taking a prebiotic while following a low FODMAP diet is currently being investigated. At the moment there is no high quality information to advise on this. Interactions like this are are never simple although it may look quite self explanatory. Just because a certain prebiotic may be beneficial for the bifidobacteria it doesn’t mean this will help with IBS symptoms or cause positive change in people with IBS. This is why research tries to provide clear answers, otherwise the effects may be simply a placebo or may be detrimental to some while benefit others.

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