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. 2022 Mar;20(3):e465-e483.
doi: 10.1016/j.cgh.2021.05.027. Epub 2021 May 20.

Effect of Exclusion Diets on Symptom Severity and the Gut Microbiota in Patients With Irritable Bowel Syndrome

Adrienne Lenhart  1 , Tien Dong  1 , Swapna Joshi  2 , Nancee Jaffe  1 , Charlene Choo  3 , Cathy Liu  2 , Jonathan P Jacobs  4 , Venu Lagishetty  1 , Wendy Shih  5 , Jennifer S Labus  2 , Arpana Gupta  2 , Kirsten Tillisch  2 , Emeran A Mayer  2 , Lin Chang  6
Affiliations

Effect of Exclusion Diets on Symptom Severity and the Gut Microbiota in Patients With Irritable Bowel Syndrome

Adrienne Lenhart et al. Clin Gastroenterol Hepatol. 2022 Mar.

Abstract

Background & aims: Altered fecal microbiota have been reported in irritable bowel syndrome (IBS), although studies vary, which could be owing to dietary effects. Many IBS patients may eliminate certain foods because of their symptoms, which in turn may alter fecal microbiota diversity and composition. This study aimed to determine if dietary patterns were associated with IBS, symptoms, and fecal microbiota differences reported in IBS.

Methods: A total of 346 IBS participants and 170 healthy controls (HCs) completed a Diet Checklist reflecting the diet(s) consumed most frequently. An exclusion diet was defined as a diet that eliminated food components by choice. Within this group, a gluten-free, dairy-free, or low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet was further defined as restrictive because they often are implicated in reducing symptoms. Stool samples were obtained from 171 IBS patients and 98 HCs for 16S ribosomal RNA gene sequencing and microbial composition analysis.

Results: Having IBS symptoms was associated with consuming a restrictive diet (27.17% of IBS patients vs 7.65% of HCs; odds ratio, 3.25; 95% CI, 1.66-6.75; P value = .006). IBS participants on an exclusion or restrictive diet reported more severe IBS symptoms (P = .042 and .029, respectively). The composition of the microbiota in IBS patients varied depending on the diet consumed. IBS participants on an exclusion diet had a greater abundance of Lachnospira and a lower abundance of Eubacterium (q value, <.05), and those on a restrictive diet had a lower abundance of Lactobacillus (q value, <.05).

Conclusions: Restrictive diets likely are consumed more by IBS patients than HCs to reduce GI symptom severity. Dietary patterns influence the composition of the fecal microbiota and may explain some of the differences between IBS and HCs.

Keywords: Diet; Fecal Microbiome; Irritable Bowel Syndrome.

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Conflict of interest statement

Conflicts of interest

This author discloses the following: Emeran A. Mayer is a scientific advisory board member of Danone, Axial Biotherapeutics, Viome, Amare, Mahana Therapeutics, Pendulum, Bloom Biosciences, and APC Microbiome Ireland. The remaining authors disclose no conflicts.

Figures

Figure 1.
Figure 1.
(A) Relative fecal abundances in constipation-predominant irritable bowel syndrome (IBS-C) compared with diarrhea-predominant irritable bowel syndrome (IBS-D). (B) Relative fecal abundances in IBS-C compared with IBS with mixed symptoms (IBS-M). (C) Relative fecal abundances in IBS-D compared with IBS-M.
Figure 2.
Figure 2.
(A) β-diversity in irritable bowel syndrome (IBS) participants on an exclusion diet compared with IBS participants not on an exclusion diet. (B) Relative fecal abundances in IBS participants on an exclusion diet compared with a nonexclusion diet.
Figure 3.
Figure 3.
(A) β-diversity in irritable bowel syndrome (IBS) participants on a restrictive diet compared with IBS participants not on a restrictive diet. (B) Relative fecal abundances in IBS participants on a restrictive diet compared with a nonrestrictive diet.
See this image and copyright information in PMC

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