Abstract
Background and objectiveRecently, dietary restriction of fermentable carbohydrates (a low-FODMAP diet) in combination with a gluten-free diet (GFD) has been proposed to reduce the symptoms in irritable bowel syndrome (IBS) patients. Different studies reported that IBS has been associated with dysbiosis in the gut microbiota. Additionally, a few studies have reported inflammation in the gastrointestinal (GI) system of adults with IBS. In this study, we aimed to investigate the effects of low FODMAP-gluten free diet (LF-GFD) on clinical symptoms, intestinal microbiota diversity, and fecal calprotectin (FC) level in Iranian patients with IBS.DesignIn this clinical trial study, 42 patients with IBS (Rome IV criteria) underwent LF-GFD intervention for 6 weeks. Symptoms were assessed using the IBS symptom severity scoring (IBS-SSS), and fecal samples were collected at baseline and after intervention and analyzed by quantitative 16 S rRNA PCR assay. The diversity of gut microbiota compared before and after 6 weeks of dietary intervention. FC was also analyzed by the ELISA method.ResultsThirty patients (mean age 37.8 ± 10.7 years) completed the 6-week diet. The IBS-SSS was significantly (P = 0.001) reduced after LF-GFD intervention compared to the baseline. Significant microbial differences before and after intervention were noticed in fecal samples. A significant increase was found in Bacteroidetes, and the Firmicutes to Bacteroidetes (F/B) ratio was significantly (P = 0.001) decreased after the dietary intervention. The value of FC was significantly decreased after 6 weeks of dietary intervention (P = 0.001).ConclusionsOur study suggests that patients with IBS under an LF-GFD had a significant improvement in IBS symptoms severity, with reduced FC level following normalization of their gut microbiota composition. Further rigorous trials are needed to establish a long-term efficacy and safety of this dietary intervention for personalized nutrition in IBS.Clinical Trial Registry Number: IRCT20100524004010N26.
Highlights
Irritable bowel syndrome (IBS) is one of the most commonly diagnosed functional gastrointestinal disorders accounting for around 10% of the world’s population [1]
The irritable bowel syndrome (IBS)-SSS was significantly (P = 0.001) reduced after LF-gluten-free diet (GFD) intervention compared to the baseline
Our study suggests that patients with IBS under an low fermentable oligo-di-mono-saccharides and polyols (FODMAP)-gluten free diet (LF-GFD) had a significant improvement in IBS symp‐ toms severity, with reduced fecal calprotectin (FC) level following normalization of their gut microbiota composition
Summary
Irritable bowel syndrome (IBS) is one of the most commonly diagnosed functional gastrointestinal disorders accounting for around 10% of the world’s population [1]. It is well evident that microbiome dysbiosis-related disorders and IBS have been reported to have similar clinical features, and more recently, IBS has been found to be in association with the bacterial community shift in the large intestine [5]. Dietary restriction of fermentable carbohydrates (a low-FODMAP diet) in combination with a gluten-free diet (GFD) has been proposed to reduce the symptoms in irritable bowel syndrome (IBS) patients. We aimed to investigate the effects of low FODMAP-gluten free diet (LF-GFD) on clinical symptoms, intestinal microbiota diversity, and fecal calprotectin (FC) level in Iranian patients with IBS
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