Study: Can the restriction of fermentable carbohydrates help children with irritable bowel syndrome?

chrumptitizi BP, Cope JL, Hollister EB, et al. Randomized clinical study: Darmicrobiom biomarkers are associated with the clinical response to a fodmap-poor diet in children with irritable bowel syndrome. food pharmacol. Ther. 2015; 42 (4): 418-427.

randomized, double-blind crossover study

Thirty-three children (age 7-17 years) with irritable bowel syndrome (IBS) according to Rome III questionnaire to the gastrointestinal tract (GI).

All participants ate their usual diet for 7 days to set the baseline. Stool samples were obtained to determine microbiome taxa. Diet 1 or diet 2 was then taken for 48 hours; A 5-day washing phase followed, during which the usual diet was consumed, the participants were switched to the other diet. Diet 1 consisted of a diet with little fermentable oligosaccharides, disaccecharides, monosaccharides and polyols (fodmaps), which contained 9 g of fod maps per day. Diet 2 consisted of a typical American childhood diet (TACD), which contained a maximum of 50 g of fod maps per day.

The frequency of abdominal pain was the primary endpoint, which was rated through a pain and chair diary over 24-hour periods during the Baseline and during the 2 days of every nutritional intervention.

Secondary endpoints were associated symptoms such as flatulence, flatulence, nausea and heartburn.

The basic microbiological composition of the intestine (uncovered by 16S-RRNA sequencing) and the metabolic capacity of the organisms were determined. The comparison of the starting microbioma was divided into a responder group (≥50 % decrease in the frequency of abdominal pain only at low fodmap diet) and a non-responder group (no improvement during both interventions).

When comparing the diets, less abdominal pain occurred during the low-Fodmap diet than with the TACD (1.1 ± 0.2 standard error of the average). [Sem] Episoden/D vs. 1.7 ± 0.4 Sem-episodes/d, p <0.05). There were also fewer episodes of abdominal pain in the Fodmap diet ( p <0.01) and more episodes on the TACD ( p <0.01) compared to the initial value. The microbiomas of the responders were more enriched with taxa with greater fermentation ability (e.g. bacteroid , ruminococcaceae , faecalibacterium prausnitzii ).

The concept of irritable bowel syndrome in children recently was used by Sandhu et al. 1 A low-fodmap diet was used to treat adults with irritable bowel syndrome. ^{2-4 So far, every application of low-fodmap diet in children on adult populations. This study by Chumpitizi and colleagues confirms that there could be a therapeutic role in a low-Fodmap diet in pediatric IBS. It also illuminates the role of microbiota when using a low-Fodmap diet in IBS in childhood.}

The authors of this study had previously shown a benefit for children according to the Fodmap diet in a small open study. ^{5 they observed that children whose symptoms best respond to a low-fodmap diet showed another microbiota composition than those whose symptoms did not speak. These preliminary results led to the current randomized, double-blind crossover study that is checked here.}

Ultimately, we have to consider that the restriction of fermentative carbohydrates can create long -term risks through changes in the intestinal environment over longer periods (months or years).

The current study confirms the assumption of the authors that the benefits of a FodMap-poor nutrition are related to a certain bacterial composition. The responders had microbes from several taxa, including bacteroids , ruminococcaceae , faecalibactterium prausnitzii and dorea , all of which have a greater fermentative potential. The Nonresponder had a larger number of genus turicibacter , which are known to have a lower fermentation ability. This indicates that NonResponder have a bacterial composition that is less fermented; Therefore, removing fermentable carbohydrates has very low effects on their IBS symptoms.

This study presents the concept of a more individual approach for the use of the low-Fodmap diet. Ideally, doctors can assess the microbiome one day before starting with the Fodmap diet and perhaps save some children (or adults) the stress of such a limited diet.

While the FodMap diet can control the symptoms in patients with IBS, 6 The diet should be used with some caution. The application of the low-Fodmap diet (and/or the specific carbohydrate diet) over longer periods has not proven to be safe in long-term studies. The concern is that many of the restricted FODMAP foods (e.g. legumes, garlic, some wholemeal products) are of crucial importance for the health of the intestine. 7 fermentable carbohydrates increase the variety of bacteria in the large intestine and promote growth firmicutes , bacteroid and bifidobacterium . These types of bacteria produce short-chain fatty acids-propionate, butyrating and acetate-all of which are necessary for a healthy gastrointestinal tract. A recently carried out study has shown that a changed microbiota appears after patients have only taken a low-Fodmap diet for 21 days.

As a clinician, we initially do not have to harm our patient. As this study has shown, the use of a FodMap-poor diet can alleviate IBS symptoms, for some in just 48 hours. If this study had kept the children on a low-Fodmap diet for 7 days, as is common in adults, we might have seen a larger reaction to the diet.

Ultimately, we have to consider that by restricting fermentative carbohydrates over longer periods (months or years), we can also create long-term risks through changes in the intestinal environment, including increased inflammation and even colon cancer. ^{9-12 As always, it is to help the patient back to optimal health, so that a varied diet is resumed can.}

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11. Wu N., Yang X., Zhang R. et al. Dysbiosis signature of the fecal microbiota in intestinal cancer patients. Microb Ecol. 2013; 66 (2): 462-470.
12. Schwabe RF, Jobin C. The microbioma and cancer. NAT RE REM Cancer. 2013; 13 (11): 800-812.

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