Randomised clinical trial: effect of low-FODMAP rye bread versus regular rye bread on the intestinal microbiota of irritable bowel syndrome patients: association with individual symptom variation

Reijo Laatikainen; Jonna Jalanka; Jussi Loponen; Sanna-Maria Hongisto; Markku Hillilä; Jari Koskenpato; Riitta Korpela; Anne Salonen

doi:10.1186/s40795-019-0278-7

Randomised clinical trial: effect of low-FODMAP rye bread versus regular rye bread on the intestinal microbiota of irritable bowel syndrome patients: association with individual symptom variation

BMC Nutr. 2019 Mar 6:5:12. doi: 10.1186/s40795-019-0278-7. eCollection 2019.

Authors

Reijo Laatikainen^{1

2

3}, Jonna Jalanka⁴, Jussi Loponen⁵, Sanna-Maria Hongisto⁵, Markku Hillilä⁶, Jari Koskenpato², Riitta Korpela⁴, Anne Salonen⁴

Affiliations

¹ 1Faculty of Medicine, Pharmacology, Medical Nutrition Physiology, University of Helsinki, Helsinki, Finland.
² 2Aava Medical Centre, Helsinki, Finland.
³ Booston Oy Ltd, Viikinkaari 6, 00790 Helsinki, Finland.
⁴ 3Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁵ Fazer Group, Vantaa, Finland.
⁶ 5Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Abstract

Background: A low intake of Fermentable, Oligo-, Di-, Mono-saccharides and Polyols (FODMAPs) is effective in the symptom control of irritable bowel syndrome (IBS) patients but may exert negative effects on the intestinal microbiota. The microbial effects of increasing regular or non-FODMAP fibre sources are largely unknown. Furthermore, it is not known if the baseline microbiota composition is associated with individual symptom control during the consumption of different rye products in IBS patients. Our objective was to evaluate whether increased consumption of low-FODMAP rye bread or regular rye bread for 4 weeks would alter the intestinal microbiota composition of IBS patients following their habitual diet, and whether these changes associate to symptoms and/or the baseline microbiota.

Methods: The study was conducted as a randomized double blind controlled cross-over study (n = 50). Microbiota was analysed by 16S rRNA gene sequencing and associated with gastrointestinal symptoms. Both microbial changes and their associations to symptoms were secondary outcomes.

Results: The consumption of the test breads did not alter microbiota diversity. Compared to baseline, consumption of the low FODMAP rye bread decreased the abundance of Bacteroides, Flavonifractor, Holdemania, Parasutterella and Klebsiella and showed a trend towards increased bifidobacteria, whereas the regular rye bread decreased the abundance of Flavonifractor. When comparing between the two test breads, Klebsiella was decreased after low-FODMAP rye bread intake. Patients whose symptoms decreased during the low-FODMAP rye bread displayed more Blautia and less Barnesiella at baseline.

Conclusions: Consumption of low-FODMAP rye bread had modest, potentially beneficial effects on patients' microbiota while increasing their intake of fibre substantially. The baseline microbiota composition was associated with the variable degrees of symptom relief experienced by the patients. Consumption of a low-FODMAP rye bread might be one way to increase dietary fibre intake and improve the mild dysbiosis often observed among patients with IBS.

Trial registration: ClinicalTrials.gov: NCT02161120. Retrospectively registered 11 June 2014.

Keywords: Bifidobacteria; Blautia; Diet; FODMAP; IBS; Intestinal microbiota; Irritable bowel syndrome; Responder; Rye; Symptoms.

Associated data

ClinicalTrials.gov/NCT02161120