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      Intestinal Microbiota And Diet in IBS: Causes, Consequences, or Epiphenomena?

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          Irritable bowel syndrome (IBS) is a heterogeneous functional disorder with a multifactorial etiology that involves the interplay of both host and environmental factors. Among environmental factors relevant for IBS etiology, the diet stands out given that the majority of IBS patients report their symptoms to be triggered by meals or specific foods. The diet provides substrates for microbial fermentation, and, as the composition of the intestinal microbiota is disturbed in IBS patients, the link between diet, microbiota composition, and microbial fermentation products might have an essential role in IBS etiology. In this review, we summarize current evidence regarding the impact of diet and the intestinal microbiota on IBS symptoms, as well as the reported interactions between diet and the microbiota composition. On the basis of the existing data, we suggest pathways (mechanisms) by which diet components, via the microbial fermentation, could trigger IBS symptoms. Finally, this review provides recommendations for future studies that would enable elucidation of the role of diet and microbiota and how these factors may be (inter)related in the pathophysiology of IBS.

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          Most cited references 113

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          Diet rapidly and reproducibly alters the human gut microbiome

          Long-term diet influences the structure and activity of the trillions of microorganisms residing in the human gut 1–5 , but it remains unclear how rapidly and reproducibly the human gut microbiome responds to short-term macronutrient change. Here, we show that the short-term consumption of diets composed entirely of animal or plant products alters microbial community structure and overwhelms inter-individual differences in microbial gene expression. The animal-based diet increased the abundance of bile-tolerant microorganisms (Alistipes, Bilophila, and Bacteroides) and decreased the levels of Firmicutes that metabolize dietary plant polysaccharides (Roseburia, Eubacterium rectale, and Ruminococcus bromii). Microbial activity mirrored differences between herbivorous and carnivorous mammals 2 , reflecting trade-offs between carbohydrate and protein fermentation. Foodborne microbes from both diets transiently colonized the gut, including bacteria, fungi, and even viruses. Finally, increases in the abundance and activity of Bilophila wadsworthia on the animal-based diet support a link between dietary fat, bile acids, and the outgrowth of microorganisms capable of triggering inflammatory bowel disease 6 . In concert, these results demonstrate that the gut microbiome can rapidly respond to altered diet, potentially facilitating the diversity of human dietary lifestyles.
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            Human gut microbiome viewed across age and geography

            Gut microbial communities represent one source of human genetic and metabolic diversity. To examine how gut microbiomes differ between human populations when viewed from the perspective of component microbial lineages, encoded metabolic functions, stage of postnatal development, and environmental exposures, we characterized bacterial species present in fecal samples obtained from 531 individuals representing healthy Amerindians from the Amazonas of Venezuela, residents of rural Malawian communities, and inhabitants of USA metropolitan areas, as well as the gene content of 110 of their microbiomes. This cohort encompassed infants, children, teenagers and adults, parents and offspring, and included mono- and dizygotic twins. Shared features of the functional maturation of the gut microbiome were identified during the first three years of life in all three populations, including age-associated changes in the representation of genes involved in vitamin biosynthesis and metabolism. Pronounced differences in bacterial species assemblages and functional gene repertoires were noted between individuals residing in the USA compared to the other two countries. These distinctive features are evident in early infancy as well as adulthood. In addition, the similarity of fecal microbiomes among family members extends across cultures. These findings underscore the need to consider the microbiome when evaluating human development, nutritional needs, physiological variations, and the impact of Westernization.
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              Linking long-term dietary patterns with gut microbial enterotypes.

              Diet strongly affects human health, partly by modulating gut microbiome composition. We used diet inventories and 16S rDNA sequencing to characterize fecal samples from 98 individuals. Fecal communities clustered into enterotypes distinguished primarily by levels of Bacteroides and Prevotella. Enterotypes were strongly associated with long-term diets, particularly protein and animal fat (Bacteroides) versus carbohydrates (Prevotella). A controlled-feeding study of 10 subjects showed that microbiome composition changed detectably within 24 hours of initiating a high-fat/low-fiber or low-fat/high-fiber diet, but that enterotype identity remained stable during the 10-day study. Thus, alternative enterotype states are associated with long-term diet.

                Author and article information

                Am J Gastroenterol
                Am. J. Gastroenterol
                The American Journal of Gastroenterology
                Nature Publishing Group
                February 2015
                27 January 2015
                : 110
                : 2
                : 278-287
                [1 ]Department of Biochemical Engineering and Biotechnology, Faculty of Technology and Metallurgy, University of Belgrade , Belgrade, Serbia
                [2 ]Division Gastroenterology-Hepatology, School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht University Medical Center+ , Maastricht, The Netherlands
                [3 ]Immunobiology Research Programme, Department of Bacteriology and Immunology, University of Helsinki , Helsinki, Finland
                [4 ]Department of Clinical Science, University of Bergen , Bergen, Norway
                [5 ]Department Microbiology and Immunology, KU Leuven , Leuven, Belgium
                [6 ]Department of Veterinary Biosciences, Microbiology, University of Helsinki , Helsinki, Finland
                [7 ]Laboratory of Microbiology, Wageningen University , Wageningen, The Netherlands
                [8 ]Digestive System Research Unit, University Hospital Vall d'Hebron, Ciberehd , Barcelona, Spain
                [9 ]Laboratory for Molecular Microbiology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade , Belgrade, Serbia
                [10 ]Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen , Tìbingen, Germany
                [11 ]Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia , Nicosia, Cyprus
                [12 ]Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel
                [13 ]Department of Psychiatry and Alimentary Pharmabiotic Centre, University College Cork , Cork, Ireland
                [14 ]Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Queens Medical Centre , Nottingham, UK
                [15 ]Department of Medical Microbiology, School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht University Medical Center+ , Maastricht, The Netherlands
                Author notes
                [* ]Department of Medical Microbiology, School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht University Medical Center+ , PO Box 5800, Maastricht 6202, AZ, The Netherlands. E-mail: j.penders@
                Copyright © 2014 American College of Gastroenterology

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. To view a copy of this license, visit


                Gastroenterology & Hepatology


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