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Are artificial sweeteners really harmless?
New research discounts the long-held notion that aspartame and other nonnutritive sweeteners (NNS) have no effect on the human body.
Researchers found that these sugar substitutes are not metabolically inert and can alter the gut microbiome in a way that can influence blood glucose levels.
The study was published online in the journal Cell.
Gut reaction?
Several years ago, a team led by Eran Elinav, MD, PhD, an immunologist and microbiome researcher at the Weizmann Institute of Science, Rehovot, Israel, observed that these sweeteners affect the microbiome of mice in ways that could affect glycemic responses.
They have now confirmed this observation in a randomized controlled trial with 120 healthy adults.
Each sweetener “significantly and distinctly” altered stool and oral microbiome, and two of them (saccharin and sucralose) significantly impaired glucose tolerance, the researchers reported.
“Importantly, by performing extensive fecal transplantation of human microbiomes into germ-free mice, we demonstrate a causal and individualized link between NNS-altered microbiomes and glucose intolerance developing in non–NNS-consuming recipient mice,” they said.
They noted that the effects of these sweeteners will likely vary from person to person because of the unique composition of an individual’s microbiome.
“We need to raise awareness of the fact that NNS are not inert to the human body as we originally believed. With that said, the clinical health implications of the changes they may elicit in humans remain unknown and merit future long-term studies,” Dr. Elinav said in a news release.
For now, Dr. Elinav said it’s his personal view that “drinking only water seems to be the best solution.”
Weighing the evidence
Several experts weighed in on the results in a statement from the U.K. nonprofit organization, Science Media Centre.
Duane Mellor, PhD, RD, RNutr, registered dietitian and senior teaching fellow, Aston University, Birmingham, England, notes that the study does not show a link between all NNS and higher blood glucose levels in the long term (only after a glucose tolerance test).
“It did suggest, though, that some individuals who do not normally consume sweeteners may not tolerate glucose as well after consuming six sachets of either saccharin or sucralose mixed with glucose per day,” Dr. Mellor says.
Kim Barrett, PhD, distinguished professor of physiology and membrane biology, University of California, Davis, concurs, saying “this well-designed study indicates the potential for NNS to have adverse effects in at least some individuals.”
The study also does not provide any information about how people who normally consume sweeteners or people with either type 1 or type 2 diabetes respond to NNS.
“Therefore, for some people, it is likely to be a better option and more sustainable approach to use sweeteners as a ‘stepping stone’ allowing them to reduce the amount of added sugar in foods and drinks, to reduce their sugar intake and still enjoy what they eat and drink, on the way to reducing both added sugar and sweeteners in their diet,” Dr. Mellor suggests.
Kevin McConway, PhD, with the Open University, Milton Keynes, England, said it’s “important to understand that the research is not saying that these sweeteners are worse for us, in heath terms, than sugar.
“But exactly what the health consequences of all this, if any, might be is a subject for future research,” Dr. McConway added.
Kathy Redfern, PhD, lecturer in human nutrition, University of Plymouth (England) agrees.
“We still have a lot to learn about the human microbiome, and although this study suggests two of the sweeteners tested in this study (sucralose and saccharin) significantly affected glucose tolerance, these deviations were small,” she says.
The International Sweeteners Association also weighs in, saying, “No conclusions about the effects of low/no calorie sweeteners on glucose control or overall health can be extrapolated from this study for the general population or for people who typically consume sweeteners, including people living with diabetes.”
They add “a recent review of the literature concluded that there is clear evidence that changes in the diet unrelated to low/no calorie sweeteners consumption are likely the major determinants of change in gut microbiota.”
Nevertheless, Dr. Redfern says the results “warrant further investigation to assess how small changes in glucose tolerance in response to NNS consumption may influence longer-term glucose tolerance and risk for metabolic complications, such as type 2 diabetes.”
The study had no specific funding. Dr. Elinav is a scientific founder of DayTwo and BiomX, a paid consultant to Hello Inside and Aposense, and a member of the scientific advisory board of Cell. Dr. Mellor has provided consultancy to the International Sweetener Agency and has worked on projects funded by the Food Standards Agency that investigated the health effects of aspartame. Dr. Barrett, Dr. McConway, and Dr. Redfern report no relevant financial relationships.
A version of this article first appeared on Medscape.com.
This article was updated 8/29/22.
New research discounts the long-held notion that aspartame and other nonnutritive sweeteners (NNS) have no effect on the human body.
Researchers found that these sugar substitutes are not metabolically inert and can alter the gut microbiome in a way that can influence blood glucose levels.
The study was published online in the journal Cell.
Gut reaction?
Several years ago, a team led by Eran Elinav, MD, PhD, an immunologist and microbiome researcher at the Weizmann Institute of Science, Rehovot, Israel, observed that these sweeteners affect the microbiome of mice in ways that could affect glycemic responses.
They have now confirmed this observation in a randomized controlled trial with 120 healthy adults.
Each sweetener “significantly and distinctly” altered stool and oral microbiome, and two of them (saccharin and sucralose) significantly impaired glucose tolerance, the researchers reported.
“Importantly, by performing extensive fecal transplantation of human microbiomes into germ-free mice, we demonstrate a causal and individualized link between NNS-altered microbiomes and glucose intolerance developing in non–NNS-consuming recipient mice,” they said.
They noted that the effects of these sweeteners will likely vary from person to person because of the unique composition of an individual’s microbiome.
“We need to raise awareness of the fact that NNS are not inert to the human body as we originally believed. With that said, the clinical health implications of the changes they may elicit in humans remain unknown and merit future long-term studies,” Dr. Elinav said in a news release.
For now, Dr. Elinav said it’s his personal view that “drinking only water seems to be the best solution.”
Weighing the evidence
Several experts weighed in on the results in a statement from the U.K. nonprofit organization, Science Media Centre.
Duane Mellor, PhD, RD, RNutr, registered dietitian and senior teaching fellow, Aston University, Birmingham, England, notes that the study does not show a link between all NNS and higher blood glucose levels in the long term (only after a glucose tolerance test).
“It did suggest, though, that some individuals who do not normally consume sweeteners may not tolerate glucose as well after consuming six sachets of either saccharin or sucralose mixed with glucose per day,” Dr. Mellor says.
Kim Barrett, PhD, distinguished professor of physiology and membrane biology, University of California, Davis, concurs, saying “this well-designed study indicates the potential for NNS to have adverse effects in at least some individuals.”
The study also does not provide any information about how people who normally consume sweeteners or people with either type 1 or type 2 diabetes respond to NNS.
“Therefore, for some people, it is likely to be a better option and more sustainable approach to use sweeteners as a ‘stepping stone’ allowing them to reduce the amount of added sugar in foods and drinks, to reduce their sugar intake and still enjoy what they eat and drink, on the way to reducing both added sugar and sweeteners in their diet,” Dr. Mellor suggests.
Kevin McConway, PhD, with the Open University, Milton Keynes, England, said it’s “important to understand that the research is not saying that these sweeteners are worse for us, in heath terms, than sugar.
“But exactly what the health consequences of all this, if any, might be is a subject for future research,” Dr. McConway added.
Kathy Redfern, PhD, lecturer in human nutrition, University of Plymouth (England) agrees.
“We still have a lot to learn about the human microbiome, and although this study suggests two of the sweeteners tested in this study (sucralose and saccharin) significantly affected glucose tolerance, these deviations were small,” she says.
The International Sweeteners Association also weighs in, saying, “No conclusions about the effects of low/no calorie sweeteners on glucose control or overall health can be extrapolated from this study for the general population or for people who typically consume sweeteners, including people living with diabetes.”
They add “a recent review of the literature concluded that there is clear evidence that changes in the diet unrelated to low/no calorie sweeteners consumption are likely the major determinants of change in gut microbiota.”
Nevertheless, Dr. Redfern says the results “warrant further investigation to assess how small changes in glucose tolerance in response to NNS consumption may influence longer-term glucose tolerance and risk for metabolic complications, such as type 2 diabetes.”
The study had no specific funding. Dr. Elinav is a scientific founder of DayTwo and BiomX, a paid consultant to Hello Inside and Aposense, and a member of the scientific advisory board of Cell. Dr. Mellor has provided consultancy to the International Sweetener Agency and has worked on projects funded by the Food Standards Agency that investigated the health effects of aspartame. Dr. Barrett, Dr. McConway, and Dr. Redfern report no relevant financial relationships.
A version of this article first appeared on Medscape.com.
This article was updated 8/29/22.
New research discounts the long-held notion that aspartame and other nonnutritive sweeteners (NNS) have no effect on the human body.
Researchers found that these sugar substitutes are not metabolically inert and can alter the gut microbiome in a way that can influence blood glucose levels.
The study was published online in the journal Cell.
Gut reaction?
Several years ago, a team led by Eran Elinav, MD, PhD, an immunologist and microbiome researcher at the Weizmann Institute of Science, Rehovot, Israel, observed that these sweeteners affect the microbiome of mice in ways that could affect glycemic responses.
They have now confirmed this observation in a randomized controlled trial with 120 healthy adults.
Each sweetener “significantly and distinctly” altered stool and oral microbiome, and two of them (saccharin and sucralose) significantly impaired glucose tolerance, the researchers reported.
“Importantly, by performing extensive fecal transplantation of human microbiomes into germ-free mice, we demonstrate a causal and individualized link between NNS-altered microbiomes and glucose intolerance developing in non–NNS-consuming recipient mice,” they said.
They noted that the effects of these sweeteners will likely vary from person to person because of the unique composition of an individual’s microbiome.
“We need to raise awareness of the fact that NNS are not inert to the human body as we originally believed. With that said, the clinical health implications of the changes they may elicit in humans remain unknown and merit future long-term studies,” Dr. Elinav said in a news release.
For now, Dr. Elinav said it’s his personal view that “drinking only water seems to be the best solution.”
Weighing the evidence
Several experts weighed in on the results in a statement from the U.K. nonprofit organization, Science Media Centre.
Duane Mellor, PhD, RD, RNutr, registered dietitian and senior teaching fellow, Aston University, Birmingham, England, notes that the study does not show a link between all NNS and higher blood glucose levels in the long term (only after a glucose tolerance test).
“It did suggest, though, that some individuals who do not normally consume sweeteners may not tolerate glucose as well after consuming six sachets of either saccharin or sucralose mixed with glucose per day,” Dr. Mellor says.
Kim Barrett, PhD, distinguished professor of physiology and membrane biology, University of California, Davis, concurs, saying “this well-designed study indicates the potential for NNS to have adverse effects in at least some individuals.”
The study also does not provide any information about how people who normally consume sweeteners or people with either type 1 or type 2 diabetes respond to NNS.
“Therefore, for some people, it is likely to be a better option and more sustainable approach to use sweeteners as a ‘stepping stone’ allowing them to reduce the amount of added sugar in foods and drinks, to reduce their sugar intake and still enjoy what they eat and drink, on the way to reducing both added sugar and sweeteners in their diet,” Dr. Mellor suggests.
Kevin McConway, PhD, with the Open University, Milton Keynes, England, said it’s “important to understand that the research is not saying that these sweeteners are worse for us, in heath terms, than sugar.
“But exactly what the health consequences of all this, if any, might be is a subject for future research,” Dr. McConway added.
Kathy Redfern, PhD, lecturer in human nutrition, University of Plymouth (England) agrees.
“We still have a lot to learn about the human microbiome, and although this study suggests two of the sweeteners tested in this study (sucralose and saccharin) significantly affected glucose tolerance, these deviations were small,” she says.
The International Sweeteners Association also weighs in, saying, “No conclusions about the effects of low/no calorie sweeteners on glucose control or overall health can be extrapolated from this study for the general population or for people who typically consume sweeteners, including people living with diabetes.”
They add “a recent review of the literature concluded that there is clear evidence that changes in the diet unrelated to low/no calorie sweeteners consumption are likely the major determinants of change in gut microbiota.”
Nevertheless, Dr. Redfern says the results “warrant further investigation to assess how small changes in glucose tolerance in response to NNS consumption may influence longer-term glucose tolerance and risk for metabolic complications, such as type 2 diabetes.”
The study had no specific funding. Dr. Elinav is a scientific founder of DayTwo and BiomX, a paid consultant to Hello Inside and Aposense, and a member of the scientific advisory board of Cell. Dr. Mellor has provided consultancy to the International Sweetener Agency and has worked on projects funded by the Food Standards Agency that investigated the health effects of aspartame. Dr. Barrett, Dr. McConway, and Dr. Redfern report no relevant financial relationships.
A version of this article first appeared on Medscape.com.
This article was updated 8/29/22.
Factors influencing disease specific QoL in IBS
Key clinical point: Gastrointestinal (GI)‐specific anxiety was the strongest contributor to reduced quality of life (QoL) in patients with irritable bowel syndrome (IBS).
Major finding: The factors independently associated with reduced IBS-QoL were a higher stool frequency (β −0.109; P = .022), GI (β −0.160; P = .009) and overall somatic symptom severity (β −0.171; P = .005), and psychological distress (β −0.194; P = .011), with GI‐specific anxiety (β −0.330; P < .001) being the strongest contributor.
Study details: This study included 314 patients with IBS from 2 prospective cohorts who completed the IBS-QoL and self‐report symptom questionnaires and tests for the measurement of oroanal transit time and rectal sensitivity.
Disclosures: This study was funded by Swedish state under the agreement between the Swedish government and the county councils (the ALF‐agreement) and others. Some authors declared serving as consultants/advisory board members or on speakers’ bureau for various sources.
Source: Melchior C et al. Irritable bowel syndrome: Factors of importance for disease-specific quality of life. United European Gastroenterol J. 2022 (Jul 13). Doi: 10.1002/ueg2.12277
Key clinical point: Gastrointestinal (GI)‐specific anxiety was the strongest contributor to reduced quality of life (QoL) in patients with irritable bowel syndrome (IBS).
Major finding: The factors independently associated with reduced IBS-QoL were a higher stool frequency (β −0.109; P = .022), GI (β −0.160; P = .009) and overall somatic symptom severity (β −0.171; P = .005), and psychological distress (β −0.194; P = .011), with GI‐specific anxiety (β −0.330; P < .001) being the strongest contributor.
Study details: This study included 314 patients with IBS from 2 prospective cohorts who completed the IBS-QoL and self‐report symptom questionnaires and tests for the measurement of oroanal transit time and rectal sensitivity.
Disclosures: This study was funded by Swedish state under the agreement between the Swedish government and the county councils (the ALF‐agreement) and others. Some authors declared serving as consultants/advisory board members or on speakers’ bureau for various sources.
Source: Melchior C et al. Irritable bowel syndrome: Factors of importance for disease-specific quality of life. United European Gastroenterol J. 2022 (Jul 13). Doi: 10.1002/ueg2.12277
Key clinical point: Gastrointestinal (GI)‐specific anxiety was the strongest contributor to reduced quality of life (QoL) in patients with irritable bowel syndrome (IBS).
Major finding: The factors independently associated with reduced IBS-QoL were a higher stool frequency (β −0.109; P = .022), GI (β −0.160; P = .009) and overall somatic symptom severity (β −0.171; P = .005), and psychological distress (β −0.194; P = .011), with GI‐specific anxiety (β −0.330; P < .001) being the strongest contributor.
Study details: This study included 314 patients with IBS from 2 prospective cohorts who completed the IBS-QoL and self‐report symptom questionnaires and tests for the measurement of oroanal transit time and rectal sensitivity.
Disclosures: This study was funded by Swedish state under the agreement between the Swedish government and the county councils (the ALF‐agreement) and others. Some authors declared serving as consultants/advisory board members or on speakers’ bureau for various sources.
Source: Melchior C et al. Irritable bowel syndrome: Factors of importance for disease-specific quality of life. United European Gastroenterol J. 2022 (Jul 13). Doi: 10.1002/ueg2.12277
Differential colonic microbial environment in IBS-D patients with vs without symptom exacerbation
Key clinical point: The colonic microbial environment changes with exacerbation of symptoms in patients with irritable bowel syndrome with diarrhea (IBS-D).
Major finding: The fecal alpha-diversity was significantly different between IBS without vs with symptom exacerbation (P < .01). The transcription levels of genes involved in enzymatic glutamine to tryptophan synthesis, putrescine to GABA synthesis, inositol degradation, menaquinone synthesis, crotonyl-CoA to butyrate synthesis, and propionate synthesis were significantly lower in IBS with vs without symptom exacerbation (P < .05).
Study details: Findings are from an analysis of 43 male patients with IBS-D and 40 healthy male controls.
Disclosures: This study was supported by grants from JSPS KAKENHI, Japan, the Japanese Food Science Institute Foundation, and others. The authors declared no conflicts of interest.
Source: Tanaka Y et al. Omics profiles of fecal and oral microbiota change in irritable bowel syndrome patients with diarrhea and symptom exacerbation. J Gastroenterol. 2022 (Jul 30). Doi: 10.1007/s00535-022-01888-2
Key clinical point: The colonic microbial environment changes with exacerbation of symptoms in patients with irritable bowel syndrome with diarrhea (IBS-D).
Major finding: The fecal alpha-diversity was significantly different between IBS without vs with symptom exacerbation (P < .01). The transcription levels of genes involved in enzymatic glutamine to tryptophan synthesis, putrescine to GABA synthesis, inositol degradation, menaquinone synthesis, crotonyl-CoA to butyrate synthesis, and propionate synthesis were significantly lower in IBS with vs without symptom exacerbation (P < .05).
Study details: Findings are from an analysis of 43 male patients with IBS-D and 40 healthy male controls.
Disclosures: This study was supported by grants from JSPS KAKENHI, Japan, the Japanese Food Science Institute Foundation, and others. The authors declared no conflicts of interest.
Source: Tanaka Y et al. Omics profiles of fecal and oral microbiota change in irritable bowel syndrome patients with diarrhea and symptom exacerbation. J Gastroenterol. 2022 (Jul 30). Doi: 10.1007/s00535-022-01888-2
Key clinical point: The colonic microbial environment changes with exacerbation of symptoms in patients with irritable bowel syndrome with diarrhea (IBS-D).
Major finding: The fecal alpha-diversity was significantly different between IBS without vs with symptom exacerbation (P < .01). The transcription levels of genes involved in enzymatic glutamine to tryptophan synthesis, putrescine to GABA synthesis, inositol degradation, menaquinone synthesis, crotonyl-CoA to butyrate synthesis, and propionate synthesis were significantly lower in IBS with vs without symptom exacerbation (P < .05).
Study details: Findings are from an analysis of 43 male patients with IBS-D and 40 healthy male controls.
Disclosures: This study was supported by grants from JSPS KAKENHI, Japan, the Japanese Food Science Institute Foundation, and others. The authors declared no conflicts of interest.
Source: Tanaka Y et al. Omics profiles of fecal and oral microbiota change in irritable bowel syndrome patients with diarrhea and symptom exacerbation. J Gastroenterol. 2022 (Jul 30). Doi: 10.1007/s00535-022-01888-2
IBS: Effect of starch‐ and sucrose‐reduced diet on gut microbiota and gastrointestinal symptoms
Key clinical point: A starch‐ and sucrose‐reduced diet (SSRD) led to a significant shift in the gut microbiota, which correlated with reduced gastrointestinal (GI) symptoms, in patients with irritable bowel syndrome (IBS).
Major finding: A significant shift in beta-diversity was observed in the intervention group (P < .001), along with a significant increase in the abundance of Proteobacteria (P = .0036), Lentisphaerae (P = .0038), and Cyanobacteria (P = .038) and a decrease in Bacteroidetes (P < .001). The abundance of Proteobacteria correlated positively (P = .0016) and Bacteroidetes negatively (P = .0017) with reduced total GI symptoms.
Study details: This study included 105 patients with IBS who were randomly assigned to receive a 4‐week SSRD intervention (n = 80) or habitual (n = 25) diet.
Disclosures: This study was partially funded by the Skåne University Hospital Foundation, Dir Albert Påhlsson Foundation, and others. The authors declared no conflicts of interest.
Source: Nilholm C et al. A starch- and sucrose-reduced dietary intervention in irritable bowel syndrome patients produced a shift in gut microbiota composition along with changes in phylum, genus, and amplicon sequence variant abundances, without affecting the micro-RNA levels. United European Gastroenterol J. 2022;10(4):363-375 (Apr 28). Doi: 10.1002/ueg2.12227
Key clinical point: A starch‐ and sucrose‐reduced diet (SSRD) led to a significant shift in the gut microbiota, which correlated with reduced gastrointestinal (GI) symptoms, in patients with irritable bowel syndrome (IBS).
Major finding: A significant shift in beta-diversity was observed in the intervention group (P < .001), along with a significant increase in the abundance of Proteobacteria (P = .0036), Lentisphaerae (P = .0038), and Cyanobacteria (P = .038) and a decrease in Bacteroidetes (P < .001). The abundance of Proteobacteria correlated positively (P = .0016) and Bacteroidetes negatively (P = .0017) with reduced total GI symptoms.
Study details: This study included 105 patients with IBS who were randomly assigned to receive a 4‐week SSRD intervention (n = 80) or habitual (n = 25) diet.
Disclosures: This study was partially funded by the Skåne University Hospital Foundation, Dir Albert Påhlsson Foundation, and others. The authors declared no conflicts of interest.
Source: Nilholm C et al. A starch- and sucrose-reduced dietary intervention in irritable bowel syndrome patients produced a shift in gut microbiota composition along with changes in phylum, genus, and amplicon sequence variant abundances, without affecting the micro-RNA levels. United European Gastroenterol J. 2022;10(4):363-375 (Apr 28). Doi: 10.1002/ueg2.12227
Key clinical point: A starch‐ and sucrose‐reduced diet (SSRD) led to a significant shift in the gut microbiota, which correlated with reduced gastrointestinal (GI) symptoms, in patients with irritable bowel syndrome (IBS).
Major finding: A significant shift in beta-diversity was observed in the intervention group (P < .001), along with a significant increase in the abundance of Proteobacteria (P = .0036), Lentisphaerae (P = .0038), and Cyanobacteria (P = .038) and a decrease in Bacteroidetes (P < .001). The abundance of Proteobacteria correlated positively (P = .0016) and Bacteroidetes negatively (P = .0017) with reduced total GI symptoms.
Study details: This study included 105 patients with IBS who were randomly assigned to receive a 4‐week SSRD intervention (n = 80) or habitual (n = 25) diet.
Disclosures: This study was partially funded by the Skåne University Hospital Foundation, Dir Albert Påhlsson Foundation, and others. The authors declared no conflicts of interest.
Source: Nilholm C et al. A starch- and sucrose-reduced dietary intervention in irritable bowel syndrome patients produced a shift in gut microbiota composition along with changes in phylum, genus, and amplicon sequence variant abundances, without affecting the micro-RNA levels. United European Gastroenterol J. 2022;10(4):363-375 (Apr 28). Doi: 10.1002/ueg2.12227
Influential role of diet in concomitant migraine and IBS
Key clinical point: A diet low in fat and copper and rich in fiber and zinc might benefit patients with comorbid migraine and irritable bowel syndrome (IBS).
Major finding: The frequency of migraine attacks per month and IBS severity scores were positively correlated with dietary intake of fats and copper (all P < .05) and negatively correlated with dietary intake of fibers and zinc (all P < .05).
Study details: Findings are from a cross-sectional study including 100 patients with concomitant migraine and IBS.
Disclosures: This study did not receive any funding, except open access funding provided by The Science, Technology, & Innovation Funding Authority in cooperation with The Egyptian Knowledge Bank. The authors declared no conflicts of interest.
Source: Magdy R et al. The potential impact of nutritional intake on symptoms severity in patients with comorbid migraine and irritable bowel syndrome. BMC Neurol. 2022;22:199 (May 30). Doi: 10.1186/s12883-022-02723-0
Key clinical point: A diet low in fat and copper and rich in fiber and zinc might benefit patients with comorbid migraine and irritable bowel syndrome (IBS).
Major finding: The frequency of migraine attacks per month and IBS severity scores were positively correlated with dietary intake of fats and copper (all P < .05) and negatively correlated with dietary intake of fibers and zinc (all P < .05).
Study details: Findings are from a cross-sectional study including 100 patients with concomitant migraine and IBS.
Disclosures: This study did not receive any funding, except open access funding provided by The Science, Technology, & Innovation Funding Authority in cooperation with The Egyptian Knowledge Bank. The authors declared no conflicts of interest.
Source: Magdy R et al. The potential impact of nutritional intake on symptoms severity in patients with comorbid migraine and irritable bowel syndrome. BMC Neurol. 2022;22:199 (May 30). Doi: 10.1186/s12883-022-02723-0
Key clinical point: A diet low in fat and copper and rich in fiber and zinc might benefit patients with comorbid migraine and irritable bowel syndrome (IBS).
Major finding: The frequency of migraine attacks per month and IBS severity scores were positively correlated with dietary intake of fats and copper (all P < .05) and negatively correlated with dietary intake of fibers and zinc (all P < .05).
Study details: Findings are from a cross-sectional study including 100 patients with concomitant migraine and IBS.
Disclosures: This study did not receive any funding, except open access funding provided by The Science, Technology, & Innovation Funding Authority in cooperation with The Egyptian Knowledge Bank. The authors declared no conflicts of interest.
Source: Magdy R et al. The potential impact of nutritional intake on symptoms severity in patients with comorbid migraine and irritable bowel syndrome. BMC Neurol. 2022;22:199 (May 30). Doi: 10.1186/s12883-022-02723-0
IBS: FODMAP-lowering diet application shows promise as an initial therapeutic approach
Key clinical point: In patients newly diagnosed with irritable bowel syndrome (IBS), an 8-week fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)-lowering diet application was superior to a spasmolytic agent, otilonium bromide (OB), in improving disease symptoms.
Major finding: At 8 weeks, the response rate (71% vs 61%; P = .03) and treatment adherence rate (94% vs 73%; P < .001) were significantly higher in the diet vs OB arm, with the improvement in IBS Symptom Severity Score being significantly higher in the diet group (P = .02). No serious adverse reactions were recorded.
Study details: Findings are from the DOMINO trial that included 459 primary care patients with IBS who were randomly assigned to the 8-week OB (40 mg, 3 times/day) or FODMAP-lowering diet application group.
Disclosures: This study was funded through the Belgian Health Care Knowledge Centre and others. The authors declared serving as scientific advisors or on speaker bureaus or receiving research support or grants from various sources.
Source: Carbone F et al. Diet or medication in primary care patients with IBS: The DOMINO study - a randomized trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute. Gut. 2022 (Apr 28). Doi: 10.1136/gutjnl-2021-325821
Key clinical point: In patients newly diagnosed with irritable bowel syndrome (IBS), an 8-week fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)-lowering diet application was superior to a spasmolytic agent, otilonium bromide (OB), in improving disease symptoms.
Major finding: At 8 weeks, the response rate (71% vs 61%; P = .03) and treatment adherence rate (94% vs 73%; P < .001) were significantly higher in the diet vs OB arm, with the improvement in IBS Symptom Severity Score being significantly higher in the diet group (P = .02). No serious adverse reactions were recorded.
Study details: Findings are from the DOMINO trial that included 459 primary care patients with IBS who were randomly assigned to the 8-week OB (40 mg, 3 times/day) or FODMAP-lowering diet application group.
Disclosures: This study was funded through the Belgian Health Care Knowledge Centre and others. The authors declared serving as scientific advisors or on speaker bureaus or receiving research support or grants from various sources.
Source: Carbone F et al. Diet or medication in primary care patients with IBS: The DOMINO study - a randomized trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute. Gut. 2022 (Apr 28). Doi: 10.1136/gutjnl-2021-325821
Key clinical point: In patients newly diagnosed with irritable bowel syndrome (IBS), an 8-week fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)-lowering diet application was superior to a spasmolytic agent, otilonium bromide (OB), in improving disease symptoms.
Major finding: At 8 weeks, the response rate (71% vs 61%; P = .03) and treatment adherence rate (94% vs 73%; P < .001) were significantly higher in the diet vs OB arm, with the improvement in IBS Symptom Severity Score being significantly higher in the diet group (P = .02). No serious adverse reactions were recorded.
Study details: Findings are from the DOMINO trial that included 459 primary care patients with IBS who were randomly assigned to the 8-week OB (40 mg, 3 times/day) or FODMAP-lowering diet application group.
Disclosures: This study was funded through the Belgian Health Care Knowledge Centre and others. The authors declared serving as scientific advisors or on speaker bureaus or receiving research support or grants from various sources.
Source: Carbone F et al. Diet or medication in primary care patients with IBS: The DOMINO study - a randomized trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute. Gut. 2022 (Apr 28). Doi: 10.1136/gutjnl-2021-325821
Safety and efficacy of peppermint oil for IBS
Key clinical point: This meta-analysis demonstrated the superiority of peppermint oil over placebo for improvements in the signs and symptoms of irritable bowel syndrome (IBS); however, adverse events were more frequent with peppermint oil use.
Major finding: Peppermint oil was superior to placebo for global IBS symptoms (relative risk [RR] for persisting global IBS symptoms 0.65; 95% CI 0.43-0.98) and abdominal pain (RR for no improvement in abdominal pain 0.76; 95% CI 0.62-0.93) after therapy. The rate of any adverse events (RR 1.57; 95% CI 1.04-2.37), particularly gastroesophageal reflux symptoms, was higher among patients receiving peppermint oil.
Study details: The data come from a meta-analysis of 10 randomized controlled trials including 1030 patients with IBS, of which 525 were assigned to receive peppermint oil.
Disclosures: This study received no external funding. No conflicts of interest were declared.
Source: Ingrosso MR et al. Systematic review and meta-analysis: Efficacy of peppermint oil in irritable bowel syndrome. Aliment Pharmacol Ther. 2022 (Aug 9). Doi: 10.1111/apt.17179
Key clinical point: This meta-analysis demonstrated the superiority of peppermint oil over placebo for improvements in the signs and symptoms of irritable bowel syndrome (IBS); however, adverse events were more frequent with peppermint oil use.
Major finding: Peppermint oil was superior to placebo for global IBS symptoms (relative risk [RR] for persisting global IBS symptoms 0.65; 95% CI 0.43-0.98) and abdominal pain (RR for no improvement in abdominal pain 0.76; 95% CI 0.62-0.93) after therapy. The rate of any adverse events (RR 1.57; 95% CI 1.04-2.37), particularly gastroesophageal reflux symptoms, was higher among patients receiving peppermint oil.
Study details: The data come from a meta-analysis of 10 randomized controlled trials including 1030 patients with IBS, of which 525 were assigned to receive peppermint oil.
Disclosures: This study received no external funding. No conflicts of interest were declared.
Source: Ingrosso MR et al. Systematic review and meta-analysis: Efficacy of peppermint oil in irritable bowel syndrome. Aliment Pharmacol Ther. 2022 (Aug 9). Doi: 10.1111/apt.17179
Key clinical point: This meta-analysis demonstrated the superiority of peppermint oil over placebo for improvements in the signs and symptoms of irritable bowel syndrome (IBS); however, adverse events were more frequent with peppermint oil use.
Major finding: Peppermint oil was superior to placebo for global IBS symptoms (relative risk [RR] for persisting global IBS symptoms 0.65; 95% CI 0.43-0.98) and abdominal pain (RR for no improvement in abdominal pain 0.76; 95% CI 0.62-0.93) after therapy. The rate of any adverse events (RR 1.57; 95% CI 1.04-2.37), particularly gastroesophageal reflux symptoms, was higher among patients receiving peppermint oil.
Study details: The data come from a meta-analysis of 10 randomized controlled trials including 1030 patients with IBS, of which 525 were assigned to receive peppermint oil.
Disclosures: This study received no external funding. No conflicts of interest were declared.
Source: Ingrosso MR et al. Systematic review and meta-analysis: Efficacy of peppermint oil in irritable bowel syndrome. Aliment Pharmacol Ther. 2022 (Aug 9). Doi: 10.1111/apt.17179
Vitamin D supplementation may improve QoL in IBS
Key clinical point: This meta-analysis found insufficient evidence on the beneficial effects of vitamin D supplementation on irritable bowel syndrome (IBS) symptoms; however, supplementation with vitamin D significantly improved the quality of life (QoL) in patients with IBS.
Major finding: Patients receiving vitamin D supplementation showed a significant improvement in IBS-QoL scores compared with those receiving placebo (mean difference 6.19; P = .04). However, IBS-Severity Scoring System scores were not significantly different between the treatment arms.
Study details: The data come from a systematic review and meta-analysis articles of 6 randomized control studies including 616 participants.
Disclosures: This study received no external funding. No conflicts of interest were declared.
Source: Abuelazm M et al. The effect of vitamin D supplementation on the severity of symptoms and the quality of life in irritable bowel syndrome patients: A systematic review and meta-analysis of randomized controlled trials. Nutrients. 2022;14(13):2618 (Jun 24). Doi: 10.3390/nu14132618
Key clinical point: This meta-analysis found insufficient evidence on the beneficial effects of vitamin D supplementation on irritable bowel syndrome (IBS) symptoms; however, supplementation with vitamin D significantly improved the quality of life (QoL) in patients with IBS.
Major finding: Patients receiving vitamin D supplementation showed a significant improvement in IBS-QoL scores compared with those receiving placebo (mean difference 6.19; P = .04). However, IBS-Severity Scoring System scores were not significantly different between the treatment arms.
Study details: The data come from a systematic review and meta-analysis articles of 6 randomized control studies including 616 participants.
Disclosures: This study received no external funding. No conflicts of interest were declared.
Source: Abuelazm M et al. The effect of vitamin D supplementation on the severity of symptoms and the quality of life in irritable bowel syndrome patients: A systematic review and meta-analysis of randomized controlled trials. Nutrients. 2022;14(13):2618 (Jun 24). Doi: 10.3390/nu14132618
Key clinical point: This meta-analysis found insufficient evidence on the beneficial effects of vitamin D supplementation on irritable bowel syndrome (IBS) symptoms; however, supplementation with vitamin D significantly improved the quality of life (QoL) in patients with IBS.
Major finding: Patients receiving vitamin D supplementation showed a significant improvement in IBS-QoL scores compared with those receiving placebo (mean difference 6.19; P = .04). However, IBS-Severity Scoring System scores were not significantly different between the treatment arms.
Study details: The data come from a systematic review and meta-analysis articles of 6 randomized control studies including 616 participants.
Disclosures: This study received no external funding. No conflicts of interest were declared.
Source: Abuelazm M et al. The effect of vitamin D supplementation on the severity of symptoms and the quality of life in irritable bowel syndrome patients: A systematic review and meta-analysis of randomized controlled trials. Nutrients. 2022;14(13):2618 (Jun 24). Doi: 10.3390/nu14132618
Internet-delivered cognitive behavioral therapy: An effective intervention in IBS
Key clinical point: Internet-delivered cognitive behavioral therapy (ICBT) significantly improved irritable bowel syndrome (IBS) symptom severity and quality of life (QoL) and was cost-effective in patients with IBS.
Major finding: Compared with the standard care, ICBT led to a significant reduction in IBS symptom severity (standardized mean difference [SMD] −0.575; 95% CI −0.714 to −0.435) and total cost including intervention cost (SMD −0.372; 95% CI −0.704 to −0.039) and improved QoL (SMD 0.582; 95% CI 0.396 to 0.769), with effects on IBS symptom severity being prominent even at 12-24 months postintervention (SMD −0.357; 95% CI −0.541 to −0.172).
Study details: Findings are from a meta-analysis of 9 randomized controlled studies that evaluated the application of ICBT in patients with IBS.
Disclosures: This study was supported by the National Research Foundation of Korea. The authors declared no conflicts of interest.
Source: Kim H et al. Internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome: Systematic review and meta-analysis. J Med Internet Res. 2022;24(6):e35260 (Jun 10). Doi: 10.2196/35260
Key clinical point: Internet-delivered cognitive behavioral therapy (ICBT) significantly improved irritable bowel syndrome (IBS) symptom severity and quality of life (QoL) and was cost-effective in patients with IBS.
Major finding: Compared with the standard care, ICBT led to a significant reduction in IBS symptom severity (standardized mean difference [SMD] −0.575; 95% CI −0.714 to −0.435) and total cost including intervention cost (SMD −0.372; 95% CI −0.704 to −0.039) and improved QoL (SMD 0.582; 95% CI 0.396 to 0.769), with effects on IBS symptom severity being prominent even at 12-24 months postintervention (SMD −0.357; 95% CI −0.541 to −0.172).
Study details: Findings are from a meta-analysis of 9 randomized controlled studies that evaluated the application of ICBT in patients with IBS.
Disclosures: This study was supported by the National Research Foundation of Korea. The authors declared no conflicts of interest.
Source: Kim H et al. Internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome: Systematic review and meta-analysis. J Med Internet Res. 2022;24(6):e35260 (Jun 10). Doi: 10.2196/35260
Key clinical point: Internet-delivered cognitive behavioral therapy (ICBT) significantly improved irritable bowel syndrome (IBS) symptom severity and quality of life (QoL) and was cost-effective in patients with IBS.
Major finding: Compared with the standard care, ICBT led to a significant reduction in IBS symptom severity (standardized mean difference [SMD] −0.575; 95% CI −0.714 to −0.435) and total cost including intervention cost (SMD −0.372; 95% CI −0.704 to −0.039) and improved QoL (SMD 0.582; 95% CI 0.396 to 0.769), with effects on IBS symptom severity being prominent even at 12-24 months postintervention (SMD −0.357; 95% CI −0.541 to −0.172).
Study details: Findings are from a meta-analysis of 9 randomized controlled studies that evaluated the application of ICBT in patients with IBS.
Disclosures: This study was supported by the National Research Foundation of Korea. The authors declared no conflicts of interest.
Source: Kim H et al. Internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome: Systematic review and meta-analysis. J Med Internet Res. 2022;24(6):e35260 (Jun 10). Doi: 10.2196/35260
Shift in fecal and mucosal microbiota correlate with clinical manifestations in IBS
Key clinical point: Fecal and intestinal mucosal microbiota are distinctly different in patients with constipation-predominant or diarrhea-predominant irritable bowel syndrome (IBS-C or IBS-D), with microbiota changes being correlated with clinical manifestations of IBS.
Major finding: Community richness and diversity of the fecal microbiota were significantly lower in patients with IBS-C or IBS-D vs healthy controls (HC; P < .05). The fecal microbiota showed a shift in the abundance of Bacteroides caccae and Roseburia (both P < .05) in patients with IBS vs HC, with both correlating with abdominal pain and distension (P < .05). In terminal ileum, Bifidobacterium and Eubacterium correlated with abdominal pain (P < .05).
Study details: This study evaluated fecal and intestinal mucosal samples from 14 patients with IBS-C, 20 patients with IBS-D, and 20 HC.
Disclosures: This study was funded by the Projects of Science and Technology for Social Development and the Innovation Engineering Project of Science and Technology in Shaanxi Province, China. The authors declared no conflicts of interest.
Source: Hou Y et al. Distinctions between fecal and intestinal mucosal microbiota in subgroups of irritable bowel syndrome. Dig Dis Sci. 2022 (Jul 25). Doi: 10.1007/s10620-022-07588-4
Key clinical point: Fecal and intestinal mucosal microbiota are distinctly different in patients with constipation-predominant or diarrhea-predominant irritable bowel syndrome (IBS-C or IBS-D), with microbiota changes being correlated with clinical manifestations of IBS.
Major finding: Community richness and diversity of the fecal microbiota were significantly lower in patients with IBS-C or IBS-D vs healthy controls (HC; P < .05). The fecal microbiota showed a shift in the abundance of Bacteroides caccae and Roseburia (both P < .05) in patients with IBS vs HC, with both correlating with abdominal pain and distension (P < .05). In terminal ileum, Bifidobacterium and Eubacterium correlated with abdominal pain (P < .05).
Study details: This study evaluated fecal and intestinal mucosal samples from 14 patients with IBS-C, 20 patients with IBS-D, and 20 HC.
Disclosures: This study was funded by the Projects of Science and Technology for Social Development and the Innovation Engineering Project of Science and Technology in Shaanxi Province, China. The authors declared no conflicts of interest.
Source: Hou Y et al. Distinctions between fecal and intestinal mucosal microbiota in subgroups of irritable bowel syndrome. Dig Dis Sci. 2022 (Jul 25). Doi: 10.1007/s10620-022-07588-4
Key clinical point: Fecal and intestinal mucosal microbiota are distinctly different in patients with constipation-predominant or diarrhea-predominant irritable bowel syndrome (IBS-C or IBS-D), with microbiota changes being correlated with clinical manifestations of IBS.
Major finding: Community richness and diversity of the fecal microbiota were significantly lower in patients with IBS-C or IBS-D vs healthy controls (HC; P < .05). The fecal microbiota showed a shift in the abundance of Bacteroides caccae and Roseburia (both P < .05) in patients with IBS vs HC, with both correlating with abdominal pain and distension (P < .05). In terminal ileum, Bifidobacterium and Eubacterium correlated with abdominal pain (P < .05).
Study details: This study evaluated fecal and intestinal mucosal samples from 14 patients with IBS-C, 20 patients with IBS-D, and 20 HC.
Disclosures: This study was funded by the Projects of Science and Technology for Social Development and the Innovation Engineering Project of Science and Technology in Shaanxi Province, China. The authors declared no conflicts of interest.
Source: Hou Y et al. Distinctions between fecal and intestinal mucosal microbiota in subgroups of irritable bowel syndrome. Dig Dis Sci. 2022 (Jul 25). Doi: 10.1007/s10620-022-07588-4