In this Research Spotlight, we shine the spotlight on our research using Bimuno® GOS in those with hyperpnoea-induced bronchoconstriction (HIB), a surrogate for exercise-induced bronchoconstriction (EIB). EIB is an acute physical response to exercise that involves the narrowing of the airways, resulting in uncomfortable chest tightness and wheezing that can negatively affect quality of life and reduce participation in exercise. Management often involves medication; however, other strategies include non-pharmacologic preventative methods such as extensive warmups, and the use of dietary supplements. Here we explore the potential for prebiotics to modulate the immune response as seen in EIB.

Infant gut microbiome: 2’-FL, Bimuno® GOS and lactose

This Research Spotlight shares insight on Human Milk Oligosaccharides (HMOs), and their role in human health. The study looks at their prebiotic effect and influence on human health in comparison to Bimuno®, a galactooligosaccharide (GOS) prebiotic.

The role of HMOs

Early colonisation of the gastrointestinal tract (GI tract), to form the gut microbiome, is important for the development of the immune system, metabolism and cognitive development. Colonisation of the GI tract by bacteria depends on the mode of delivery and type of feeding. Human breast milk provides the infant with bioactive compounds, including Human Milk Oligosaccharides (HMOs). These are structurally diverse carbohydrates that are highly abundant and specific to human milk - and have known health benefits. HMOs are resistant to digestion by intestinal enzymes and reach the colon where they act as prebiotics, nourishing beneficial gut bacteria.

Typical features of HMOs, such as their bifidogenic effect, modulatory effect on immune function and the gut barrier in infants, are thought to be equally beneficial to health in adulthood[1]. As a result, there is a growing interest in developing alternative sources other than breastmilk for HMOs. Comparison of their effects to the prebiotics on the market provides a realistic idea as to whether that is a commercially attractive approach.

In human breast milk, the most abundant HMO is 2′-fucosyllactose (2′-FL), which is available in large scale commercial production for use in infant formulas. The concentration of 2′-FL is highest in early lactation post-partum and selectively promotes the growth of bifidobacteria[2].

Comparison of 2’-FL, Bimuno® GOS and lactose

The study by Sallli et al. (2019) compared two prebiotics, 2’-FL and Bimuno® GOS, with lactose, a simple sugar. The research looks at their effects on gut microbiota composition and short-chain fatty acids (SCFA) production. The primary role of lactose is to provide a readily available energy source to newborns and is normally absorbed before reaching the colon where the majority of gut bacteria reside.

While lactose is not a prebiotic, it is a simple sugar that bacteria will utilise. Salli et al (2019) modelled bacterial fermentation in the infant colon using the EnteroMIX® colon simulator. The study demonstrated that Bimuno® GOS supports the growth of a wider range of beneficial microbes compared to 2′-FL. In comparison to 2’FL, GOS had promoted better growth of bifidobacteria and lactobacilli growth. In addition, GOS led to higher acetate and lactate production than 2′-FL[2].

In another study, GOS resulted in a less diverse gut microbiota and SCFA production than 2′-FL; this creates a more homogenous gut microbiota, which is often preferred in infants. This was an outcome from Bimuno® GOS supplementation, which may be due to the integral presence of HMOs, 3-galactosyl-lactose being the most abundant. This has been demonstrated to have a beneficial effect, such as anti-inflammatory effects when added to infant formula[3]. The addition of HMOs and GOS to the diet changes the metabolite profile in a matter of weeks. This is due to bifidobacteria being initial degraders of the HMOs in a cross-feeding interaction with butyrate producers likeClostridium coccoides or Eubacterium rectale as secondary degraders. Cross-feeding of HMOs in the adult gut microbiome improves gut barrier function. The research suggests using prebiotics, such as HMOs, to promote gut barrier function in adults[1]. More research is required in this area as it was carried outin vitro.

In Summary

The research by Salli et al., (2019) demonstrated that Bimuno® GOS had a better prebiotic effect for the infancy early life stage and on SCFA production than 2’-FL. Not only does the research suggest a wider functionality of HMOs, but that Bimuno® GOS has potential to promote gut barrier function in adults. However, it is recommended that further research is conducted in clinical trials to determine both mechanisms of action and efficacy.

β-Galactooligosaccharide with a Low FODMAP Diet improves IBS

This Research Spotlight introduces the low-FODMAP diet (LFD), how it can be helpful for people with IBS or functional gut disorders and where prebiotics can be beneficial to patients on a LFD. Read further to explore this study on the connections between IBS and dietary practices, particularly the low-FODMAP diet.

The prevalence of IBS

Globally, the prevalence of Functional Gastrointestinal Disorders (FGIDs) is as high as 40% and this includes Irritable Bowel Syndrome (IBS). IBS is a chronic FGID affecting Quality of Life (QoL) and health care use[1]. Although the exact pathophysiology of IBS is still unknown, genetic factors, the gut microbiome, gastrointestinal motility and enteric nervous system disturbances, visceral hypersensitivity and psychological distress are likely to play a role in combination[2].

Due to a lack in understanding of the pathophysiology and individual variability of IBS, managing symptoms can be challenging. The Low-Fermentable Oligosaccharide, Disaccharide, Monosaccharide, and Polyol diet (low-FODMAP diet, LFD) is one approach, and has advantages in some patients, improving symptoms and QoL. However, downfalls of an LFD include that it is not a long-term solution, it is time intensive and can be detrimental to nutritional status of an individual[2].

The LFD naturally leads to restriction of fructans and oligosaccharides in the diet, important complex carbohydrates with a prebiotic action. The restriction in an LFD may lead to a reduction in beneficial bacteria - and reductions in fecal bifidobacteria levels have been shown to relate to negative pain scores in IBS patients[3]. Based on the deleterious effects of the LFD on gut microbiota, other strategies should be explored[3].

The role of prebiotics

Prebiotics, specifically Bimuno® galactooligosaccharides (GOS), are shown to help reduce the symptoms of IBS similarly to the LFD diet. Prebiotic GOS Bimuno® is selective toBifidobacterium genus, that has a recognised capacity to support lower gut health, and support significant reductions to flatulence and bloating, along with improved stool consistency.

The reduction in flatulence was thought to be due to an increase in bifidobacteria as this does not produce gas[4]. Daily supplementation of Bimuno® GOS is equally as effective as a LFD and in the short term, reduces flatulence, while increasing beneficial bacteria5. The research demonstrating Bimuno® GOS to be equally as effective as the LFD was carried out in a population of individuals eating a Mediterranean diet, suggesting that those more accustomed to a diet higher in fibre may be more responsive to the prebiotic supplement[5]. Additionally, the combination of various therapies may have a beneficial effect to combine improved QoL and support the gut microbiota and gave reason for the research conducted by Wilsonet al., (2020) investigating the use of Bimuno® GOS in conjunction with the low-FODMAP diet.

Wilson et al., (2020) conducted a randomised, placebo controlled, three-arm trial on a cohort of 63 patients. A control sham diet with placebo supplement was compared to a low-FODMAP diet with placebo or LFD with 1.4g/day of Bimuno® galactooligosaccharides (GOS) supplement over a 4-week period6. The sham diet restricts a similar number of foods as the LFD and is similarly difficult to follow, without affecting the intake of nutrients, fibre or FODMAPs[6]. The LFD combined with Bimuno® GOS prebiotic produced a greater symptom response than the sham diet plus placebo, but addition of 1.4 g/d Bimuno® GOS did not prevent the reduction of bifidobacteria. The low-FODMAP diet reduced faecalActinobacteria andButyrate, thus strict long-term use should not be advised.

The outcome of the study was positive IBS symptom relief in ~70% of individuals in the LFD plus Bimuno® group compared to 30% of subjects in the sham diet control group and 50% in the LFD plus placebo group. Individual IBS symptoms, including pain, distension/bloating and bowel dysfunction improved more markedly in the LFD plus Bimuno® group compared to the sham diet control group, as well as a lower incidence and severity of abdominal pain and loose stools in the LFD plus Bimuno® group compared to the sham diet control group.

In conclusion

Results of the study indicate that Bimuno® GOS prebiotics are equally as good as the LFD in alleviating digestive discomfort related to IBS. The research points towards prebiotics – particularly Bimuno®, the subject of the study – as a potential approach to managing IBS symptoms as an alternative to a low-FODMAP diet. Bimuno® GOS is a powder supplement that fits easily into a daily routine and is supported by 100 scientific publications and over 20 clinical trials. Further research on Bimuno® GOS and a LFD is encouraged to determine the potential to support the gut microbiota whilst on a LFD.

Exercise-Induced Bronchoconstriction (EIB) and the gut microbiome

1. The Place of Physical Exercise and Bronchodilator Drugs in the Assessment of the Asthmatic Child
2. Is there a unifying hypothesis for exercise- induced asthma?
3. An Official American Thoracic Society Clinical Practice Guideline: Exercise-induced Bronchoconstriction
4. Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management
5. Global Asthma Guidelines
6. WADA
7. Comparable reductions in hyperpnoea-induced bronchoconstriction and markers of airway inflammation after supplementation with 6·2 and 3·1 g/d of long-chain n-3 PUFA in adults with asthma
8. Diet and Asthma: Is It Time to Adapt Our Message?
9. A prebiotic galactooligosaccharide mixture reduces severity of hyperpnoea-induced bronchoconstriction and markers of airway inflammation
10. Immune nutrition and exercise: narrative review and practical recommendations

Infant gut microbiome: 2’-FL, Bimuno® GOS and lactose

1. Effects of Human Milk Oligosaccharides on the Adult Gut Microbiota and Barrier Function (nih.gov)
2. The effect of 2′-fucosyllactose on simulated infant gut microbiome and metabolites; a pilot study in comparison to GOS and lactose | Scientific Reports (nature.com)
3. Human Milk Oligosaccharides and Synthetic Galactosyloligosaccharides Contain 3′-, 4-, and 6′-Galactosyllactose and Attenuate Inflammation in Human T84, NCM-460, and H4 Cells and Intestinal Tissue Ex Vivo | The Journal of Nutrition | Oxford Academic (oup.com)

β-Galactooligosaccharide with a Low FODMAP Diet improves IBS

1. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study
2. Irritable Bowel Syndrome and Dietary Interventions
3. Controversies and Recent Developments of the Low-FODMAP Diet
4. Clinical trial: the effects of a trans‐galactooligosaccharide prebiotic on faecal microbiota and symptoms in irritable bowel syndrome
5. Effects of Prebiotics vs a Diet Low in FODMAPs in Patients With Functional Gut Disorders
6. β-Galactooligosaccharide in Conjunction With Low FODMAP Diet...