People who consume frozen microbiome capsules derived from their own feces when dieting may limit their weight regain, according to a new study published in Gastroenterology, in a collaboration led by BGU researchers.
In an unprecedented 14-month clinical trial in Israel, BGU Prof. Iris Shai (pictured above); then-BGU Ph.D. student Dr. Ehud Rinott and Dr. Ilan Youngster at Tel-Aviv University, collaborated with a group of international experts from U.S. and European research institutes.
“It is well known that most dieters reach their lowest body weight after 4-6 months and are then challenged by the plateau or regain phase, despite continued dieting,” says Prof. Shai, a member of BGU’s School of Public Health. “In this groundbreaking study, our international group of researchers explored whether preserving the optimized personal microbiome from fecal transplants after six months helps maintain weight loss by transplanting back the optimized microbiome during the subsequent regain phase.”
In the weight loss trial, abdominally obese or dyslipidemic (high cholesterol) participants in Israel were randomly assigned to one of three groups: healthy dietary guidelines, a Mediterranean diet, and a green-Mediterranean diet. After six months during the weight-loss phase, 90 eligible participants provided a fecal sample that was processed into an autologous fecal microbiota transplantation (aFMT) by frozen, opaque and odorless capsules. The participants were then randomly assigned to two groups that received 100 capsules containing their own fecal microbiota or a placebo, which they ingested until month 14.
In the green-Mediterranean diet group, participants were provided with Mankai, a specific duckweed aquatic strain in a green shake, green tea and 28g. of walnuts. This was the only group diet strategy that induced a significant change in the gut microbiome composition during the weight loss phase.
The 90 participants lost 8.3 kg (18.2 lbs.) on average after six months. However, only in the green-Mediterranean diet group did aFMT limit weight regain to 17.1%, versus 50% for the placebo.
“The green-Mediterranean diet also resulted in preservation of weight loss-associated specific bacteria and microbial metabolic pathways, mainly glucose transport, following the microbiome intervention, compared to the control,” says Dr. Rinott.
“This study is the first of its kind to prove in humans that preservation of an "ideal" gut microbial composition can be used at a later point in time to achieve metabolic benefits,” says Dr. Youngster, director of the Pediatric Infectious Diseases Unit and the Center for Microbiome Research at Shamir Medical Center. “Using the patient’s own stool after optimization is a novel concept that overcomes many of these barriers. It is my belief that the use of autologous fecal microbiota transplantation will be applicable in the future for other indications as well.“
Furthermore, a green plant-based diet such as Mankai, better optimizes the microbiome for the microbiota transplantation procedure. This potentially optimizes the conditions for the aFMT, collected during the maximal weight loss phase.
In a complementary Mankai-specific mouse model experiment conducted by Prof. Omry Koren at Bar-Ilan University, the researchers were able to reproduce the effects of aFMT on regain and insulin sensitivity, and to isolate specifically how Mankai induces these effects. The Mankai duckweed aquatic plant is being grown in Israel and other countries in a closed environment and is highly environmentally sustainable - requiring a fraction of the amount of water to produce each gram of protein compared to soy, kale or spinach.
According to Prof. Koren, “The nutrition-microbiome axis has been proven in this study, as high polyphenols diet, and specifically, Mankai, a protein-based plant and dietary fibers could ideally optimize the microbiome in the weight loss phase. It induces the potent microbiome to recall the flora of germs related to regain attenuation and improved glycemic state after transplantation.”
“These findings might be a good application of personal medicine,” says Prof. Shai, who is also an adjunct professor at Harvard University. “Freezing a personal microbiome bank could be an effective way to maintain healthy weight while dieting, since the rapid weight loss phase is accompanied by optimal cardiometabolic health. By optimizing the composition and function of the gut microbiome within the host, we have a novel approach for metabolic-memory preservation.”
This work was supported by Israel Science Foundation (grant 1733/18), Israel Ministry of Health (grant no. 87472511), Israel Ministry of Science and Technology (grant 3-13604); the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – Projektnummer 209933838 – SFB 1052; the Deutsche Forschungsgemeinschaft, Obesity Mechanisms; the Rosetrees trust (grant A2623); the Project “Cabala_diet & health” ( http://www.cabalaproject.eu/ ; – ERA-Net Cofund ERA-HDHL No 696295) “, and the California Walnuts Commission. Dr. Dong D. Wang’s research was supported by research grants from the National Institutes of Health (K99 DK119412) and the Boston Nutrition Obesity Research Center.
“Effects of Diet-Modulated Autologous Fecal Microbiota Transplantation on Weight Regain”
Gastroenterology 2020
Ehud Rinott* 1, Ilan Youngster* 2,3, Anat Yaskolka Meir 1, Gal Tsaban 1, Hila Zelicha 1, Alon Kaplan 1, Dan Knights 4,5, Kieran Tuohy 6, Francesca Fava 6, Matthias Uwe Scholz 6,Oren Ziv 7, Elad Reuven 7, Amir Tirosh 8,9,Assaf Rudich 1, Matthias Blüher 10, Michael Stumvoll 10, Uta Ceglarek 10, Karine Clement 11, Omry Koren 7, Dong D. Wang 12, Frank B. Hu 12,13, Meir J Stampfer 12,13, Iris Shai 1,14
*Both authors contributed equally to the manuscript
1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
2 Shamir Medical Center, Be’er Ya’akov, Israel
3 Tel-Aviv University, Tel-Aviv, Israel
4 University of Minnesota; Saint Paul, MN 55108, USA
5 University of Minnesota, Minneapolis, MN 55455, USA
6 Research and Innovation Centre, Fondazione Edmund Mach, Via E. Mach 1, San Michele all’Adige, Trento 38016. Italy.
7 Bar Ilan University, Safed, Israel
8 Sheba Medical Center, Tel-Hashomer, Israel; and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
9 , Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
10 University of Leipzig, German
11 Sorbonne University/Inserm, Pitié-Salpêtrière hospital, Paris, France
12 Harvard T.H. Chan School of Public Health
13, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, USA
14 Adjunct Faculty, Harvard T.H. Chan School of Public Health
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