Very low-calorie diets elicit extensive changes to the gut microbiota, influencing weight loss.

Many popular diet programs emphasize calorie reduction as a means to lose weight. However, this approach to weight loss minimizes evidence suggesting that the gut microbiota plays important roles in body weight and likely influences the host’s metabolic response to diet. Findings from a recent study suggest that very low-calorie diets elicit extensive changes to the gut microbiota, influencing how much weight a person loses when dieting.

Low-calorie diets (1,200 to 1,500 calories per day) and very low-calorie diets (less than 800 calories per day) have gained popularity in recent decades. These diets often rely on the use of meal replacements, typically in the form of ready-made meals, shakes, or bars. When combined with behavior modification, evidence suggests that low-calorie and very low-calorie diets are useful strategies for losing weight.

The investigators drew on data from the PREVIEW study, a three-year lifestyle intervention study aimed at type-2 diabetes prevention. The current study involved more than 2,200 adults (aged 20 to 70 years) with overweight or obesity and pre-diabetes. Participants consumed a meal replacement that provided approximately 810 calories and 13 grams of fiber daily for eight weeks. They were also allowed to consume up to 400 grams (about 200 calories) of non-starchy vegetables daily. Before and after the intervention, participants provided fecal samples for microbial sequencing.

The investigators observed that the overall makeup of the participants' gut microbial populations underwent considerable changes over the eight-week intervention. Not only did microbial numbers (termed “richness”) increase, but the diversity of microbes increased, as well. In addition, the numbers of bacteria that may be beneficial for metabolic health, such as Akkermansia and _ Christensenellaceae_, increased, but butyrate production decreased, an indication of fewer butyrate-producing microbes. Butyrate plays important roles in maintaining gut health. These changes were correlated with changes in body fat and weight.

These findings suggest that very low-calorie diets induce marked changes in the overall composition of microbes in the gut, influencing changes in body fat and weight. Other issues complicate weight loss, however. For example, excess body weight has profound, deleterious effects on the gut microbiome, driving dysbiosis and impairing critical aspects of nutrient metabolism. Of particular concern is the inability to metabolize flavonoids, some of which participate in fat metabolism. This dysbiosis persists, even after weight loss, likely promoting recurrent (or “yo-yo”) obesity. Learn more about this phenomenon in this clip featuring Dr. Eran Elinav.

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