Medically reviewed by Onikepe Adegbola, MD, PhD
A study suggests that persistent symptoms in celiac patients who have been treated can be reduced with a gluten-free, low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, which is a recognized treatment for Irritable Bowel Syndrome (IBS).
Patients treated for celiac disease are often put on a gluten-free diet, which helps manage the symptoms significantly. However, most patients still presented persistent symptoms.
The study, “A Low FODMAP Diet Reduces Symptoms in Treated Celiac Patients with Ongoing Symptoms–A Randomized Controlled Trial,” published in the journal Clinical Gastroenterology and Hepatology, analyzes the effects of a gluten-free, low FODMAP diet on persistent symptoms in treated celiac patients.
Celiac disease is a severe autoimmune disease of the digestive tract that affects the small intestine. Consumption of food that contains gluten can trigger this. The most common characteristic symptoms of celiac disease include fatigue, abdominal pain, nausea, vomiting, bloating, gas, diarrhea, and/or constipation. All of these symptoms keep the patients from eating as well as they should, thereby resulting in significant weight loss.
The body produces antibodies against gliadin, which is a substance found in gluten. These antibodies attack the healthy cells of the intestine and cause inflammation, which is why the only way to treat celiac disease is a gluten-free diet. However, some ongoing symptoms persist even in patients with mucosal remission after treatment.
Patients included in the study had a Gastrointestinal Symptom Rating Scale (GSRS-IBS) score of 30 and more, were aged between 18 and 75 years, and a biopsy verified their disease. All the participants were on a gluten-free diet for 12 months.
Seventy participants were divided into 2 groups. One group of 34 participants was made to follow a gluten-free, low FODMAP diet for 4 weeks, and the control group of 36 participants was put on a regular gluten-free diet.
The GSRS-IBS scores and Celiac Symptom Index (CSI) were recorded in week 1 and week 4. The GSRS-IBS scores were significantly lower at the end of the study period. There was a significant reduction in bloating, pain, diarrhea, and satiety. The effect on constipation was not as significant as it was on other ongoing symptoms. By the end of 4 weeks, the Celiac Symptom Index had also significantly dropped in the intervention group who was on a gluten-free, low FODMAP diet.
The study also analyzed the effect of this dietary intervention on fatigue. At 1 week 1, 75% of participants in the intervention group reported fatigue, and the number came down to just 35% at the end of the 4 weeks. 42% of the participants in the control group reported fatigue at the end of week 1, and the number came down to 56% at the end of the study period.
The study showed that a gluten-free, low FODMAP diet reduces gastrointestinal symptoms and increases celiac-specific health. It also reduced fatigue by a considerable degree. This approach should be considered to manage persistent ongoing symptoms in patients who have already been treated for celiac disease and who have also been consuming a gluten-free diet.
van Megen, F., Skodje, G. I., Lergenmuller, S., Zühlke, S., Aabakken, L., Veierød, M. B., Henriksen, C., & Lundin, K. (2022). A Low FODMAP Diet Reduces Symptoms in Treated Celiac Patients With Ongoing Symptoms-A Randomized Controlled Trial. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, S1542-3565(22)00034-9. Advance online publication. https://doi.org/10.1016/j.cgh.2022.01.011