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A Low FODMAP Diet Reduces Ongoing Symptoms In Treated Celiac Patients

Study suggests gluten-free, low FODMAP diet can reduce persistent symptoms in celiac patients.

hplictawa@gmail.com' by Editorial Team
May 7, 2022
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A Low FODMAP Diet Reduces Ongoing Symptoms In Treated Celiac Patients
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Medically reviewed by Onikepe Adegbola, MD, PhD

celiac disease

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).

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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.

Reference:

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

Tags: celiac patientsgluten-freepersistent symptoms in treated celiac patients
hplictawa@gmail.com'

Editorial Team

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A research paper was published in the Brazilian Journal of Biology, titled "Using Bifidobacterium and Propionibacterium Strains in Probiotic Consortia to Normalize the Gastrointestinal Tract." Based on expert opinions in the study, the microorganisms Bifidobacterium and Propionibacterium genera qualities can be preserved and encapsulated. This research backs up expert suggestions with clinical evidence, proving that the experts were correct. The gut microflora is responsible for regulating the body's activities and maintaining its health. Diabetes, obesity, inflammation, atherosclerosis, and other chronic diseases are due to dysbiosis. In the 2024 recommendations, experts recommended probiotics for living microorganisms that benefit the microflora and improve the health of the host organism helping prevent these diseases. Lactic acid bacteria from the Bifidobacterium and Propionibacterium genera are the frequent probiotics recommended. Bifidobacterium adolescentis-1909, Bifidobacterium longum infantis-1912, Propionibacterium jensenii B-6085, Propionibacterium freudenreichii -11921, Propionibacterium thoenii -6082, and Propionibacterium acidipropionici-5723 were examined for their probiotic characteristics in the study. This study was conducted in the Laboratory for Bio testing Natural Nutraceuticals at Kemerovo State University (Russia). The study used collection strains of the lactic acid bacteria Bifidobacterium adolescentis АС-1909, Bifidobacterium longum infantis АС-1912, Propionibacterium jensenii В-6085, Propionibacterium freudenreichiiВ-11921, Propionibacterium thoenii В-6082, and Propionibacterium acidipropionici В-5723. Lactic acid cultures were tested for antibacterial activity against the test cultures Salmonella enterica ATCC 14028, Staphylococcus aureusATCC 25923, Pseudomonas aeruginosa B6643, Proteus Vulgaris ATCC 63, and Listeria monocytogenes ATCC 7644. Additionally, the antibiotic resistance of lactic acid cultures was tested using the disk diffusion method. Bifidobacterium adolescentis-1909, Propionibacterium jensenii B-6085, and Propionibacterium thoenii 6082 showed moderate antibacterial activities against all test cultures. According to research, some Propionibacterium and Bifidobacterium strains, or their consortia, could be employed as probiotic cultures in dietary supplements or functional foods to prevent various chronic diseases like IBS. Why is this study important for patients with IBS Symptoms Although IBS is bothersome and inconvenient, it does not increase the chance of developing other health problems. However, the success of the treatment depends on what grade of IBS it is and how it is addressed. Bifidobacterium bacteria are particularly significant compared with other gut microbiota in probiotic cultures. Probiotics have a favorable effect in four ways. First, they produce antimicrobial compounds. Second, they are hostile to pathogenic and opportunistic strains. They also adhere to epithelial cells (cells of intestinal walls), posing a competitive threat to disease-causing bacteria. Finally, they inhibit the production of metabolites by pathogenic bacteria and cancer cells. What is the Key Takeaway from this Study Large doses of probiotics that contain these bacteria in dietary supplements or functional fermented milk products can stimulate their proliferation in the large intestine. The development of functional foods containing probiotics, particularly Bifidobacterium strains, is driven by the increased demand for health-beneficial foods. However, Propionibacterium 'dairy' strains have recently gained popularity. As a result, probiotic consortia of these species can be established to normalize the gastrointestinal microbiota's function. To preserve their quality, these microorganisms can be encapsulated (immobilized). All the strains can be employed to form various dietary supplements or functional product consortia.
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