Low FODMAP Diet Helps Gluten-Free Celiac Patients Reduce Ongoing Symptoms

Celiac.com 02/21/2022 - For most people with celiac disease, a gluten-free diet typically leads to mucosal remission, but many people continue to have ongoing symptoms. 

A low FODMAP diet, that is a diet low in fermentable oligo-, di-, monosaccharides and polyols (FODMAPS), has been shown to improve symptoms of irritable bowel syndrome (IBS). 

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Could a low FODMAP diet help gluten-free celiacs with ongoing symptoms? A team of researchers recently set out to assess the effects of a moderately low FODMAP diet on ongoing symptoms in gluten-free celiac patients.

The research team included Frida van Megen, Gry I. Skodje, Simon Lergenmuller, Stephanie Zühlke, Lars Aabakken, Marit B. Veierød, Christine Henriksen, and Knut E. A. Lundin.

They are variously affiliated with the Department of Clinical Services, Oslo University Hospital Rikshospitalet, Oslo, Norway; the Department of Nutrition, Institute of Basic Medical Sciences; the K.G. Jebsen Coeliac Disease Research Centre; the Oslo Centre for Biostatistics and Epidemiology; the Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; ||Healthy Life Centre, Municipality of Nes, Årnes, Norway; and the Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.

The team conducted a randomized controlled trial on 70 adults with biopsy-proven celiac disease from 2018 to 2019. 

The study included patients with persistent gastrointestinal symptoms, as defined by a Gastrointestinal Symptom Rating Scale (GSRS)–IBS version score of 30 or higher, gluten-free diet treatment for 12 months or longer, and serologic and mucosal remission. 

The team randomized study subjects into a group receiving a low FODMAP–gluten-free diet (intervention) or the usual gluten-free diet (control group). 

The team recorded GSRS-IBS scores at baseline and at weeks 1 to 4, and the Celiac Symptom Index at baseline and at week 4. Their statistical analysis included marginal models for repeated data and analyses of covariance.

Time development of GSRS–IBS total scores differed significantly between the 34 participants in the intervention group and 36 in the control group, was evident after 1 week, and persisted through week four. 

Moreover, the intervention group showed significantly lower scores for the dimensions of pain, bloating, diarrhea, and satiety, but not constipation. FODMAP intake during the intervention was moderately low, averaging just over eight grams per day. The Celiac Symptom Index was significantly lower in the intervention group at week four.

In this study, a short-term moderately low FODMAP diet significantly reduced gastrointestinal symptoms and increased celiac disease–specific health in celiacs with persistent symptoms, and should be considered for managing the disease in those patients.

Read more in the cghjournal.org