A Low FODMAP Gluten-Free Diet Improves Functional Gastrointestinal Disorders and Overall Mental Health of Celiac Disease Patients: A Randomized Controlled Trial

Abstract

A subset of patients with celiac disease (CD) on a gluten-free diet (GFD) reported the persistence of functional gastrointestinal disorders. Foods containing fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) can trigger a broad range of gastrointestinal symptoms in sensitive individuals. We evaluated the effects of a low FODMAP diet (LFD) on gastrointestinal and psychological symptomatology in CD patients. A total of 50 celiac patients on GFDs and with persistence of gastrointestinal symptoms were included. The patients were randomly allocated to one of two dietary groups—one on a low FODMAP GFD (LF-GFD, n = 25) and the other on a regular GFD (R-GFD, n = 25)—for 21 days. Psychological symptomatology and quality of life were evaluated by the Symptom Checklist-90-R (SCL-90) and the Short Form (36) Health Survey (SF-36) questionnaires, respectively. Gastrointestinal symptomatology and general well-being were evaluated by visual analogue scale (VAS) scores. After 21 days, 21 and 23 patients completed the dietary treatment on LF-GFD and R-GFD, respectively. A reduced global SCL-90 index (p < 0.0003) was found in the LF-GFD group but not in the R-GFD one. However, the SF-36 scores did not differ between groups after treatment. The VAS for abdominal pain was much lower, and the VAS for fecal consistency enhanced after treatment in the LF-GFD group. General well-being increased in both groups but with a much higher improvement in the LF-GFD (p = 0.03). A short-term LFD regimen helps to improve the psychological health and gastrointestinal symptomatology with enhanced well-being of CD patients with persisting functional gastrointestinal symptomatology. The long-term clinical effects of LFD in particular subgroups of CD patients need further evaluation.

Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease

“…At the end of the 21 days, symptoms were reduced in the LF-GFD group, but not in the R-GFD group. General wellbeing increased in both groups, but a significantly higher improvement was noted in the LF-GFD group [26]. This suggests an additive effect of combining a low FODMAP diet with a GFD in certain individuals with NRCD.…”

“…In addition, functional gastrointestinal disorders, such as irritable bowel syndrome (IBS) and gastrointestinal dysmotility, are more prevalent in individuals with CD [23,24] and should not be overlooked as a cause of persisting symptoms in individuals with normal repeat duodenal histology. For these individuals, a low fermentable oligo-, di-, mono-saccharide and polyol (FODMAP) diet may improve symptoms and quality of life [25,26]. In one study, 41 CD patients with IBS who had been on a GFD for at least 1 year demonstrated significant improvement in IBS-symptom severity scores after 3 months on the low FODMAP diet [25].…”

The Availability and Nutritional Adequacy of Gluten-Free Bread and Pasta

“…CD patients following a GFD consume inadequate fiber levels, especially women, with intakes of 13.7 g per day [ 15 ] and 12 g per day [ 14 ] observed in UK dietary studies (fiber expressed as non-starch polysaccharides). There is limited scientific evidence of the effects these products have on the digestive system, but recently a study has shown that a subset of CD patients is sensitive to fermentable fibers [ 22 ]. Understanding these effects is important, especially as the digestive mechanism of CD patients may differ to that of the general population, as CD is an abnormal immune response to a food component.…”

Psychiatric Manifestations of Coeliac Disease, a Systematic Review and Meta-Analysis

“…Possible explanations for this increase include easier diagnostic methods and better targeted screening [4,5]. In addition to classic gastrointestinal (GI) symptoms, extra-intestinal symptoms such as neurological, psychiatric, and skin related are increasingly recognised [1,[6][7][8][9]. These extra-intestinal symptoms when presenting in isolation are challenging in the diagnosis of CD [1,10].…”