New Protocol for Production of Reduced-Gluten Wheat Bread and Pasta and Clinical Effect in Patients with Irritable Bowel Syndrome: A randomised, Double-Blind, Cross-Over Study

Abstract

It has been suggested that sourdough fermented products have beneficial health effects. Fungal proteases and selected sourdough lactic acid bacteria were used to produce wheat bread and pasta with a reduced-gluten content (<50% of traditional products). Fermentable oligo-, di- and mono- saccharides and polyols and amylase/trypsin inhibitors were also evaluated. The sensorial features of new products were similar to traditional ones. The efficacy of these new products in reducing the severity of symptoms in Irritable Bowel Syndrome (IBS) patients were compared to traditional bread and pasta using a randomized, crossover-controlled trial. While on a strict gluten-free diet, patients were randomized to consume a reduced- or normal-gluten diet for 2weeks; then, patients from both arms started the wash-out period of one week, and subsequently started the final 2-week period on a normal or reduced-gluten diet. Compared to normal-gluten content, the administration of a reduced-gluten content diet resulted in a decrease of the Visual Analogue Scale score (p = 0.042), while no differences were found in the IBS-Severity Score, Hospital Anxiety and Depression Scale, and IBS-Quality of Life. Data herein reported are novel encouraging findings that should spur a new avenue of research aiming to develop products specifically designed for IBS patients.

Bacterial-Based Strategies to Hydrolyze Gluten Peptides and Protect Intestinal Mucosa

“…The efficacy of these products (containing <50% gluten content) was tested in a randomized, double-blind, crossover-controlled trial of 24 patients with irritable bowel syndrome (IBS) (compared to traditional bread and pasta). We demonstrated that, while consuming bread and pasta with reduced gluten content, IBS patients had significant symptom improvement as measured by the visual analogue scale score (p = 0.042) (27).…”

Sourdough Fermentation Degrades Wheat Alpha-Amylase/Trypsin Inhibitor (ATI) and Reduces Pro-Inflammatory Activity

“…Gastrointestinal symptoms after consumption of control bread or sourdough bread were not significantly different. In a randomized, double-blind, cross-over study, tolerance of pasta and bread fermented with lactobacilli and fungal proteases was compared but only one questionnaire showed a lower score for IBS patients [ 45 ]. In both studies [ 32 , 45 ], effective degradation or reduction of ATI were poorly documented and the study subjects were recruited from IBS patients.…”

“…In a randomized, double-blind, cross-over study, tolerance of pasta and bread fermented with lactobacilli and fungal proteases was compared but only one questionnaire showed a lower score for IBS patients [ 45 ]. In both studies [ 32 , 45 ], effective degradation or reduction of ATI were poorly documented and the study subjects were recruited from IBS patients. In IBS patients, effects of ATI degradation are confounded by reduced levels of fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) in sourdough bread.…”

Recent Advances in the Use of Sourdough Biotechnology in Pasta Making

“…Gluten sensitivity symptoms disappear in people that follow a gluten free diet. Nevertheless, the threshold of gluten intake related to the adverse reaction in subjects affected by gluten sensitivity is still debated and it has not yet been precisely established [56]. People suffering from gluten sensitivity are commonly affected by irritable bowel syndrome (IBS), an intestinal disorder that causes abdominal pain, bloating, diarrhea, constipation, and gut microbiota unbalance [2].…”

“…In a recent study, pasta with a reduced gluten content was produced using fermented semolina [56]. Gluten hydrolysis was carried out by sourdough fermentation using a pool of selected lactobacilli and fungal proteases [50].…”