Low FODMAP Diet Reduces Symptoms in Celiac Disease

A small study indicates that the short-term application of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet can relieve persistent symptoms among patients with celiac disease.

The investigators noted that patients with celiac disease can often achieve mucosal remission by following a strict gluten-free diet, but may continue to experience pain, bloating, and diarrhea. They set out to determine if a low FODMAP diet, often recommended for patients with irritable bowel syndrome (IBS), could be helpful in alleviating these symptoms.

The researchers conducted a randomized controlled trial during 2018-2019, enrolling 70 adults with biopsy-proven celiac disease and persistent gastrointestinal symptoms as defined by the Gastrointestinal Symptom Rating Scale-IBS version (GSRS-IBS) score≥ 30. Participants also were required to have adhered to a gluten-free diet for at least 12 months, and to have achieved serological and mucosal remission.

The participants were randomized to a low FODMAP-gluten-free diet cohort (n = 34) or to a control group that followed the usual gluten-free diet (n = 36). Patients’ GSRS-IBS scores were recorded at baseline and at weeks 1-4; their Celiac Symptom Index (CSI) scores were recorded at baseline and week 4.

“Time development of GSRS-IBS total scores differed significantly between the groups (Pinteraction<0.001), evident after one week (mean difference (95% CI) intervention versus control (-8.2 (-11.5,-5.0)) and persisting through week 4 (-10.8 (-14.8,-6.8)),” the authors wrote. “Moreover, significantly lower scores were found for the dimensions pain, bloating, diarrhea and satiety (Pinteraction≤ 0.04), but not constipation (Pinteraction=0.43). FODMAP intake during the intervention was moderately low (mean 8.1 g/day (95% CI 6.7, 9.3)). CSI was significantly lower in the intervention group at week 4 (mean differences (95% CIs): -5.8 (-9.6,-2.0).”

The short-term application of a moderately low FODMAP diet significantly reduced gastrointestinal symptoms among patients with celiac disease, improved celiac disease-specific health markers, and should be considered for the management of persistent symptoms among patients with celiac disease.

—Rebecca Mashaw

Reference:
Frida van Megen F, Skodje GI, Lergenmuller S. A low FODMAP diet reduces symptoms in treated celiac patients with ongoing symptoms – a randomized controlled trial. Clin Gastroenterol Hepatol. Published online: January 17, 2022. DOI:10.1016/j.cgh.2022.01.011