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    Can Sourdough Fermentation Speed Intestinal Recovery in Celiac Patients at Start of Gluten-free Diet?


    Jefferson Adams

    Celiac.com 04/19/2012 - A team of researchers examined the effect of corn, rice and amaranth gluten-free sourdoughs on the release of nitric oxide (NO) and synthesis of pro-inflammatory cytokines by duodenal mucosa biopsies of eight celiac disease patients.

    Image: Sourdough starter: CC--andersbknudsenThe research team included Maria Calasso, Olimpia Vincentini, Francesco Valitutti, Cristina Felli, Marco Gobbetti and Raffaella Di Cagno.

    The team used select lactic acid bacteria as starters for making corn, rice and amaranth sourdoughs. From these gluten-free sourdough matrices, they made chemically acidified doughs, without bacterial starters, and doughs started with baker’s yeast alone.

    They produced pepsin-trypsin (PT) digests from all sourdoughs and doughs, and used the results to the measure the recovery of biopsy specimens from eight celiac disease patients at diagnosis. They also measured the release of NO and the synthesis of pro-inflammatory cytokines interferon-γ (IFN-γ).

    They found that lactic acid bacteria acidified and grew well (ca. log 9.0 CFU/g) during fermentation, showing strong proteolysis on all gluten-free samples.

    They also found that duodenal biopsy specimens still released NO and IFN-γ when subjected to treatments with basal medium (control), PT-digest from chemically acidified doughs and PT-digest from doughs fermented with baker’s yeast alone.

    In fact, in every case, biopsy specimens treated with PT-digests from all gluten-free matrices with sourdough fermentation substantially reduced NO release and IFN-γ synthesis.

    From their results, the team concludes that sourdough fermentation might offer an easy and effective way to speed recovery from intestinal inflammation of celiac patients beginning a gluten-free diet.

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    Guest gluten

    Posted

    Can you really trust the 'gluten free' label on a product? From what I understand these things are not that heavily regulated, especially with foods produce outside of the country. I've picked up quite a few products only to later find traces of gluten.

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    Guest M. Sutherland

    Posted

    It did not give the recipe for the sourdough stater.

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    I found this article very interesting. As a newly diagnosed celiac disease patient I'm having a difficult time not only adapting to the diet, but also affording the gluten free groceries.

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    Guest Steven M. Weil

    Posted

    Kudos for Jefferson Adams!

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    So, how about some gluten-free sourdough recipes?

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    Guest Nancy

    Posted

    So, how about some gluten-free sourdough recipes?

    Sourdough recipes would be awesome!!

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    Guest d. smith

    Posted

    Good article, but there are no recipes for the sourdough mix and I agree with Kim. As a senior on a fixed income I find the price of gluten-free food atrocious.

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    I've been over 6 months gluten-free and usually notice within a few minutes when I slip and eat the wrong thing. But I reintroduced regular sourdough bread (Scholtzky's) and had zero ill effects. No reaction whatsoever. So I ate another one the next day. Still no effects--no heartburn, no painful joints, no bad stomach, no effects at all. Can't believe it.

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    Guest Michelle

    Posted

    I am new to the gluten-free world. Missing my pizza, and bread!! I had some sourdough bread here for company and I said forget it...I am going to have a large slice with butter. Yummy! I had no ill effect at all. I love it--sour dough is my new best friend.

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    Guest admin

    Posted

    I am new to the gluten-free world. Missing my pizza, and bread!! I had some sourdough bread here for company and I said forget it...I am going to have a large slice with butter. Yummy! I had no ill effect at all. I love it--sour dough is my new best friend.

    If you are a celiac or gluten intolerant we highly advise that you don't eat any wheat-based breads. In this study corn, rice and amaranth sourdoughs were used, so they were gluten-free.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com.

    Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book Dangerous Grains by James Braly, MD and Ron Hoggan, MA.

  • Related Articles

    Jefferson Adams
    Celiac.com 06/18/2009 - According to the results of a recent study, complete recovery of intestinal mucosa occurs very rarely in patients with celiac disease, despite adherence to a gluten-free diet.
    Generally, when people with celiac disease go on a gluten-free diet, they can expect to enjoy some healing of small intestinal mucosa. However, new data casts doubt over how much of this benefit is experienced in adult celiac patients.
    In order to analyze the factors that influence histological outcome of a gluten-free diet in a large cohort of adult celiac patients, a team of researchers reviewed data on 465 consecutive celiac patients studied before and during the gluten-free diet.
    The team was made up of A. Lanzini, F. Lanzarotto, V. Villanacci, A. Mora, S. Bertolazzi, D. Turini, G. Carella, A. Malagoli, G. Ferrante, B.M. Cesana, and C. Ricci. The researchers made duodenal biopsies of subjects at diagnosis, and classified results. They found 11 cases of Marsh I, 25 cases of Marsh II, and 429 cases of Marsh III.
    After an average of 16 months on a gluten-free diet, 38 patients (8%) showed histological ‘normalization’, 300 patients (65%) showed  ‘remission’ with persistent intraepithelial lymphocytosis, 121 patients (26%) remained unchanged, while 6 patients (1%) showed ‘deterioration’.* Celiac disease-related blood tests were negative in 83% of patients with Marsh III lesion during the gluten-free diet.
    Researchers independently associated male gender and adherence to a gluten-free diet with histological ‘normalization’ and ‘remission’. There seemed to be no association between persistence of intraepithelial lymphocytosis and human lymphocyte antigen gene dose, or with Helicobacter pylori infection.
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    Aliment Pharmacol Ther 29, 1299–1308
    *Author's note: Could such deterioration be due to undetected exposure to gluten over time?

    Jefferson Adams
    Study Supports Gluten-free Diet for 'Potential' Celiac Disease Patients
    Celiac.com 12/26/2010 - Should everyone with symptoms of celiac disease go on a gluten-free diet? Current practice allows many patients with symptoms of celiac disease, but no gut damage, and thus no official diagnosis, to forgo a gluten-free diet.
    In a new study, researchers found that people with celiac disease symptoms have the same distinctive metabolic fingerprint as patients with full-blown disease, and who must follow a gluten-free diet to avoid permanent damage to the gut.
    The new study, by Ivano Bertini and colleagues, is stirring up the discussion about just which patients with symptoms of celiac disease should follow a gluten-free diet.
    Their research shows that people currently diagnosed as "potential" celiac disease patients and not advised to follow a gluten-free diet may not be "potential" patients at all.
    Celiac disease is widely regarded as undiagnosed or misdiagnosed. For their study, the researchers used magnetic resonance metabolic profiling to analyze the biochemical markers in the blood and urine of 61 patients with celiac disease, 29 with potential celiac disease, and 51 healthy people.
    The researchers found that people with unproven celiac disease largely shared the same profile as those with confirmed celiac disease and that the biochemical markers in both groups differed sharply from those of healthy individuals.
    The researchers conclude that their findings "demonstrate that metabolic alterations may precede the development of small intestinal villous atrophy and provide a further rationale for early institution of gluten-free diet in patients with potential celiac disease, as recently suggested by prospective clinical studies."
    The authors do note receiving funding from Boehringer Ingelheim Italy.
    Source:

    American Chemical Society Journal of Proteome Research

    Jefferson Adams
    Mucosal Recovery and Mortality in Adults With Celiac Disease Following a Gluten-Free Diet
    Celiac.com 02/23/2011 - In most adults with celiac disease, clinical symptoms disappear with a gluten-free diet. However, the exact effects of a gluten-free diet on rates of mucosal recovery in adults with celiac disease is less certain.
    A group of clinicians recently set out to assess rates of mucosal recovery under a gluten-free diet in adults with celiac disease, and to gauge the clinical prospects of ongoing mucosal damage in celiac patients who follow a gluten-free diet.
    The study group included Alberto Rubio-Tapia, MD; Mussarat W. Rahim, MBBS; Jacalyn A. See, MS, RD, LD; Brian D. Lahr, MS; Tsung-Teh Wu, MD; and Joseph A. Murray, MD.
    Each patient in the study had biopsy-proven celiac disease, and was assessed at the Mayo Clinic. Also, each patient received duodenal biopsies at diagnosis. After beginning a gluten-free diet, each patient had at least one follow-up intestinal biopsy to assess mucosal recovery.
    The study team focused on mucosal recovery and overall mortality. Of 381 adult patients with biopsy-proven celiac disease, a total of 241 (175 women - 73%) had both a diagnostic and follow-up biopsy available for re-review.
    Using the Kaplan–Meier rate of confirmed mucosal recovery to assess these 241 patients, the study group found that 34% of the patients enjoyed mucosal recovery at 2 years after diagnosis (95% with a confidence interval (CI): 27–40 % ), and 66% of patients enjoyed mucosal recovery at 5 years (95% CI: 58–74 % ).
    More than 80% of patients showed some clinical response to the gluten-free diet, but clinical response was not a reliable marker of mucosal recovery ( P = 0.7). Serological response was, by far, the best marker for confirmed mucosal recovery ( P = 0.01).
    Patients who complied poorly with a gluten-free diet ( P < 0.01), those with severe celiac disease defined by diarrhea and weight loss ( P < 0.001), and those with total villous atrophy at diagnosis ( P < 0.001) had high rates of persistent mucosal damage.
    With adjustments for gender and age, patients who experienced confirmed mucosal recovery had lower mortality rates overall (hazard ratio = 0.13, 95 % CI: 0.02 – 1.06, P = 0.06).
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    Compared to those patients who suffered persistent damage, patients who experienced confirmed mucosal recovery had lower rates of mortality independent of age and gender.
    The group notes that systematic follow-up via intestinal biopsy may be advisable for adults with celiac disease.
    Source:

     Am J Gastroenterol. 9 February 2010; doi: 10.1038/ajg.2010.10

    Jefferson Adams
    Gluten-free Diet Benefits Newly Screened Older Celiac Disease Patients
    Celiac.com 05/02/2012 - Doctors and researchers are still debating the usefulness of active blood screening for spotting celiac disease in older populations. Studies do suggest that many cases of celiac disease go undetected, especially in the older population. One unanswered question is whether screening does any good for older people who have been eating gluten many decades.
    A team of researchers recently studied the clinical benefit of a gluten-free diet in screen-detected older celiac disease patients. The research team included Anitta Vilppula, Katri Kaukinen, Liisa Luostarinen, Ilkka Krekelä, Heikki Patrikainen, Raisa Valve, Markku Luostarinen, Kaija Laurila, Markku Mäki, and Pekka Collin.
    They are affiliated with the Department of Neurology, the Department of Internal Medicine and the Department of Surgery at Päijät-Häme Central Hospital, and the University of Helsinki's Department of Education and Development in Lahti, Finland, the Department of Gastroenterology and Alimentary Tract Surgery the School of Medicine, and the Paediatric Research Centre at the University of Tampere and Tampere University Hospital, Tampere, Finland.
    For their study, the researchers evaluated the benefit of active detection and implementation of a gluten-free diet in elder populations with for celiac disease.
    The team evaluated thirty-five biopsy-proven celiac patients over 50 years of age, each of whom had celiac disease detected by mass blood screening.
    They looked at bone mineral density, dietary compliance, disease history, quality of life, and symptoms at baseline and after 1-2 years of a gluten-free diet. They also looked at small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density.
    Using surveys, the team established gastrointestinal symptom ratings and quality of life by psychological general well-being. The used this information to rate symptoms.
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    Initially low vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on a gluten-free diet.
    Patient histories showed that those with celiac disease had sustained more low-energy fractures, and sustained such fractures more frequently than the general population. A gluten-free diet brings with it a beneficial increase in bone mineral density.
    The team also noticed that many gastrointestinal symptoms disappeared, even though though many patients reported only subtle symptoms upon diagnosis.
    Quality of life remained unchanged. According to the study team, two out of three patients would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been factored in.
    Results showed that patients who had celiac disease detected by mass blood screen did, in fact, benefit from a gluten-free diet. For doctors evaluating older patients, the team advocates a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening.
    Source:
    BMC Gastroenterology 2011, 11:136. doi:10.1186/1471-230X-11-136

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