Jump to content
  • Join Our Community!

    Do you have questions about celiac disease or the gluten-free diet?

  • Frank W. Jackson MD

    Do You Still Have Symptoms on a Gluten-Free Diet? It May Be Your Microbiotia

      Journal of Gluten Sensitivity Winter 2011 Issue. NOTE: This article is from a back issue of our popular subscription-only paper newsletter. Some content may be outdated.

    Caption: Chocory root is high in inulin, a prebiotic. Image: CC--Peter O'Connor aka anemoneprojectors

    Celiac.com 04/13/2019 - The word microbiota is a fancy medical word.  It means the vast numbers of bacteria that inhabit the digestive track. These bugs, most of which were once  thought to be only a nuisance or worse, are now known to be a very important part of the overall health of the gut, indeed, of the entire body. So what does this have to do with celiacs and the gluten intolerant?

    Wheat

    For many thousands of years wheat has been a major part of the human diet. It was easy to grow, cultivate and domesticate. It was quickly found to be highly nutritious with lots of calories, to have most of the amino acids the body needs to make protein, many vitamins and minerals, and last but not least, a considerable amount of fiber to keep the bowels regular. Just as important, wheat could be baked in many ways and stored for later use. So, wheat became the backbone of the diet for much of the human race. It was the perfect food. And, alas, it was too perfect to last for the celiac patient and the gluten intolerant.

    Celiac and Gluten

    It was only 60 years ago that the cause of celiac disease was uncovered. In the late 1930s a Dutch physician, began to treat celiac children with a wheat free diet. During WW II when there was famine and no wheat available in Holland, many of these sickly children became even more remarkably and miraculously well.  They then became sick once again when wheat became available after the war. It was quickly found that the gluten protein in wheat was the culprit. An abnormal antibody in the blood was discovered. The tissue lining the small bowel was found to be badly damaged when wheat and gluten were eaten. But there was one additional thing in wheat that has more recently been discovered.  Prebiotics!

    The Prebiotics—Oligofructose and Inulin

    These 2 food fibers are prebiotics. A prebiotic is not a probiotic. A probiotic is a live bacteria usually found in yogurt, other dairy products and pills. For a fiber to be called a prebiotic it must be tested by research and found to produce distinct health benefits in the gut and, indeed, throughout the body. They occur when these specific fibers are consumed which, in turn, causes the vigorous growth of certain beneficial bacteria in the gut. It is these healthy bacteria that produce the health benefits. These unique food fibers are found in many plants throughout the world. In plants consumed by humans they are present not only in wheat and barley but also in onions, garlic, yams, leeks, asparagus, bananas, chicory root, Jerusalem artichoke, and even in dandelions. However, it is only wheat and barley that contain gluten. All the others are gluten-free. In the 1990s it was found that wheat supplied 70-80 % of the prebiotics in the American diet. However, this information was just recently rediscovered (1).

    The Health Benefits of Prebiotics

    This has been a remarkable story. In just over 20 years a huge amount of medical research has uncovered a dramatic array of prebiotic induced health benefits in both animals and humans. This data has just been recently reviewed and highlighted in an extensive, state-of-the-science review on prebiotics (2). The key findings in this 63 page review are that when prebiotics beneficially change the bacterial makeup of the gut, certain health benefits occur. The following occur as measured by medical research:

    • Increased calcium absorption and stronger bone density
    • Enhanced immunity as measured by research techniques
    • Better colon digestive and bacterial balance
    • Improved regularity, bulking and stool softness
    • Improvement in leaky, permeable bowel with reduced toxin absorption
    • Enhanced appetite control through hormone regulation
    • Reduced intestinal infection

    The following are tentatively considered to occur.

    • Reduced risk of obesity and type 2 diabetes
    • Reduced risk and/or improvement of intestinal inflammation such as Crohns or ulcerative colitis
    • Reduced risk of colon cancer

    These are remarkable findings. Were a drug developed that produced these health benefits, it would be a worldwide sensation. Yet, these benefits are available to most people if they include a significant amount of these plant fibers in their diet and/or take a supplement.

    The Diabolical Celiac/Gluten Dilemma 

    We can now study the bacterial composition of the gut with remarkable new, genetic techniques. What has been found in the celiac person and also in anyone who follows a gluten-free diet is that the bacterial makeup of the gut deteriorates significantly. These adverse changes seem to be associated with the reduction of prebiotics in the diet. It is also likely that this change in the bacterial makeup in some people can lead to digestive symptoms. So, what might be the answer? Certainly, increasing the consumption of these prebiotic-rich but gluten-free foods is a positive first step. The goal should be to consume up to 8 grams of the oligofructose and inulin prebiotics each day. A prebiotic supplement might also be useful in order to reach this goal. The bottom line is that for most of us, a gluten-free diet by itself is not enough. The second part of the dietary gluten-free equation is to replace the prebiotics lost when wheat is removed from the diet. This can be done by ingesting enough prebiotic-rich but gluten-free foods and/or with prebiotic supplements. 

    References:
    1. Jackson FW (2010) Effects of a gluten-free diet on the gut microbiota and immune function in healthy adult human subjects-comment by Jackson. Br J Nutr Sept; 104(5):773 Epub 2010 May 14
    2. Roberfroid M, Gibson GR, Hoyles L et al (2010) Prebiotic effects: metabolic and health benefits. Br J Nutr Aug; 104 Suppl 2: S1-63.

    \-->

    User Feedback

    Recommended Comments

    There are no comments to display.



    Join the conversation

    You can post now and register later. If you have an account, sign in now to post with your account.
    Note: Your post will require moderator approval before it will be visible.

    Guest
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • About Me

    Dr. Jackson was educated at Princeton, Johns Hopkins and the University of Pennsylvania and practiced gastroenterology for almost 40 years. He is the founder of several companies, including Jackson GI Medical, Chek-Med, GI Supply,  and Meducate. Dr. Jackson leads our product development and medical research efforts. He president of Jackson GI Medical, producer of a prebiotic supplement.

  • Related Articles

    Jefferson Adams
    A team of researchers has announced what they are calling a 'pivotal advance' regarding the differential influence of bifidobacteria and gram-negative bacteria on immune responses to inflammatory triggers in celiac disease.
     
    Their study provides strong evidence that various intestinal bacteria in celiac patients can influence inflammation, and that dietary probiotics and prebiotics can help improve the quality of life for patients with celiac and other associated diseases, such as type 1 diabetes and various autoimmune disorders.
    To conduct their study, they the team used cultures of human peripheral mononuclear cells (PBMCs) as in vitro models. This was possible because blood monocytes constantly replenish intestinal mucosal monocytes, and accurately represent an in vivo situation.
    To duplicate the intestinal environment surrounding celiac disease, researchers exposed cell cultures to Gram-negative bacteria and bifidobacteria they had isolated from celiac patients, both alone and in the presence of disease triggers.
    They then assessed the effects on surface marker expression and cytokine production by PBMCs. Gram-negative bacteria induced higher pro-inflammatory cytokines than did bifidobacteria.
    The Gram-negative bacteria also up-regulated expression of cell surface markers involved in inflammatory aspects of the disease, while bifidobacteria up-regulated the expression of anti-inflammatory cytokines.
    Research team still need to confirm the results in clinical trials on people, but the findings offer the first support for new treatment options that may change how celiac disease is treated and possibly prevented.
    In the same way the certain foods may contribute to poor health, notes Louis Montaner, D.V.M., M.Sc., D.Phil. Editor-in-Chief of the Journal of Leukocyte Biology, "others can have positive effects. For people with celiac disease, this opens a line of research into new therapies that may be as accessible as a grocer's shelf."
    SOURCE: Journal of Leukocyte Biology. 2010;87:765-778.


    Alexander R. Shikhman, MD, PhD, FACR
    Celiac.com 04/09/2014 - The human gastrointestinal tract contains approximately 1014 bacterial cells that form a unique, diverse and very dynamic microbial ecosystem also known as gut microbiota. The genomes of all intestinal microbes form the “microbiome”, representing more than 100 times the human genome. The composition of gut microbiota is crucial for human health. Normal gut microbiota enhances digestive processes, produces certain vitamins and nutrients, facilitates absorptive processes, participates in development and maturation of the immune system and limits colonization of the gut by pathogenic microorganisms. It has been demonstrated that the following predominant microorganisms constitute for the normal gut microbiota: Bacteroides, Clostridium, Eubacterium, Veillonella, Ruminococcus, Bifidobacterium, Fusobacterium, Lactobacillus, Peptostreptococcus and Peptococcus. Diet is a major environmental factor influencing gut microbiota diversity and functionality.
    Abnormalities in the composition of normal gut microbiota, also known as dysbiosis, frequently result in the development of chronic inflammatory, autoimmune and atopic processes not only within the gut but also in the distant body compartments such as skin, exocrine glands, the brain, muscles and joints.
    It is well recognized that people affected by poorly controlled celiac disease have detectable dysbiosis.
    Compared to healthy individuals, people with active celiac disease are characterized by higher numbers of Gram-negative bacteria, known to activate pro-inflammatory processes, and lower numbers of Gram-positive bacteria benefiting the gastrointestinal tract and anti-inflammatory responses. Furthermore, recent studies of children with celiac disease showed that even a strict compliance with a gluten-free diet does not completely restore the normal gut microbiota. Di Cagno and colleagues analyzed the composition of gut microbiota in children with celiac disease on a strict gluten-free diet as compared to a group of matched, non-celiac controls. The study showed that the levels of Lactobacillus, Enterococcus and Bifidobacteria were significantly higher in fecal samples from healthy children rather than from celiac children. On the contrary, cell counts of potentially pathogenic microorganisms such as Bacteroides, Staphylococcus, Salmonella, Shighella and Klebsiella were significantly higher in celiac children compared to healthy children.
    Based on the aforementioned data, it is obvious to propose that probiotics, defined as viable microorganisms benefiting gastrointestinal health, may serve as a valuable addition to the maintenance protocols for those with celiac disease.
    Well established probiotic effects include:
    Beneficial effects on dysbiosis including control of yeast (Candida albicans) overgrowth Facilitation of pathogenic bacteria elimination (for example, Clostridium difficile and Helicobacter pylori) Reduction of local and systemic inflammatory responses Prevention of autoimmune and allergic reactions Prevention and treatment of antibiotic-associated diarrhea Normalization of intestinal contractions and stool consistency Reduction of the concentration of cancer-promoting enzymes and metabolites in the gut Prevention of upper respiratory and urogenital infections Cholesterol-lowering activity Experimental data indicate that probiotics can benefit celiac disease.
    Lindfors K. and colleagues showed that live probiotic, Bifidobacterium lactis, bacteria inhibit the toxic effects induced by wheat gliadin in intestinal epithelial cell culture.
    Papista C. et al. demonstrated (in a mouse model) that probiotics can prevent intestinal damage of celiac disease.
    The published data on the beneficial effects of probiotics in celiac patients is limited. Our clinical experience (Institute for Specialized Medicine – www.ifsmed.com) indicates that appropriately selected probiotics significantly reduce diarrhea and bloating in patients with gluten intolerance and celiac disease. Furthermore, we see positive reduction of gluten-associated joint and muscle pain, fatigue and brain fog as well as on gut colonization with yeast. Probiotics also normalize markers of inflammation (for example, C-reactive protein) and markers of mucosal immune responses (for example, fecal secretory immunoglobulin A – sIgA). Typically, the benefits of probiotics administration cannot be seen instantly. It takes at least 4-6 months to see measurable benefits.
    The choice of probiotics is another difficult issue for an inexperienced consumer.
    The following probiotic strains may benefit those with celiac disease and gluten intolerance:
    a. Lactobacillus acidophilus is a species of Lactobacilli which occurs naturally in the human and animal gastrointestinal tract and in many dairy products. The L. acidophilus strain DDS-1 is one of the best characterized probiotic strains in the world. The medicinal properties of L. acidophilus DDS-1 include: production of lactic acid supporting good bacteria in the gut, production of B and K vitamins, prevention of colon cancer, prevention of ‘traveler’s diarrhea’, inhibition of gastric/duodenal ulcers caused by Helicobacter pylori, reduction of symptoms of eczema and atopic dermatitis, reduction of serum cholesterol level, fermentation of lactose and reduction of symptoms of lactose intolerance, and reduction of intestinal pain.
    b. Lactobacillus plantarum is a Gram-positive bacterium naturally found in many fermented food products including sauerkraut, pickles, brined olives, Korean kimchi, sourdough, and other fermented plant material, and also some cheeses, fermented sausages, and stockfish. The medicinal properties of L. plantarum include: production of D- and L-isomers of lactic acid feeding beneficial gut bacteria, production of hydrogen peroxide killing pathogenic bacteria, production of enzymes (proteases) degrading soy protein and helping people with soy intolerance, synthesis of amino-acid L-lysine that promotes absorption of calcium and the building of muscle tissue, production of enzymes (proteases) digesting animal proteins such as gelatin and helping people with pancreatic insufficiency.
    c. Lactobacillus casei is a species of Lactobacilli found in the human intestine and mouth. The medicinal properties of L. casei include: production of lactic acid assisting propagation of desirable bacteria in the gut, fermentation of lactose and helping people with lactose intolerance, fermentation of beans causing flatulence upon digestion.
    d. Lactobacillus rhamnosus is a species of Lactobacilli found in yogurt and other dairy products. The medicinal properties of L. rhamnosus include: production of lactic acid supporting good bacteria in the gut, production of bacteriocins and hydrogen peroxide killing pathogenic bacteria, prevention of diarrhea of various nature, prevention of upper respiratory infections, reduction of symptoms of eczema and atopic dermatitis, affecting GABA neurotransmitting pathway and reducing symptoms of anxiety.
    e. Lactobacillus salivarius is a species of Lactobacilli isolated from saliva. The medicinal properties of L. salivarius include: production of lactic acid supporting good bacteria in the gut, reduction of inflammatory processes causing colitis and inflammatory arthritis, prevention of colon cancer.
    f. Bifidobacterium bifidus is a Gram-positive bacterium which is a ubiquitous inhabitant of the human gastrointestinal tract. B. bifidus are capable of fermenting various polysaccharides of animal and plant origin. The medicinal properties of B. bifidus include: production of hydrogen peroxide killing pathogenic bacteria, modulation of local immune responses, production of vitamins B, K and folic acid, prevention of colon cancer, bioconversion of a number of dietary compounds into bioactive molecules.
    g. Bifidobacterium lactis is a Gram-positive bacterium which is found in the large intestines of humans. The medicinal properties of B. lactis include: production of hydrogen peroxide killing pathogenic bacteria, modulation of local immune responses, production of vitamins B, K and folic acid, prevention of colon cancer.
    h. Lactococcus lactis is a Gram-positive bacterium used in the production of buttermilk and cheese.  The medicinal properties of L. lactis include: production of lactic acid supporting good bacteria in the gut, prevention of colon cancer, fermentation of lactose and reduction of symptoms of lactose intolerance.
    i. Saccharomyces boulardii is a probiotic strain of yeast first isolated from lychee and mangosteen fruit. Upon consumption, S. boulardii remains within the gastrointestinal lumen, and maintains and restores the natural flora in the large and small intestine.  There are numerous randomized, double-blind placebo-controlled studies showing the efficacy of S. boulardii in the treatment and prevention of various gastrointestinal disorders. Potential indications for use of Saccharomyces boulardii in humans include: 1) diarrhea/traveler’s diarrhea/antibiotic-associated diarrhea, 2) infection with Clostridium difficile/pseudomembranous colitis, 3) irritable bowel syndrome, 4) ulcerative colitis and Crohn’s disease, 5) partial IgA deficiency, 6)peptic-ulcer disease due to Helicobacter pylori. Published data also indicate that enzymes produced by S. boulardii can digest alpha-gliadin and related molecules.
    j. Bacillus coagulans, also known as Lactobacillus sporogenes, is a gram-positive, spore-forming probiotic which is characterized by the increased survival in acidic gastric environment and in bile-acid-associated duodenal environment as compared to the commonly used probiotic microorganisms. Bacillus coagulans do not adhere to the human intestinal epithelium and is completely eliminated in four to five days unless chronic administration is maintained. Once in the intestines, Bacillus coagulans is activated and releases anti-inflammatory molecules or acts indirectly to eradicate organisms in the gut responsible for the inflammatory immune response. Activated Bacillus coagulans produces bacteriocins and lowers local pH by producing L(+) lactic acid that, along with competition for sites of mucosal adherence, works to dislodge and eliminate any antagonizing microbes that may be contributing to an inflammatory response. Bacillus coagulans also produces short-chain fatty acids such as butyric acid, a compound known to support the health and healing of cells in the small and large intestines and to contribute to modulation of the mucosal immune system.
    To achieve therapeutic responses, the daily dose of the probiotics should be at least 25 billion CFUs (colony-forming units) and above. We recommend taking probiotics on an empty stomach either 20-30 minutes before breakfast or one-two hours after dinner with plenty of fluids. In those taking antibiotics, the time of the probiotic administration needs to be spaced out from that of antibiotics for at least several hours.
    References:
    Papista C, Gerakopoulos V, Kourelis A, Sounidaki M, Kontana A, Berthelot L, Moura IC, Monteiro RC, Yiangou M.  Gluten induces coeliac-like disease in sensitised mice involving IgA, CD71 and transglutaminase 2 interactions that are prevented by probiotics. Lab Invest. 2012 Feb 13. doi: 10.1038/labinvest.2012.13. Sanz Y, De Pama G, Laparra M.  Unraveling the ties between celiac disease and intestinal microbiota. Int Rev Immunol. 2011 Aug;30(4):207-18. de Vrese M, Schrezenmeir J.  Probiotics, prebiotics, and synbiotics. Adv Biochem Eng Biotechnol. 2008;111:1-66. Lindfors K, Blomqvist T, Juuti-Uusitalo K, Stenman S, Venäläinen J, Mäki M, Kaukinen K.  Live probiotic Bifidobacterium lactis bacteria inhibit the toxic effects induced by wheat gliadin in epithelial cell culture. Clin Exp Immunol. 2008 Jun;152(3):552-8. Raffaella Di Cagno, Maria De Angelis, Ilaria De Pasquale, Maurice Ndagijimana, Pamela Vernocchi, Patrizia Ricciuti, Francesca Gagliardi, Luca Laghi, Carmine Crecchio, Maria Elisabetta Guerzoni, Marco Gobbetti, Ruggiero Francavilla.  Duodenal and faecal microbiota of celiac children: molecular, phenotype and metabolome characterization.  BMC Microbiology 2011, 11:219.

    Jefferson Adams
    Celiac.com 06/08/2015 - Many people with celiac disease take probiotic supplements to aid with digestion and improve gut health.
    However, a new study reveals that many popular probiotics actually contain traces of gluten, which is worrying for people who may have celiac disease or gluten intolerance.
    Researchers at the Celiac Disease Center at Columbia University Medical Center used a detection technique called liquid chromatography-mass spectrometry to analyze 22 popular, high-selling probiotics and measure gluten content. The team found that more than half of them (55%) contained gluten, including products labeled "gluten-free," according to research presented on May 16 at Digestive and Disease Week in Washington DC.
    For reasons doubtless including liability, the team did not list the names of the brands or products they tested. It is safe to assume that these would include major, easily accessible brands.
    These revelations may be unsurprising, given recent reports about gluten contamination in dietary supplements.
    So, if you have celiac disease or gluten intolerance, and take probiotic supplements, be sure to double-check your products; they may contain traces of gluten.

    Source:
    Time Magazine

    Jefferson Adams
    Celiac.com 10/09/2017 - New trial data suggests that the probiotic strains Lactobacillus plantarum Heal 9 and Lactobacillus paracasei 8700:2 may provide support for the immune system and delay the onset of gluten intolerance in children.
    The findings, recently presented at the International Celiac Disease Symposium in New Delhi, suggest that Probi's patented probiotic strains have a 'surprisingly consistent' effect on suppressing coeliac autoimmunity and may delay the onset of the disease in children who are genetically pre-disposed to the condition.
    "To our knowledge this is the first time a probiotic study has been performed on this specific population and the results show immune-supporting properties of these probiotics as well as a potential preventive effect on the development of celiac disease," said Dr Daniel Agardh of Lund University.
    Agardh and colleagues identified and recruited 78 children with a genetic pre-disposition to coeliac disease. The children were as a subpopulation in a multinational and multiyear autoimmunity study with thousands of children.
    The randomized, double-blind, placebo-controlled trial lasted six months and found that disease-related antibodies were significantly reduced in the probiotic group and significantly increased in the placebo group during the course of the study.
    Results show that the probiotic strains had a suppressing effect on celiac autoimmunity and may delay the onset of the disease – with tissue transglutaminase autoantibodies (tTGA) decreased in the treatment group, but increased in the placebo group.
    In addition, several significant differences were observed between the groups on a cellular level indicating that the probiotic may counteract coeliac disease-associated ongoing immunological and inflammatory response.
    "This is an excellent example of a well working collaboration between academia and the industry" commented Probi CEO Peter Nählstedt.
    "We see a growing interest in children's probiotics and these results enable Probi to build a product platform for children."
    Read more at: Nutraingredients.com

×
×
  • Create New...