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

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

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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.