A short-term, moderately low FODMAP diet, in addition to a strict gluten-free diet, significantly reduced gastrointestinal symptoms and improved disease-specific health in celiac patients, according to a study.
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- “There are no recommendations or guidelines for patients with [celiac disease (CeD)] in remission with ongoing symptoms, but dietary interventions, in addition to a gluten-free diet, could be a treatment option for persistent IBS-like symptoms in CeD,” Frida van Megen, a doctoral research fellow at the department of clinical services at Oslo University Hospital Rikshospitalet in Norway, and colleagues wrote in Clinical Gastroenterology and Hepatology.
Van Megan and colleagues sought to assess the efficacy of a moderately low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet, along with a strict gluten-free diet, on persistent GI symptoms, CeD-specific health and fatigue, compared with a gluten-free diet alone.
In a randomized, controlled study, researchers included 70 adults with biopsy-proven celiac disease and persistent GI symptoms, defined by a Gastrointestinal Symptom Rating Scale-IBS version (GSRS-IBS) score greater than or equal to 30; gluten-free diet adherence for at least 12 months; and serological and mucosal remission.
Patients were randomized to either the low FODMAP-gluten-free diet intervention group or the gluten-free diet control group. GSRS-IBS was recorded at baseline and weeks 1 through 4, and Celiac Symptom Index (CSI) was recorded at baseline and week 4.
FODMAP intake during the intervention period was classified as moderately low (mean 8.1 g/day; 95% CI, 6.7-9.3).
Although GSRS-IBS total scores between the intervention group and control group were similar at baseline (39 vs. 36.8, respectively), they differed significantly after week 1 (29.5 vs. 36.3, respectively) and persisted through week 4 (27.1 vs. 36.1, respectively).
- CSI scores also were significantly lower in the intervention group at week 4 compared with the control group (31.9 vs. 37.1, respectively), as were recordings of pain, bloating, diarrhea and satiety (P 0.04). However, significantly lower scores were not observed for constipation.
- “A low FODMAP diet should be considered [for implementation] in clinical practice for the management of persistent symptoms in treated CeD,” Van Megen and colleagues concluded.
- “However, patients with CeD already follow a restrictive diet, and further dietary restrictions may increase the burden of CeD by limiting food variability and make eating outside of home extremely challenging.”