A Low FODMAP Diet Reduces Symptoms in Treated Celiac Patients With Ongoing Symptoms-A Randomized Controlled Trial.
Study Goal
The researchers aimed to assess the efficacy of a moderately low FODMAP diet in reducing persistent gastrointestinal symptoms in treated celiac disease patients.
Results Summary
The study found that a short-term moderately low FODMAP diet significantly reduced gastrointestinal symptoms (pain, bloating, diarrhea, and satiety) and improved celiac disease-specific health compared to a usual gluten-free diet, with effects evident within one week and persisting through four weeks.
Population
Adults with biopsy-proven celiac disease, persistent gastrointestinal symptoms, and adherence to a gluten-free diet for ≥12 months.
Effective Dosage
Mean FODMAP intake of 8.1 g/day (95% CI, 6.7-9.3 g/day).
Duration
4 weeks
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
low FODMAP-gluten-free diet | decrease | GSRS-IBS total scores | adults with biopsy-proven celiac disease | mean difference in intervention vs control, -8.2; 95% CI, -11.5 to -5.0 | differed significantly | #1 |
low FODMAP-gluten-free diet | decrease | GSRS-IBS total scores | adults with biopsy-proven celiac disease | mean difference in intervention vs control, -10.8; 95% CI, -14.8 to -6.8 | differed significantly | #2 |
low FODMAP-gluten-free diet | decrease | pain | adults with biopsy-proven celiac disease | - | significantly lower scores | #3 |
low FODMAP-gluten-free diet | decrease | bloating | adults with biopsy-proven celiac disease | - | significantly lower scores | #4 |
low FODMAP-gluten-free diet | decrease | diarrhea | adults with biopsy-proven celiac disease | - | significantly lower scores | #5 |
low FODMAP-gluten-free diet | decrease | satiety | adults with biopsy-proven celiac disease | - | significantly lower scores | #6 |
low FODMAP-gluten-free diet | no change | constipation | adults with biopsy-proven celiac disease | - | not significantly lower scores | #7 |
low FODMAP-gluten-free diet | decrease | Celiac Symptom Index | adults with biopsy-proven celiac disease | mean difference, -5.8; 95% CI, -9.6 to -2.0 | significantly lower | #8 |
short-term moderately low FODMAP diet | decrease | gastrointestinal symptoms | celiac disease patients with persistent symptoms | - | significantly reduced | #9 |
short-term moderately low FODMAP diet | increase | celiac disease-specific health | celiac disease patients with persistent symptoms | - | increased | #10 |
BACKGROUND & AIMS: A gluten-free diet usually leads to mucosal remission in celiac disease, but persistent symptoms are common. A low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet is an established treatment for irritable bowel syndrome (IBS). We have assessed the efficacy of a moderately low FODMAP diet on persistent symptoms in treated celiac patients. METHODS: A randomized controlled trial was performed from 2018 to 2019 in 70 adults with biopsy-proven celiac disease. Inclusion criteria were as follows: persistent gastrointestinal symptoms defined by a Gastrointestinal Symptom Rating Scale (GSRS)-IBS version score of 30 or higher, gluten-free diet adherence for 12 months or longer, and serologic and mucosal remission. Participants were randomized to a low FODMAP-gluten-free diet (intervention) or usual gluten-free diet (control). The GSRS-IBS score was recorded at baseline and at weeks 1 to 4, and the Celiac Symptom Index at baseline and at week 4. Statistics included marginal models for repeated data and analyses of covariance. RESULTS: We included 34 participants in the intervention group and 36 in the control group. Time development of GSRS-IBS total scores differed significantly between the groups (Pinteraction < .001), evident after 1 week (mean difference in intervention vs control, -8.2; 95% CI, -11.5 to -5.0) and persisting through week 4 (mean difference in intervention vs control, -10.8; 95% CI, -14.8 to -6.8). Moreover, significantly lower scores were found for the dimensions of pain, bloating, diarrhea, and satiety (Pinteraction ≤ .04), but not constipation (Pinteraction = .43). FODMAP intake during the intervention was moderately low (mean, 8.1 g/d; 95% CI, 6.7-9.3 g/d). The Celiac Symptom Index was significantly lower in the intervention group at week 4 (mean difference, -5.8; 95% CI, -9.6 to -2.0). CONCLUSIONS: A short-term moderately low FODMAP diet significantly reduced gastrointestinal symptoms and increased celiac disease-specific health, and should be considered for the management of persistent symptoms in celiac disease. CLINICALTRIALS: gov: NCT03678935.