Can Probiotics Help Celiac Disease Symptoms?

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Can probiotics help your celiac disease symptoms?. Rolf Ritte/Cultura Science/Getty Images

Question: I have celiac disease. Can probiotics help me manage my symptoms?

Answer: Possibly. There's a little bit of evidence that certain types of probiotics may help people with celiac disease who are not following the gluten-free diet. However, it's not clear whether these effects would carry over to people with celiac who already are gluten-free.

There's also evidence of lower levels of a particular probiotic strain in people with celiac, compared to people without the condition.

But again, it's not completely clear what this means in practical terms.

Some explanation is obviously in order.

What's Living In Your Gut?

Our intestines are home to large populations of microbes — mainly various types of bacteria, but with some yeast thrown in. Some of these micro-organisms (the so-called "friendly" bugs) work synergistically with our digestive tracts to help us break down food and use the nutrients in it for energy. Others may work against healthy digestion and potentially cause disease.

There's a tremendous amount of interest right now in the gut microbiome and its possible effect on a wide variety of chronic conditions, including both celiac disease and non-celiac gluten sensitivity. Theoretically, changes in the gut microbiome could lead to changes that either promote disease or inhibit it.

Eventually, we may be able to make our microbiomes healthier (and possibly treat some diseases) by eating certain foods or through procedures such as fecal implants.

However, the research on this is in its formative stages and is purely experimental at this point. No one really knows what population of microbes should be residing in your intestines to make your gut the healthiest gut possible, or how you can change your existing microbe population to make it healthier.

So What Does The Research Show So Far?

Studies have shown that people with celiac disease seem to have different microbes living in their intestines when compared to people without the condition. Specifically, celiacs have lower levels of particular strains of bacteria thought to be healthy, and higher levels of bacteria thought to promote inflammation.

These differences persist even when the people with celiac disease are following the gluten-free diet. For example, a 2008 study published in BMC Microbiology found reduced numbers of total Bifidobacterium microbes ("good" bugs) in celiac children regardless of whether they were eating gluten-free or not.

Eating gluten-free might help some: the same study found higher levels of helpful Bifidobacterium microbes in the children's intestines after they had begun eating gluten-free, indicating their microbiome might have begun to recover. However, the celiac children still had lower levels than normal of the helpful microbes, even when on the diet.

"The results suggest that total and specific Bifidobacterium species could be possible protective factors for celiac disease," the authors wrote. "Therefore, the administration of specific probiotics and prebiotics to increase their intestinal levels could constitute a possible adjuvant therapeutic strategy for this disorder." However, more research is needed before recommending such a strategy, they said.

Note that the children weren't taking supplements containing this particular Bifidobacterium species; the study simply measured what was already living in their intestines without trying to alter their microbiomes.

Particular Strain Could Help Celiac Symptoms

Another study, this one published in the Journal of Clinical Gastroenterology in 2013, considered whether taking supplements containing a particular probiotics strain would help alleviate symptoms and intestinal damage in adults with celiac disease who were not following the gluten-free diet.

A total of 22 patients consumed either this particular strain of Bifidobacterium infantis or capsules containing a placebo for three weeks. They also consumed at least 12 grams of gluten each day (see How Much Gluten Can Make Me Sick? for some perspective on how much gluten this is).

At the end of the study, the researchers found that leaky gut caused by celiac disease wasn't impacted. Still, those consuming the probiotics reported improvements in indigestion, constipation and reflux. The study concluded that B. infantis may help to alleviate celiac disease symptoms in those consuming gluten.

The Bottom Line

As I said, research into all of this is very preliminary when it comes to celiac disease, and research regarding non-celiac gluten sensitivity and probiotics hasn't even been conducted yet.

Priobiotics are no substitute for the gluten-free diet in celiac disease. That being said, you may feel probiotics are worth trying to see if they help with your symptoms overall, or when you inadvertently get exposed to gluten.

If you decide to take probiotics, look for a product made by a reliable manufacturer that contains a high number of live micro-organisms. And, don't forget to make sure the product you choose is gluten-free!

Sources:

Collado MC et al. Imbalances in faecal and duodenal Bifidobacterium species composition in active and non-active coeliac disease. BMC Microbiology. 2008 Dec 22;8:232.

Smecuol E et al. Exploratory, randomized, double-blind, placebo-controlled study on the effects of Bifidobacterium infantis natren life start strain super strain in active celiac disease. Journal of Clinical Gastroenterology. 2013 Feb;47(2):139-47.

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