KEY POINTS:

  • Early research theorizes that specific gastrointestinal microbiome profiles may play a central role in the development of celiac disease. 1
  • The gluten-free diet itself appears to negatively affect the healthy intestinal microbiome balance since it is low in prebiotics which are vital for the optimal effects of probiotics. 2
  • Subjects with treated and untreated celiac disease are at increased long term risk for dysbiosis. 3
  • There is ongoing research on the therapeutic effects of specific strains of probiotics in managing celiac disease and other inflammatory and autoimmune diseases that are associated with an altered microbiome. 4,5
  • Probiotics, such as Lactobacillus acidophilus (which works in the small intestine) Bifidobacteria (which works in the large intestine), and active yogurt cultures, are safe, well tolerated, and may promote overall gut health6
  • Targeting the types and amounts of dietary probiotics may be an important potential adjunct to the gluten-free diet, which remains to be the cornerstone treatment of celiac disease. 7,8
  • In addition to probiotics, other promising treatment options of dysbiosis include narrow spectrum antibiotics, dietary interventions and fecal transplantation. 9

TAKE HOME MESSAGES:

  • The utility of probiotics and prebiotics in restoring a healthy microbiome profile and improving dysbiosis are areas of avid research that target a deeper understanding of what triggers celiac disease and what could be potential future treatment options. 1
  • Dietary supplements of specific probiotic strains could be a valuable adjunct in treating celiac disease.
  • Despite their promising proposed role in alleviating celiac disease, all probiotic foods and supplements should be gluten-free.

References:

  1. Sanz Y. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult humans. Gut Microbes. 2010 May-Jun;1(3):135-7.
  2. 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
  3. Collado MC, Donat E, Ribes-Koninckx C, Calabuig M, Sanz Y. Specific duodenal and faecal bacterial groups associated with paediatric coeliac disease. J Clin Pathol. 2009 Mar;62(3):264-9.
  4. Cotter PD. Small intestine and microbiota. Curr Opin Gastroenterol. 2011 Mar;27(2):99-105.
  5. Ivanov II, Honda K. Intestinal commensal microbes as immune modulators. Cell Host Microbe. 2012 Oct 18;12(4):496-508.
  6. Noland D, Pugh GF. Balancing Your Gut: Functional Medicine in Celiac Disease. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffler D. AGA Press, Bethesda, MD. 2010.
  7. Food Microbiol. 2007 Apr;24(2):187-96. Sourdough lactobacilli and celiac disease. Gobbetti M, Giuseppe Rizzello C, Di Cagno R, De Angelis M.
  8. Hall EH, Crowe SE. Environmental and lifestyle influences on disorders of the large and small intestine: implications for treatment. Dig Dis. 2011;29(2):249-54.
  9. Walker AW, Lawley TD. Therapeutic modulation of intestinal dysbiosis. Pharmacol Res. 2013 Mar;69(1):75-86.

Revision Date: 5-16-13 
Authors: Christine Doherty, N.D. 
Editors: Melinda Dennis, MS, RD, LDN, Toufic Kabbani MD, MPH

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