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Feb 276 min read

Probiotics as an Aid in the Control of Gluten Intolerance

Every 1 in 600 Brazilians has celiacs. The same association raises concerns about the number of individuals affected by this intolerance, which is thought to be much higher. Many go undiagnosed due to a lack of access to appropriate services, or because they do not seek healthcare systems. Probiotics are live microorganisms that contribute to the balance of the intestinal microbiota (a population of microorganisms with the function of maintaining the integrity of the intestinal mucosa and preventing the proliferation of pathogenic bacteria). They tolerate acids and bile salts and survive the passage through the stomach and small intestine to reach the large intestine. For the intestinal microbiota to protect the intestinal mucosa, a combination of probiotics, prebiotics, and symbiotics is needed, with prebiotics being non-digestible microorganisms that stimulate the growth of desirable bacteria and symbiotics being the combination of probiotics with prebiotics. Having a healthy intestinal mucosa facilitates nutrient absorption, which is important for those who are gluten intolerant because celiac disease damages the walls of the small intestine, causing inflammation, and is also characterized by poor nutrient absorption. Is there a relationship between reducing gluten intolerance and the use of probiotics? 


This research is justified by the fact that intolerance is highly prevalent, treatment is long-term and can be costly, and the association with probiotics, if positive, can facilitate treatment and access to it. Since many products are associated with probiotics, their consumption may be more common and easier. Similarly, not using allopathic medications can reduce the problem of side effects. The overall objective of this article is to examine the literature for the relationship between the use of probiotics and improvement in gluten intolerance. It also aims to provide information about the benefits of using probiotics, since it is believed that the use of certain probiotics can reduce the harmful effects that are common to celiacs.


Probiotics

Probiotics are non-pathogenic bacteria that, when ingested in appropriate quantities, are beneficial to health. There is no limit to the consumption of probiotics; however, if consumed excessively, they can cause nausea, constipation, and abdominal cramps. For adults, the recommended dose is 5 billion colony-forming units (CFUs) per day for five days. To be considered a probiotic, the microorganism must meet certain criteria, such as being safe for both dietary and clinical use, the ability to survive the intestinal transit, the capacity to adhere to mucous surfaces, and the ability to antagonize pathogenic bacteria, as well as having clinically documented and validated health effects. They are generally used to control intestinal microbiota, strengthen the functional intestinal barrier, and regulate the immune system. Foods like natural yogurt, kombucha (a fermented tea drink), kimchi (a typical Korean dish made from vegetables), and kefir are rich in probiotics. They help maintain a healthy intestinal flora, prevent and treat diseases, improve vitamin absorption, and reduce the growth of pathogenic bacteria in our microbiome. According to GANEDEN, a company that develops probiotic-based products, Latin America is the largest consumer of probiotics in the world, with 52% of consumers located in Brazil.


In addition to probiotics, there are also prebiotics. This term was coined by Gibson and Roberfroid to refer to "non-digestible nutritional ingredients that beneficially affect the host by selectively stimulating the growth and activity of one or more beneficial bacteria in the colon, improving the host's health." Prebiotics can be found in foods such as beans, bananas, tomatoes, garlic, and onions. There are also synbiotics that, together with prebiotics and probiotics, act on the intestinal microbiota. Synbiotics promote the increase of intestinal bifidobacteria, control blood sugar levels, and reduce cholesterol levels. When they work together, they stimulate immunity, build resistance to pathogens, and increase the absorption of minerals and vitamins.



Celiac disease 

Celiac disease is an autoimmune disorder characterized by the inability or difficulty in ingesting gluten, which is found in cereals such as wheat, barley, malt, and rye. The exact number of people affected by this disease is unknown, often due to a lack of information or difficulty accessing the healthcare system. According to the National Federation of Celiac Associations in Brazil (Fenacelbra), it is estimated that there are two million celiacs in Brazil alone. Gluten intolerance can have genetic, immunological, or environmental causes, with the main symptoms including diarrhea, heartburn, abdominal pain, nausea, and cramps. To diagnose this disease, blood tests and an intestinal biopsy are required to examine the intestinal mucosa and inflammation. 


There is no cure for gluten intolerance, and there are no medications to alleviate the condition. The only available option is a gluten-free diet, which involves avoiding foods containing gluten and taking precautions to prevent cross-contamination with other foods. However, this diet is extremely challenging and costly, leading many people to give up on it. According to Nature Reviews, individuals with celiac disease are more likely to develop autoimmune diseases such as diabetes and Hashimoto's thyroiditis than those without it. This is because in individuals with celiac disease, the body sees gluten as harmful, leading to inflammation of the villi in the intestines. As a consequence, the body stops absorbing essential vitamins and minerals. In addition to physical problems, celiac disease can also cause psychological issues, according to research conducted by the University Hospital of Brasília. This includes difficulties in socializing after starting the treatment (diet) and the significant challenge of coping with a gluten-free diet.


Benefits of Probiotics for  Intolerant Individuals

Allergy occurs when the body reacts to specific proteins in a food as invaders and sends defense cells to fight them. Symptoms after ingestion may include swelling of the lips, itching, cough, diarrhea, glottic edema, and difficulty breathing. On the other hand, food intolerance is caused by a deficiency of an enzyme that would process a certain nutrient, and it can take hours or even days to manifest. Symptoms typically occur in the digestive system, leading to abdominal pain, gas, and nausea, as seen in gluten intolerance.

In addition to a gluten-free diet, other methods for treating celiac disease are being researched, including the use of probiotics. Studies reveal a significant difference in the quantity of bifidobacteria (anaerobic bacteria that act as beneficial probiotics for human health) between the intestinal microbiota of a healthy individual and that of a celiac individual. These bacteria have beneficial functions in humans, such as vitamin production, immune system stimulation, inhibition of potentially pathogenic bacteria, and the maintenance of intestinal microbiota.


Intestinal microbiota is a set of commensal microorganisms that have evolved harmoniously with their host, improving the host's health. These microorganisms involved in the development of the immune system and the regulation of the response to pathogens are essential for establishing and maintaining immune tolerance in the mucosa. The composition of intestinal microbiota is involved in various physiological processes, as well as metabolic functions of the body, such as the production of vitamins and other substrates. Butyric acid and butyrate, found in the colon lumen after digestion, regulate the differentiation of intestinal mucosa cells and induce apoptosis to control inflammation and prevent cancer development. According to a study conducted by PUC Goiás, after the supplementation of a mix of probiotic strains in celiacs, the microbiota of these individuals became similar to that of healthy individuals. This supplementation increased fecal bifidobacteria and reduced the symptoms of the disease. In agreement with another study, it was found that after daily consumption of yogurt with probiotics, both healthy and gluten-intolerant groups had a significant increase in bifidobacteria. However, a study conducted on celiacs in the Australia and New Zealand Clinical Trials Registry revealed that after a 12-week period of taking oral probiotic formula, there were no significant effects on the microbiota of intolerant individuals. In line with this, another study conducted by the Federal University of Santa Catarina reported that, according to their research, probiotics significantly increased bifidobacteria in the feces of celiacs but were not sufficient to reach the concentration of a healthy individual.


Results

The number of gluten-intolerant individuals is likely much higher than currently recognized. Likewise, many people experience various unpleasant symptoms without realizing they may be related to intolerance. Therefore, a more detailed analysis by specialists becomes necessary. When the diagnosis is positive for gluten intolerance, there are few options available to affected individuals. Typically, gluten removal from the diet is the most recommended approach. However, this is not easy for those with intolerance, as many everyday foods contain gluten. An alternative considered more natural and often overlooked is the use of products that improve intolerance. In this case, the use of probiotics has proven to be quite effective, as demonstrated by the researched scientific articles.


A portion of the population lacks the adequate information that probiotics are readily available and low-cost. However, specific knowledge and guidance are necessary for administering these probiotics, which are known to have a significantly positive effect associated with improving celiac disease. It is essential for public health organizations and major laboratories to invest more in research in the field of medicine and pharmacology.

What can be observed from the research is that the improvement in gluten intolerance is noticeable in individuals who use probiotics indefinitely. This suggests that probiotics can be a valuable tool in managing gluten intolerance, offering potential relief for those affected by this condition. Further research and increased awareness of these findings can contribute to better treatments and improved quality of life for individuals with gluten intolerance.


 


Ana Sofia is a fifteen year old girl living in Brazil who has a strong affection for her family, music, and science. During her leisure moments, she enjoys listening to BTS, playing with her little brother, talking to her parents and doing research.

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