Reduced {FODMAPS} in gluten-free grains may explain the improved symptoms in people with {IBS} following a gluten-free diet

摘要

Background/Aims: Individuals with IBS blame gluten-containing grains fortriggering gastrointestinal symptoms. Another component of grains thatrequires consideration is the FODMAPs mostly fructans and galacto-oligsaccharides(GOS).We aim to analyse the gluten and FODMAP content of 22 grain-flours (Study 1) and using two gluten-containing grains, with varyingFODMAP content, compare effects on breath hydrogen and symptomresponse in healthy volunteers and individuals with IBS (Study 2).Methods: In Study 1, 22 common grains (nine gluten-containing and 13gluten-free) were analysed using well-established techniques for totalFODMAPs and gluten (gliadin and glutenin). In Study 2, 19 subjects (ninehealthy and 10 with IBS) undertook a single-blind, crossover interventiontrial that involved consuming a low FODMAP diet supplemented withgluten-containing low FODMAP WestonLite (PBR) spelt bread (LFS) orgluten-containing high FODMAP rye bread (HFR) for 2 days. Gastrointestinalsymptom diaries were kept and on day 2 of each diet breath hydrogensamples (marker of colonic fermentation) were collected hourly over 14 h.Results: Gluten-free grains were lower in fructans/GOS than gluten-containinggrains. Human volunteers produced more (78.6 ± 10.3 ppm$12hr) breathhydrogen over the day (p < 0.001), following consumption of the HFR,compared totheLFS (32.3±6.0ppm$12hr). Greater gastrointestinal symptomswere recorded (p?0.0156) for people with IBS after consuming the HFR bread.Conclusions: Fructan/GOS and not the gluten component of grains may beresponsible for triggering gastrointestinal symptoms in IBS. These resultsoffer a possible explanation underlying the improved symptoms reportedwith a gluten-free diet.