Periodic gluten exposure does not significantly affect the gut microbiome in people with celiac disease (CeD) and non-celiac gluten sensitivity (NCGS) who are on a gluten-free diet, a recent study found. The study was conducted because “the wide diversity of symptoms with gluten exposure remains a mystery; some people with celiac disease get severely ill when exposed to gluten, others have no symptoms, and most fall somewhere in between these poles,” explained Ben Lebwohl, MD, Director of Clinical Research, Celiac Disease Center at Columbia University, Celiac Disease Foundation Young Investigator Awardee, and one of the study authors. “We wanted to see if differences in the effect of gluten on the gut microbiome can account for the different symptoms people experience.”

The researchers investigated the impact of gluten exposure, in the form of a 14-day gluten challenge, on the gut microbiome in patients with CeD and NCGS and found that the makeup of the microbiome at baseline (start of the study) looked different between participants with celiac disease, non-celiac gluten sensitivity, and controls. However, the gluten challenge did not cause meaningful changes in microbiome in the CeD and NCGS cohorts. “For adults with celiac disease or non-celiac gluten sensitivity on a well-established gluten free diet, temporary gluten exposure does not have a big impact on the makeup of the gut microbiome,” says lead author, Yael Nobel, MD. Likewise, Dr. Lebwohl explains that the wide variety of symptoms among the participants did not impact the microbiome. “In fact, the populations of colonic bacteria remained fairly stable during this 2-week gluten challenge,” he says. “So it appears that while the microbiome remains a subject of intense interest and promise, it does not appear to account for the diverse symptom experience in people with celiac disease.” Furthermore, for adults with celiac disease and non-celiac gluten sensitivity, the microbes in your gut do not influence how sensitive you are to gluten, so developing drugs to target intestinal villi damage upon gluten ingestion instead of the gut microbiome may be more beneficial.

The size of this study was small, and larger studies are necessary to confirm these findings, but Dr. Nobel explains these preliminary results show that “while it is highly likely that the gut microbiome contributes to the development of celiac disease in infancy or childhood, our findings suggest that the gut microbiome may not play a big role in disease course later on, in adulthood.”

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