New Protocol for Production of Reduced-Gluten Wheat Bread and Pasta and Clinical Effect in Patients with Irritable Bowel Syndrome: A randomised, Double-Blind, Cross-Over Study

Maria Calasso, Ruggiero Francavilla, Fernanda Cristofori, Maria De Angelis, Marco Gobbetti, Maria Calasso, Ruggiero Francavilla, Fernanda Cristofori, Maria De Angelis, Marco Gobbetti

Abstract

It has been suggested that sourdough fermented products have beneficial health effects. Fungal proteases and selected sourdough lactic acid bacteria were used to produce wheat bread and pasta with a reduced-gluten content (<50% of traditional products). Fermentable oligo-, di- and mono- saccharides and polyols and amylase/trypsin inhibitors were also evaluated. The sensorial features of new products were similar to traditional ones. The efficacy of these new products in reducing the severity of symptoms in Irritable Bowel Syndrome (IBS) patients were compared to traditional bread and pasta using a randomized, crossover-controlled trial. While on a strict gluten-free diet, patients were randomized to consume a reduced- or normal-gluten diet for 2weeks; then, patients from both arms started the wash-out period of one week, and subsequently started the final 2-week period on a normal or reduced-gluten diet. Compared to normal-gluten content, the administration of a reduced-gluten content diet resulted in a decrease of the Visual Analogue Scale score (p = 0.042), while no differences were found in the IBS-Severity Score, Hospital Anxiety and Depression Scale, and IBS-Quality of Life. Data herein reported are novel encouraging findings that should spur a new avenue of research aiming to develop products specifically designed for IBS patients.

Keywords: diet; gluten; irritable bowel syndrome; lactic acid bacteria; pasta; wheat bread.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results”.

Figures

Figure 1
Figure 1
Crossover design of the study and the timing of clinical evaluations. IBS-SS, Irritable Bowel Syndrome Severity Score; VAS, Visual Analogue Scale; HADS, Hospital Anxiety and Depression Scale; QoL, Quality of Life.
Figure 2
Figure 2
Sensory analysis of bread (A) and pasta (B) made with normal (NG) or reduced content of gluten (RG) flours. Reduced-gluten wheat flour was fermented with fungal proteases and selected lactobacilli at 30 °C for 8 h. Data are the means of three independent analyses.
Figure 3
Figure 3
Flow diagram of patients into the trial from eligibility to the end of gluten challenge.
Figure 4
Figure 4
Permutation analysis based on clinical scores. Euclidean distance and McQuitty’s criterion were used for clustering. Cases (patients) were numbered from P1 to P20. Variables were reported as abbreviation of clinical scores (IBS-SS, Irritable Bowel Syndrome Severity Score; VAS, Visual Analogue Scale; HADS, Hospital Anxiety and Depression Scale; QoL, Quality of Life) plus the type of diet (HD, Habitual Diet; GFD, Run-in Open gluten-free diet; RGD, Reduced-gluten diet; NGD, Normal-gluten diet). Colours correspond to normalized mean data levels from low (green) to high (red).

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