Abstract
Many patients suspect wheat as being a major trigger of their irritable bowel syndrome (IBS) symptoms. Our aim was to evaluate whether sourdough wheat bread baked without baking improvers and using a long dough fermentation time (>12 h), would result in lower quantities of alpha-amylase/trypsin inhibitors (ATIs) and Fermentable, Oligo-, Di-, Mono-saccharides and Polyols (FODMAPs), and would be better tolerated than yeast-fermented wheat bread for subjects with IBS who have a poor subjective tolerance to wheat. The study was conducted as a randomised double-blind controlled 7-day study (n = 26). Tetrameric ATI structures were unravelled in both breads vs. baking flour, but the overall reduction in ATIs to their monomeric form was higher in the sourdough bread group. Sourdough bread was also lower in FODMAPs. However, no significant differences in gastrointestinal symptoms and markers of low-grade inflammation were found between the study breads. There were significantly more feelings of tiredness, joint symptoms, and decreased alertness when the participants ate the sourdough bread (p ≤ 0.03), but these results should be interpreted with caution. Our novel finding was that sourdough baking reduces the quantities of both ATIs and FODMAPs found in wheat. Nonetheless, the sourdough bread was not tolerated better than the yeast-fermented bread.
Highlights
Functional gastrointestinal disorders (FGDs) are common, and irritable bowel syndrome (IBS)is one of the most typical forms, affecting 11% of the adult population in developed countries [1].IBS patients typically report intolerance to wheat, milk, onion, garlic, apples, alcohol, coffee, chili, and beans [2]
The present study aimed to evaluate whether a sourdough wheat bread could reduce the symptoms of subjective wheat sensitivity and low-grade inflammation in IBS patients when compared to regular toast bread, baked with added gluten, larger amounts of baker’s yeast, and baking additives
26 subjects with IBS were recruited into the study and none withdrew during its duration
Summary
IBS patients typically report intolerance to wheat, milk, onion, garlic, apples, alcohol, coffee, chili, and beans [2]. Non-coeliac gluten sensitivity, known as wheat sensitivity, has attracted attention, both in the popular media and scientific literature [3,4,5,6]. Gluten per se has been long postulated to cause symptoms in some IBS patients, 86% of patients with subjective wheat tolerance do not seem to respond to gluten pills in masked conditions [7], leaving the role of gluten unclear. A randomised 7-day study concluded that gluten, in low or high doses, did not worsen symptoms of IBS when compared to a whey protein-based placebo in low-FODMAP diet conditions [8].
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