How to Choose the Best Probiotic for Celiac Disease

Why Probiotics Are Key for Gluten-Intolerant People

• The Best Probiotic for Celiac Disease|
• Symptoms of Celiac Disease and NCGS|
• Probiotics for Celiac and NCGS|
• The Bottom Line|

If you have celiac disease or a non-celiac gluten sensitivity, and your symptoms haven’t improved with a gluten-free diet, you may benefit from taking probiotics. Probiotics have been shown to significantly improve the effectiveness of a gluten-free diet and reduce stubborn digestive symptoms of celiac disease. 

So what’s the best probiotic for celiac disease? How do you know if you should take one? In this article, we’ll outline probiotic safety for those with a gluten allergy or sensitivity, how they can improve gastrointestinal symptoms (and other symptoms), and the research that supports our recommendations.

What’s the Best Probiotic for Celiac Disease?

There’s no data to suggest that one probiotic strain or species is better than another for helping to treat celiac symptoms. Rather, there’s quite a bit of research that shows that probiotics (in seemingly any combination of different strains and species) are generally helpful when combined with a gluten-free diet. That’s because they all improve microbiota composition, something all gastroenterology patients could probably benefit from.

Probiotics are made up of specific strains of good bacteria and/or beneficial fungal strains. By nature, they are gluten-free dietary supplements. The capsules that contain them are usually either made out of vegetable cellulose or gelatin, which are also naturally gluten-free. So, in essence, you’re going to end up with a gluten-free probiotic no matter which one you choose. And they’re all considered safe for celiac patients and those with non-celiac gluten sensitivity (NCGS). 

The only potential exposure would be in trace amounts if your probiotic was manufactured in a place that also manufactured something with gluten. In this case, an average probiotic dosage likely wouldn’t upset even the most sensitive celiac patient on a strict gluten-free diet. 

Celiac patients typically experience symptoms when they eat more than 10 mg of gluten in a day, and the FDA and other health authorities deem something gluten-free if the product contains less than 20 parts per million of gluten. So, these potential trace amounts are considered safe 1 2.

In the case of severe gut imbalances, especially all health issues involving leaky gut (intestinal permeability), which can cause food sensitivities and reactions like NCGS, our clinic recommends the triple therapy probiotic approach. It includes probiotics from all three categories:

1. Lactobacillus bacteria and Bifidobacterium
2. Saccharomyces boulardii (a type of beneficial fungus)
3. Soil-based probiotics

We see tremendous improvements in digestive health across a number of health conditions with the simultaneous use of probiotics from these three categories. It’s worth considering this approach if you’re still experiencing symptoms while on a strict gluten-free diet.

Symptoms of Celiac Disease and NCGS

While both types of gluten intolerance can be painful and lead to an inflammatory response, celiac disease is an autoimmune disorder and can lead to complications. When celiac disease goes unchecked, it can cause malabsorption of nutrients, which can be dangerous to long-term health 3. NCGS is generally less severe than celiac disease, but the gastrointestinal and other symptoms overlap. The most common symptoms of any sort of gluten intolerance include:

• Abdominal swelling/bloating
• Gas
• Nausea
• Diarrhea
• Constipation
• Incomplete bowel movements
• Poor stool consistency
• Urgency when a movement arises
• Non-GI symptoms like:
  • Muscle pain
  • Brain fog
  • Fatigue
  • Depression
  • Anxiety
  • Weakness
  • Rashes
  • General inflammation

While celiac disease is an autoimmune condition — your body reacts to gluten as an invader and launches an inflammatory immune response in your digestive tract — NCGS is a less understood condition. We know that, despite the absence of an allergic response, gluten can irritate the digestive lining in NCGS patients. This can lead to the development of a leaky gut, which activates the immune system (and possibly anti-gliadin antibodies), causing both gut and systemic inflammation that further reacts to gluten 4.

We also know that many foods that contain gluten (like wheat) also contain fructan (the “F” in FODMAP), a type of fiber that can be difficult for some to digest. Fructan then ferments in the intestine, irritating and feeding bad, gas-producing bacteria. In this case, gluten isn’t actually the main problem 5. Much like in celiac disease, the continued ingestion of gluten can cause long-term damage to your digestive system due to the inflammation it creates. 

Probiotics Improve Symptoms of Celiac Disease and NCGS

Probiotics can help improve the response to a gluten-free diet for both celiac and NCGS patients. 

It’s well-established among health care professionals (whether conventional or functional) that a gluten-free diet is the first line of defense for gluten intolerance. Removing the allergen or irritant can give your body a chance to reset and turn off the inflammatory cascade that leads to so many unpleasant symptoms. It can also give beneficial gut bacteria a chance to reestablish themselves in your large intestine and begin making more healthy and protective microbes 6.

But for many patients with celiac disease or NCGS, a gluten-free diet is not enough. Symptoms may improve only minimally or not at all. In fact, up to 30% of celiac patients experience persistent digestive symptoms in spite of following a strict gluten-free diet 7.

In these cases, there may be another underlying gut issue that can be remedied with the use of probiotics. Digestive conditions that have been shown to be common among those with celiac disease include SIBO, FODMAP intolerance, histamine intolerance, IBS, and lactose intolerance (all of which have been clearly shown to benefit from probiotic supplementation) 7 8 9.

Taking a probiotic essentially compounds the progress a celiac disease patient (or NCGS patient) makes by cutting gluten. That’s because it adds even more beneficial bacteria, which can help reduce inflammation and improve digestion and nutrient absorption.

• A 2020 systematic review and meta-analysis of six randomized controlled trials involving more than 5,000 participants with celiac disease showed that probiotics improved GI symptoms by an average of around 29% 10.
• A systematic review of randomized control trials looking at children with celiac showed that probiotics combined with a gluten-free diet reduced inflammation (inflammatory cytokines) and changed their gut microbiota to resemble those of healthy kids 11.
• Another trial involving adult celiac disease patients showed a reduction in IBS-like symptoms by as much as 20% after six weeks of a gluten-free diet with probiotic use 12.
• In a non-randomized clinical trial involving NCGS patients, symptoms like bloating, gas, diarrhea, abdominal pain, stool consistency, and constipation were all reduced with a gluten-free diet combined with probiotics. Everyone who went gluten-free (even those given a placebo instead of a probiotic) reported improvement in non-GI symptoms like brain fog, headache, fatigue, anxiety, and rashes. But those who took the probiotics (and started out with more severe symptoms) showed greater improvement in these areas than the placebo group 13.

Evidence also shows that probiotics can help reduce a pro-inflammatory marker called tumor necrosis factor-alpha (TNF-ɑ) in kids with celiac disease, but only while actively taking them daily. TNF-ɑ returned to normal three months after the probiotics were stopped 14.

Gut Microbiome Biodiversity in Gluten-Intolerant Patients

That might seem like a lot of big words, but to simplify, we know that a wide array of beneficial microorganisms in your large intestine is good for your gut health. The better your gut health, the better your overall health. So supporting that diversity through diet and supplementation is a good idea. But these bacteria belong in the large intestine, and they don’t belong in the small intestine. 

Several studies have shown that patients with celiac disease have too much diversity and quantity of bacteria in their small intestine — SIBO (small intestinal bacterial overgrowth) 6 15 16 17 18. Because these bacteria are living where they don’t belong, they’re disrupting a healthy digestive process and causing a lot of the symptoms you see in celiac patients. 

It might seem counterintuitive to then add more bacteria by taking a probiotic supplement, but that is exactly what we recommend doing. That’s because probiotics can kill the unwanted bacterial overgrowth and help restore balance to your gastrointestinal tract. 

Several high-quality studies clearly show that probiotics are an effective treatment for SIBO, including a meta-analysis of 18 clinical trials. These show that probiotics reduce bacterial overgrowth and hydrogen concentrations (the gas the bacteria give off) and improve symptoms, including abdominal pain 19.

Another comparative study looked at how probiotics performed compared to Metronidazole, an antibiotic used in treatment. The probiotics were more effective 20.

The Bottom Line

The best probiotics for celiac disease include an array of species and strains and ideally cover all three probiotic categories. All probiotics are gluten-free. Taking them every day is more important than choosing any specific strain or species. 

Whether you have an autoimmune disease like celiac or a non-celiac gluten sensitivity, going gluten-free and adding a probiotic has been shown to help reduce symptoms and inflammation, increase biodiversity in the microbiome, and improve overall health. 

If you’re having trouble with your diet or finding that you have persistent symptoms, reach out to our clinic. We’d love to help you.