Two randomized crossover multicenter studies investigating gastrointestinal symptoms after bread consumption in individuals with noncoeliac wheat sensitivity: do wheat species and fermentation type matter?

A - Papers appearing in refereed journals

De Graaf, M. C. G., Timmers, E., Bonekamp, B., Van Rooy, G., Witteman, B. J. M., Shewry, P. R., America, T., Keszthelyi, D., Brouns, F. J. P. H. and Jonkers, D. M. A. E. 2024. Two randomized crossover multicenter studies investigating gastrointestinal symptoms after bread consumption in individuals with noncoeliac wheat sensitivity: do wheat species and fermentation type matter? The American Journal of Clinical Nutrition. 119 (4), pp. 896-907. https://doi.org/10.1016/j.ajcnut.2024.02.008

AuthorsDe Graaf, M. C. G., Timmers, E., Bonekamp, B., Van Rooy, G., Witteman, B. J. M., Shewry, P. R., America, T., Keszthelyi, D., Brouns, F. J. P. H. and Jonkers, D. M. A. E.
Abstract

Background: Many individuals reduce their bread intake due to the belief that wheat is the cause of their gastrointestinal (GI) symptoms. Different grains and processing methods may impact tolerability.

Objective: We investigated the effects of six different types of bread on GI symptoms in individuals with self-reported non-coeliac wheat sensitivity (NCWS).

Methods: Two parallel randomised double-blind crossover multicentre studies were conducted. NCWS individuals, in whom coeliac disease and wheat allergy were ruled out, received five slices of (study A, n=20) yeast fermented (YF) or (study B, n=20) sourdough fermented (SF) bread made of bread wheat, spelt or emmer on three separate intervention days. Each test day was preceded by a run-in period of 3 days and separated by a wash-out period of at least 7 days. GI symptoms were evaluated by change in symptom score (test day minus average of the 3-day run-in period) on a 0-100mm visual analogue scale (delta VAS). Responders were defined as an increase in delta VAS of at least 15mm for overall GI symptoms, abdominal discomfort, abdominal pain, bloating and/or flatulence.
Results: The overall change in GI symptoms did not differ between breads of different grains (YF p=0.267; SF p=0.144). The number of responders was also comparable for both YF (6 to wheat, 5 to spelt, and 7 to emmer, p=0.761) and SF breads (9 to wheat, 7 to spelt, and 8 to emmer, p=0.761).

Conclusion: The majority of NCWS individuals experienced GI symptoms for at least one of the breads, but on a group level, no differences were found between different grain types for either YF or SF breads.

Clinical Trial Registry: ClinicalTrials.gov, NCT04084470

KeywordsNon-coeliac wheat sensitivity; Gastrointestinal symptoms; Wheat; Spelt; Emmer; Yeast fermented bread; Sourdough fermented bread; Delta VAS
Year of Publication2024
JournalThe American Journal of Clinical Nutrition
Journal citation119 (4), pp. 896-907
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ajcnut.2024.02.008
Open accessPublished as ‘gold’ (paid) open access
FunderBiotechnology and Biological Sciences Research Council
Funder project or codeWell on wheat
Publisher's version
Accepted author manuscript
Output statusPublished
Publication dates
Online18 Feb 2024
Publication process dates
Accepted16 Feb 2024
PublisherAmerican Society for Nutrition

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