Carbohydrate malabsorption and non-celiac gluten/wheat Sensitivity: The role of probiotic biomodulation

In recent years, cases of food hypersensitivity reactions in the Western population have significantly increased, with over 50% of patients with functional gastrointestinal disorders (FGID) believing that food triggers their symptoms. The main culprits include FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) and specific protein components of wheat, such as gluten and amylase/trypsin inhibitors (ATIs). Gastrointestinal symptoms related to carbohydrate malabsorption stem from two primary mechanisms. First, unabsorbed carbohydrates can feed certain gut bacteria, leading to fermentative dysbiosis and gas production, which causes bloating and abdominal distension. Second, a diet rich in unabsorbed sugars draws water into the intestinal lumen, accelerating transit and resulting in diarrhea. Adverse reactions to gluten include celiac disease, wheat allergy, and non-celiac gluten/wheat sensitivity (NCGS/WS). The latter triggers both intestinal and extra-intestinal symptoms, which improve upon gluten withdrawal. Recent studies suggest that, in addition to gluten, other wheat components, such as ATIs and FODMAPs, can contribute to symptom exacerbation. NCGS/WS is associated with intestinal dysbiosis and immune alterations. Although a gluten-free diet is currently considered the only available therapeutic strategy, it may negatively impact gut microbiota and the bioavailability of minerals and vitamins. Recent research suggests the use of strain-specific probiotics to improve fermentative dysbiosis, reducing gas-producing species and enhancing the digestion and absorption of carbohydrates, gluten proteins, and micronutrients. In conclusion, an integrated approach combining a low-FODMAP diet (LFD) with specific probiotics could be an effective strategy for managing carbohydrate malabsorption symptoms in FGID, restoring intestinal homeostasis, and counteracting associated microbial hyperfermentation.