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One of the most common questions I get is “do I need to take probiotics for celiac disease?” followed by “what gluten-free probiotics do you recommend”.
Here’s the thing about celiac disease and probiotics, it’s not as simple as just finding a gluten-free probiotic and taking it daily to heal your gut. A lot of things factor into taking probiotics with celiac disease. So let’s dive into what probiotics are, how they can support gut health, and when to take them.
Written by Sierra King and reviewed/edited by Tayler Silfverduk
Before we talk about probiotics and celiac disease, we first need to understand the bigger picture. Probiotics are just a small part of what is called the microbiome.
The microbiome, also known as gut bacteria or gut flora, is made up of fungi, protozoa, viruses, and bacteria. These microbes live in and around the human body. The majority of the microbes are located in your small and large intestines. The microbiome is so important that it is also known as the supporting organ and without it we would all struggle to survive.
Now that we know what the microbiome is, we need to understand its role in gut health and how that factors into taking probiotics with celiac disease.
The microbiome is developed from birth. As you age, and as your diet becomes more diverse, the more your gut bacteria in your microbiome become diverse. And the more diverse your gut microbiome is, often the healthier your gut!
The microbiome can help digest breast milk and fiber, communicate with your immune cells to help you fight infections, and talks to your vagus nerve to support brain function. In addition, the microbiome is able to produce essential nutrients like vitamin K.
Now that we know about what the Microbiome is and how probiotics are a small piece of it, we can talk about how celiac impacts the microbiome. By understanding how celiac impacts the microbiome, we can understand where probiotics fit in the puzzle.
Celiac disease impacts the intestinal barrier. In other words, untreated celiac can cause leaky gut (increased intestinal permeability) due to villi damage done by gluten.
This directly impacts the health of the gut, including the healthy microbes present. This leads to an increased prevalence of SIBO or small intestinal bacterial overgrowth in celiacs. And while some studies note that probiotics may help with symptoms of SIBO, other studies indicate they may worsen them.
Some research indicates that the state of your microbiome may even trigger celiac. However, we are unable to identify a map of what a microbiome altered by celiac truly looks like to take these findings any further than an acknowledgment that the bacteria in your gut may play a role in celiac development.
Furthermore, research has even suggested that celiac symptoms may be impacted by the state of the microbiome. Again, more research is needed before we can say more.
Ultimately, there is no denying that the microbiome plays a role in celiac disease. And probiotics may play a complementary role in supporting the microbiome with celiac. However, what role and how probiotics should be used should be determined on a case-by-case basis with a celiac specialized health care team.
Maintaining a healthy microbiome with celiac disease goes beyond just taking probiotics. In fact, probiotics are just a small part of the gut health equation.
Things like a balanced celiac diet, fermented food, routine enjoyable physical activity, getting enough sleep, managing stress, and more can help support a healthy gut.
Prebiotics are food for your gut bacteria to keep it healthy so it can keep you healthy. It’s usually found in foods that have a lot of fiber. Thus, eating enough fiber on a gluten-free diet is essential to getting enough prebiotics to support your gut. Some examples of prebiotic foods include onions, bananas, whole oats, apples, spinach, blueberries, and asparagus.
Note: for some, prebiotics can be a trigger for other GI distress depending on your individual situation. This is why including a celiac registered dietitian into your gut healing journey is imperative as they will be able to help you figure the best route towards gut health possible for your unique needs.
Eating probiotics with celiac is another way to support your microbiome. Probiotics are living yeast or bacteria that live in your body to help with the digestive system. They may be helpful with digestion, decreasing depression, and supporting heart health. Some examples of gluten-free food sources of probiotics include yogurt with active or live cultures, kefir, raw kimchi, kombucha, and raw pickles.
Another important thing to note about probiotics and celiac are the benefits of the waste of probiotics. Yeah… basically the “poop” of the bacteria in your gut. Otherwise known as postbiotics, the waste of the probiotics when they are fed is also good for you.
Postbiotics support the immune system by reducing the risk of diarrhea and decrease the symptoms connected to IBS and certain kinds of allergies. Gluten-free food sources of postbiotics include yogurt, sauerkraut, bread, buttermilk, and tempeh.
Additionally, you can support your microbiome with celiac by moving your body enjoyably every day, getting enough sleep, and eating a balanced gluten-free diet.
When it comes to movement, studies have suggested that a person increasing their exercise can increase the number of good microbes in the gut. In fact, with every session of exercise, you could change your microbiome for the better.
Getting enough sleep can also impact your microbiome with celiac. In fact, the status of the microbiome is positively correlated with the amount of sleep a person gets and what time in bed. Meaning, the diversity in the gut microbiome may support better rest.
Lastly, maintain a healthy gut microbiome by eating a balanced diet. Not only does a balanced diet potentially support better sleep which we know can support the microbiome, but eating a balanced diet is the best thing to do for your inner gastrointestinal ecosystem.
A generally balanced celiac diet typically includes a good mix of gluten-free whole grains, fruits, vegetables, nuts, seeds, and maybe some fermented foods here and there.
While not an all-encompassing list, eating prebiotic, probiotic, and postbiotic-rich foods via a balanced gluten-free diet is a great way to support a celiac microbiome. Getting enough sleep, reducing stress, drinking enough water, and engaging in routine exercise can also be beneficial.
Ultimately, there is no one-size fits all when it comes to microbiome health. It depends largely on the individual and their unique circumstances.
Now that we understand what role probiotics play in our body’s microbiome, we can talk more specifically about them and how probiotics impact celiac disease.
As mentioned previously, probiotics are the “good” living bacteria or yeast that are found naturally in your body. By good, I mean they aren’t causing the infection but instead are helping keep a balanced microbiome. They do this by preventing overgrowth, supporting digestion, and your overall health.
Perhaps the most important thing to note with probiotics is that there is no one size fits all approach for probiotics, in general, and especially when it comes to celiac disease.
In the past, we’ve believed the probiotics at worst have no effect and best provide some benefits. However, current research on probiotics is showing that we may need to think harder before taking them.
Current research on probiotics tells us a cautionary tale. From probiotics not colonizing the gut, to probiotics delaying recolonization after antibiotic treatments, there are many studies out there suggesting we might want to be more conservative about taking probiotics.
That being said, kicking this probiotic research off on a positive note, a 2020 study found that probiotics may improve GI symptoms of people with celiac. But before your run out a buy yourself some, there are some others things to consider.
In a 2018 study on probiotic colonization of the gut, only 6 out of 15 participants were successful in colonizing their gut with probiotics. The rest of the participants did not see the probiotics taken colonize in their gut, even though the probiotic bacteria was found in their stool. This shows us that not all probiotics are created equal and not everyone is able to benefit from them.
In another study, 21 healthy volunteers took probiotics after treatment of broad-spectrum antibiotics and it resulted in a delay for the participant’s gut’s to return back to normal. Meaning, antibiotics may change when someone should take probiotics. In this case, taking probiotics with antibiotics delayed people’s guts from recovery.
A meta-analysis of research on probiotic strains and efficacy done in 2018 found that the efficacy of probiotics is largely dependent on the strain of the probiotics and the disease patients were struggling with. Meaning, it’s important you take and trial the right probiotics for the symptoms and disease you’re trying to use them for.
Probiotics have certain strains that could take the opportunity and harm the individual if the individual has a weak immunity or has an underlying condition. When people intake probiotics without guidance, it can increase the risk of antibiotic resistance to transfer to opportunistic microbes in the gut. Opportunistic bacteria in our microbiome are those that can provide benefits to our bodies but can cause problems if the opportunity arises for them to overgrow.
Basically, when taking a probiotic it is essential you are considering the the type, timing, and your individual health history.
Now that we have the recent research on probiotic supplements with celiac, let’s talk about about the benefits of probiotic supplements versus probiotic foods (or raw fermented foods).
The first thing to note about probiotic supplements versus fermented foods is that with the supplements, you know what specific strains and the doses you are getting.
However, with raw fermented foods, that is not always the case. This is something to keep in mind since we know strain and dose matter in order to get some of the benefits of probiotics.
Additionally, if a fermented food is pasteurized, which often happens in the case of yogurts, krauts, and other conventional ferments, then the live good bacteria is killed. However, this does not mean there are no benefits to the fermented food, you still have access to the postbiotics and the pre-digested nutrients for increased absorption.
This increased absorption is definitely a pro for fermented foods. In fact, fermented foods often have more bioavailable forms of essential vitamins like calcium, magnesium, B 12 and more. All of which can be common nutrient deficiencies in celiac.
All of this said, no research has concluded which is better. As a food-first advocate, a huge fan of fermented foods, and having operated my own fermented food business, I’m biased towards fermented foods.
However, I acknowledge this bias and know that probiotic supplements may be the better option for some if specific strains and doses of probiotics are needed. It all depends on the individual and what they are hoping to get from probiotics.
So we have the down-low on probiotics, but do they contain gluten? In other words, are probiotics safe for people with celiac? In a WebMD article on probiotics containing traces of gluten, Dr. Benjamin Lebwohl, an assistant professor of medicine and epidemiology at the Celiac Disease Center says that it is unlikely taking a probiotic will expose celiacs to unsafe levels of gluten. The article continues to state that “[m]ost probiotics are tested positive for gluten but have less than 20 parts per million”.
That being said, if you are going to take a probiotic supplement, I would make sure it has a gluten-free claim or certification. Really, best case scenario it would contain a gluten-free certification as the supplement industry is largely unregulated.
Also, when it comes to all supplements, you want to look for a NSF certification to make sure it’s 3rd party tested.
Whether celiacs should or shouldn’t take a probiotic is dependent on each celiac’s unique needs. Gut health is not a one-size-fits-all approach and that also applies to probiotics.
While we know there are many benefits, there is also reason to be conservative with recommending probiotic supplements given that strain, timing, delivery, and dose matter. Additionally, if you’re not feeling better after going gluten-free, something else may be going on that probiotics may worsen. In fact, the new 2023 American Journal of Gastroenterology guidelines for celiac state “There is insufficient evidence to recommend for or against the use of probiotics for the treatment of [celiac disease]”
Additionally, remember all we discussed that supports the microbiome? Gut health has many moving pieces, and probiotics are just one small part of that. A lot of people use them as a holy grail healing tool but at best, they are truly complementary. Meaning, they might assist but they are not anywhere near the complete answer. Ultimately, it’s best to consult your healthcare provider to see if probiotics are right for you and which strains to trial.
So you’ve talked to you healthcare team about taking probiotics and now you’re looking for the best probiotic supplement for celiac disease? Below are four gluten-free probiotic supplements available on the market. Please remember to consult your healthcare team before starting any supplement. As mentioned above, strain, timing, and diagnoses matter for probiotics (among other things).
Disclaimer, the above links may be affiliate links, meaning I get a small percent of the sale at no cost to you should you use them.
A much safer route for probiotics is eating fermented foods. Below is a list of gluten-free fermented food options (but of course always be sure to check the food label when buying to make sure no gluten snuck in).
I also have a probiotic fermented pickled carrot stick recipe, probiotic pickled celery recipe, and a probiotic fizzy ginger drink recipe on my blog too if you want to try your hand at making your own probiotic food.
To understand the role probiotics have with celiac disease, you first need to understand the microbiome and the role of probiotics in it. Essentially probiotics help support a healthy microbiome and a healthy gut, but they are not the only answer.
Other things like prebiotics, postbiotics, sleep, stress, exercise, diet, and more impact the microbiome. Meaning, probiotics are a small part of the big picture, and given current research, we may want to be more conservative with our use of probiotics as they may not always be harmless at worst.
So can and should celiacs take probiotic supplements? While there are gluten-free probiotics on the market, whether or not someone with celiac should take probiotics depends largely on their unique health status. Strain, timing, dose, diagnoses, and more, all factor into determining if probiotics are a good fit for someone.
If you’re really stuck on probiotics, you may lean on the safer side and instead, choose to incorporate more probiotic foods into your celiac diet.