Skip to main content
Evidence-Based Supplement Research
Evidence-Based Supplement Research
Pillser
Search
Sign UpLog In

Prebiotic Supplementation in Celiac Disease: A Systematic Review of Clinical Efficacy, Safety, and Nutritional Outcomes.

  • 2026-06-27
  • Journal of gastrointestinal and liver diseases : JGLD 35(2)
    • Muhammad Shahzil
    • Mariyah Zainab Irfan
    • Syeda Kanza Kazmi
    • Anza Muhammad
    • Kofi Clarke

Study Design

Type
Systematic Review
Sample size
n = 66
Population
patients with celiac disease (CD)
Methods
systematically searched PubMed, Embase, Web of Science, and CENTRAL through May 2025 for clinical studies evaluating the effects of prebiotics in CD, derived from either supplements or foods naturally abundant in prebiotics; eligible trials and observational studies were assessed using Cochrane RoB 2.0 or Newcastle-Ottawa tools, and data were synthesized narratively

Background and aims

Despite a strict gluten-free diet (GFD), many patients with celiac disease (CD) continue to experience symptoms and nutrient deficiencies. Prebiotics, non-digestible substrates that foster beneficial bacteria and short-chain fatty acid (SCFA) production, may offer adjunctive benefits, though their role in CD remains unclear. We aimed to determine the clinical efficacy, safety, and nutritional outcomes of prebiotics in CD.

Methods

Following PRISMA guidelines, we systematically searched PubMed, Embase, Web of Science, and CENTRAL through May 2025 for clinical studies evaluating the effects of prebiotics in CD, derived from either supplements or foods naturally abundant in prebiotics. Eligible trials and observational studies were assessed using Cochrane RoB 2.0 or Newcastle-Ottawa tools, and data were synthesized narratively.

Results

Twelve studies (1,066 participants) were included. Oligofructose-enriched inulin (Synergy 1) increased fecal SCFAs by 31%, Bifidobacterium abundance, osteocalcin, and serum vitamins D and E. It also reduced hepcidin by 61% without gastrointestinal intolerance. Oats (50-70 g/day) for up to 24 months maintained histologic remission, negative serology, and improved dietary iron, fiber, thiamin, and zinc intake without worsening hemoglobin or ferritin status. Quinoa modestly lowered cholesterol, and amaranth enhanced growth and corrected trace element deficiencies in children. No study reported serious adverse events; adherence improved when prebiotics diversified the GFD.

Conclusions

Prebiotics appear safe and may enhance microbiota composition, nutrient absorption, and barrier integrity without compromising mucosal healing. Larger standardized randomized trials are needed to confirm these findings.

Research Insights

  • amaranth→Corrected Trace Element Deficiency

    amaranth enhanced growth and corrected trace element deficiencies in children.

    Effect
    Beneficial
    Effect size
    Small
  • amaranth→Enhanced Growth

    amaranth enhanced growth and corrected trace element deficiencies in children.

    Effect
    Beneficial
    Effect size
    Small
  • oats→Improved Fiber Intake

    Oats (50-70 g/day) ... improved dietary iron, fiber, thiamin, and zinc intake without worsening hemoglobin or ferritin status.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    50-70 g/day
  • oats→Improved Iron Levels

    without worsening hemoglobin or ferritin status

    Effect
    Neutral
    Effect size
    Small
    Dose
    50-70 g/day
  • oats→Improved Thiamin Intake

    Oats (50-70 g/day) ... improved dietary iron, fiber, thiamin, and zinc intake without worsening hemoglobin or ferritin status.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    50-70 g/day
  • oats→Improved Zinc Intake

    Oats (50-70 g/day) ... improved dietary iron, fiber, thiamin, and zinc intake without worsening hemoglobin or ferritin status.

    Effect
    Beneficial
    Effect size
    Small
    Dose
    50-70 g/day
  • oats→Increased Hemoglobin Levels

    without worsening hemoglobin or ferritin status

    Effect
    Neutral
    Effect size
    Small
    Dose
    50-70 g/day
  • oats→Maintained Hemoglobin Level

    Oats (50-70 g/day) for up to 24 months maintained ... without worsening hemoglobin or ferritin status

    Effect
    Neutral
    Effect size
    Small
    Dose
    50-70 g/day
  • oats→Maintained Histologic Remission

    Oats (50-70 g/day) for up to 24 months maintained histologic remission, negative serology, and improved dietary iron, fiber, thiamin, and zinc intake without worsening hemoglobin or ferritin status.

    Effect
    Neutral
    Effect size
    Small
    Dose
    50-70 g/day
  • oats→Maintained Negative Serology

    Oats (50-70 g/day) for up to 24 months maintained histologic remission, negative serology, and improved dietary iron, fiber, thiamin, and zinc intake without worsening hemoglobin or ferritin status.

    Effect
    Neutral
    Effect size
    Small
    Dose
    50-70 g/day
  • oats→Not Worsened Ferritin Level

    Oats (50-70 g/day) for up to 24 months maintained ... without worsening hemoglobin or ferritin status

    Effect
    Neutral
    Effect size
    Small
    Dose
    50-70 g/day
  • quinoa→Reduced Total Cholesterol Levels

    Quinoa modestly lowered cholesterol

    Effect
    Beneficial
    Effect size
    Small

Adverse Events Reported

  • quinoa→Overall tolerability

    No study reported serious adverse events; adherence improved when prebiotics diversified the GFD.

    Finding
    Reported
  • amaranth→Overall tolerability

    No study reported serious adverse events; adherence improved when prebiotics diversified the GFD.

    Finding
    Reported
  • oats→Overall tolerability

    No study reported serious adverse events; adherence improved when prebiotics diversified the GFD.

    Finding
    Reported
Back to top