Narrative review examines fermentation effects on non-celiac gluten sensitivity and IBS componentsBread fermentation might help sensitive guts, but proof is still missing

Fermentation is a traditional food process that has been used for ages, notably contributing to the production of bread, one of the main staple foods. The aim of this review is to explore how fermentation may be leveraged to enhance the digestibility and nutritional value of bread, addressing potential gastrointestinal disorders related to its consumption. Emerging gastrointestinal disorders such as non-celiac gluten or wheat sensitivity and irritable bowel syndrome (IBS) are discussed, highlighting the complex and often poorly understood, nature of these conditions involving both physiological and psychological aspects. Yeasts and lactic acid bacteria used in the bread making process can positively influence bread characteristics through the enhancement of mineral bioaccessibility or the reduction of triggering components like gluten and FODMAPs, especially when selecting microorganisms with targeted properties. However, the characterization and selection of these microorganisms require further standardization, and the clinical implications need to be firmly established as the strength of the evidence remains insufficient. The review also discusses the potential for fermentation to generate beneficial metabolites, such as exopolysaccharides (EPS) and short-chain fatty acids (SCFA). While these compounds show promise, their actual content, stability, and bioavailability in baked bread require further investigation. Overall, fermentation appears as a versatile transformative tool for the creation of digestible and nutritionally enhanced bread. Yet well-designed human studies are needed to substantiate the clinical benefits and better define the conditions where modification through fermentation may provide gastrointestinal health advantages.