Gluten sensitivity and FODMAPs: Is there a connection?
Non-celiac gluten sensitivity (also known as gluten sensitivity) is not yet well understood. The currently accepted means of diagnosing this condition is to rule out celiac disease, wheat allergy and other possible causes of symptoms. Then, if a gluten-free diet leads to improvement in symptoms, gluten sensitivity may be diagnosed.
Should FODMAPs be considered one of these “other possible causes of symptoms”? Limited research suggests this may sometimes be the case. Some individuals who believe they have gluten sensitivity and experience an improvement in IBS (irritable bowel syndrome)-like symptoms when on a gluten-free diet may be benefitting from reduced consumption of FODMAPs rather than from elimination of gluten. It has been concluded in some research that gluten may not be a trigger of GI symptoms in some individuals once FODMAPs have been reduced.
Here’s where overlap exists between a low-FODMAP diet and a gluten-free diet: the gluten-containing grains wheat, rye and barley also happen to be high-FODMAP foods. (It is the type of carbohydrates in these foods, however, not the gluten protein, which makes them high FODMAP.) So, when these foods are eliminated on a gluten-free diet, this source of FODMAPs is also reduced.
What are FODMAPs?
FODMAP stands for Fermentable-Oligosaccharide-Disaccharide-Monosaccharide-And-Polyols. Essentially, FODMAPs are certain types of sugars and shorter chain carbohydrates. They are found in a broad range of foods, including some items from each of the following categories: fruits, vegetables, nuts, seeds, grains and grain-based products, dairy and dairy alternatives, sugars and sweeteners.
The low FODMAP diet was developed to control gastrointestinal symptoms associated with irritable bowel syndrome (IBS). Low digestibility of FODMAPs means they are poorly absorbed in the small intestine and therefore proceed to the large intestine, where they are fermented by bacteria. This leads in some people to IBS-like symptoms including gas, bloating, abdominal discomfort, pain and altered bowel function. Some evidence indicates that reducing intake of FODMAPs provides relief to approximately 75% of individuals experiencing IBS-like symptoms. Many foods are sources of FODMAPs and it is important that a low FODMAP diet be well planned to ensure that it provides sufficient nutrients. Generally, the low FODMAP diet is followed strictly for a period of two to six weeks. This is followed by re-introduction of some foods to determine which specific FODMAP sources are problematic for each particular individual.
Individuals interested in considering a low FODMAP diet should consult with their personal healthcare provider, and with a dietitian who has specific knowledge of this diet and of food intolerances. In addition, it should be determined in consultation with a healthcare provider whether other testing and/or treatment is indicated, which may include testing for celiac disease.
A strict low FODMAP diet is not meant to be followed long term, it can be restrictive and lower levels of some of the good bacteria in our large bowel. It is important to re-challenge high FODMAP foods to allow you to determine which FODMAPs you can tolerate and what portion size is tolerated. A registered dietitian with training and experience in the Low FODMAP diet can guide you through this process.
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Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR. No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates. J Gastro. 2013; 145 -2.
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The Monash University Low FODMAP Diet. Monash University. Published 2010. Updated January 8, 2013. Accessed March 21, 2014.http://www.med.monash.edu/cecs/gastro/fodmap/description.html.
Shepherd S. (2014, March 26). Is Gluten Really the Problem? The Role of FODMAPs in Gluten-Related Disorders. Live webinar, hosted by the National Foundation for Celiac Awareness.www.celiaccentral.org/webinars/archive/.