Non-Celiac Gluten Sensitivity is poorly understood and no valid test currently exists to diagnose it. A new study questions whether or not gluten is really the cause of symptoms in gluten sensitive individuals who do not have celiac disease.
An article published in the journal, Gastroenterology, in August 2013, looked at a possible link between non-celiac gluten sensitivity and “FODMAPS.” FODMAPS, an abbreviation for fermentable, oligo, di, monosaccharides and polyols, are particular types of carbohydrates found in some foods such as apples, watermelon, onions, garlic and wheat. When these carbohydrates are not well- absorbed, they create symptoms such as gas, bloating, diarrhea and fatigue.
A small study but important findings
The study looked at 37 people with non-celiac gluten sensitivity and IBS. Celiac disease had been ruled out as a cause of symptoms. When all 37 people were taken off of food that contained FODMAPS, they improved significantly. When they reintroduced only gluten and not the other FODMAP foods, only 8% of the 37 people with “Non-Celiac Gluten Sensitivity” actually reacted to gluten.
Are we looking at the wrong culprit in non-celiac gluten sensitivity?
At present, non-celiac gluten sensitivity is still not well- defined. It is currently diagnosed when a person has symptoms after eating gluten, and celiac disease has been ruled out as the cause. At present, there is no validated test for non-celiac gluten sensitivity; it is currently what we call “a clinical diagnosis.” This means it is diagnosed based on symptoms rather than an actual lab test. It is difficult to create a test for diagnosis when the mechanism and pathology of the disease have not been clearly defined. Since we have no test, and one of the FODMAP foods is wheat, are we being fooled? Is the real issue the carbohydrate and not the gluten?
The symptoms of IBS, FODMAP Intolerance, Celiac Disease and Lactose Intolerance look alike
The symptoms of FODMAP intolerance can be easily confused with the symptoms of IBS, celiac disease, gluten sensitivity, and lactose intolerance. Recent research shows a high percentage of people with IBS to be sensitive to foods containing FODMAP carbohydrates. Could an intolerance to FODMAP- containing foods also be the cause of some cases of non-celiac gluten sensitivity as well?
Could the FODMAPS food craze be next?
While the study only examined 37 people, it spotlights an issue that, in the future, may bring relief to many people. FODMAP- free food anyone?
Recommended resources for a low FODMAP diet:
1. Monash University Low Fodmap App for I-phone and Android: http://www.med.monash.edu/cecs/gastro/fodmap/iphone-app.html
2. Monash University Website: http://www.med.monash.edu/cecs/gastro/fodmap/ The leaders in research and information on the low FODMAP diet
3. http://www.ibsfree.net/- Patsy Catsos, RD- Fantastic website with information on following a low FODMAP diet
4. http://www.pinterest.com/pcatsos/ Pinterest site with photos of low FODMAP products
5. http://blog.katescarlata.com/ Kate Scarlata, RD A terrific blog with recipes and information on a low FODMAP diet
6. http://theceliacmd.com/2013/09/gluten-really-culprit-gluten-sensitivity/ An explanation of the study that discusses the role of FODMAPS in gluten sensitivity
7. Book: A great consumer friendly, resource for anyone on a LOW FODMAP Diet. Written by Dr. Sue Shepard and Peter Gibson from Monash University
THIS ARTICLE IS COPYRIGHTED BY AMY BURKHART, MD, RD.
Past columns by Dr. Burkhart:
November 2015: Cold Sores, Canker Sores and Gluten
July/August 2015: A New Home Test To Monitor Gluten Exposure
February/March/April 2015: Arsenic in the Gluten-Free Diet: Facts and Tips
December 2014/ January 2015: The Microbiome and Celiac Disease: A Bacterial Connection
October 2014: Should You Trust Gluten-Free Labels?
September 2014: Triggers for celiac disease: One possible answer
July/August 2014: Ten Tips for a Healthier Gluten-Free Diet
June 2014: Back Pain and Gluten
April 2014: Update on Restaurants and Gluten-Free Dining
January 2014: Four Vitamin Toxicities on a Gluten-Free Diet
December 2013: Move Over Gluten-Free, Low FODMAP is Next
November 2013: SIBO, Gluten and IBS: What Is The Connection?
September 2013: Is gluten really the culprit in gluten sensitivity?
August 2013: Clarifying the Gluten-Free Labeling Rule
June/July 2013: No such thing as Mild Celiac Disease
May 2013: Magnesium Deficiency
March 2013: Why am I having migraines?
February 2013: What is fructose malabsorption?
January 2013: Educating doctors about celiac disease
December 2012: Are supplements to digest gluten safe and useful?
Photo by www.michaelandersongallery.com
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