Gluten sensitive individuals cannot tolerate
gluten and may develop gastrointestinal symptoms similar to those in celiac
disease, but the overall clinical picture is typically less severe. Non-celiac
gluten sensitivity refers to an adverse reaction to eating gluten that usually
does not lead to damage of the small intestine.
Non-celiac gluten sensitivity was virtually unrecognized a decade
ago but is now a perplexing problem that has driven many studies in the past few
years. Its prevalence appears to be more wide spread than celiac disease
itself. It was a topic of hot debate at
the International Celiac Disease Symposium in late 2013, where it was widely
debated if the frequency of gluten sensitivity is really due to gluten, or
whether other factors and food culprits could be part of the cause.
For people with self-diagnosed non-celiac gluten
sensitivity, it may not be gluten which is causing their problem. An Australian
researcher into gluten sensitivity, Peter Gibson, of Melbourne's Monash
University believes that people who get relief with a gluten free diet, do so
because they avoid FODMAPs rather than gluten itself. ''What our study has shown is that, in people with gut
symptoms who have had some relief with the gluten free diet, it is not the
gluten that is the culprit, but it is more likely to be FODMAPs,'' Gibson says.
FODMAP’s stands for Fermentable, Oligosaccharides,
Disaccharides, Monosaccharides And Polyols. They are all short-chain
carbohydrates found in many foods, particularly in the western diet, which
can be poorly absorbed by some people. They are in particularly high amounts in wheat, rye and barley, the three
cereals that contain gluten. So researchers are curious whether the benefits of
the gluten-free diet among people with gluten sensitivity may actually be a
result of reducing FODMAP intake.
Examples of oligosaccharides include fructans (polymers
of fructose); disaccharides include lactose; monosaccharides include fructose; and
polyols include sugar alcohols such as sorbitol and mannitol.
Poor absorption
of most FODMAP carbohydrates is common to everyone. Any FODMAPs that are not
absorbed in the small intestine pass
into the large intestine large where bacteria normally found in the gut ferment them.
The resultant production of gas potentially results in bloating and flatulence.
Most individuals do not suffer significant symptoms but some may suffer the
symptoms of
IBS. Restriction of FODMAP intake
in IBS sufferers has been found to result in improvement of symptoms.
As for people
mistakenly believing they are gluten sensitive, Gibson suggested that there
were two other possible explanations, other than gluten sensitivity itself
which could be making them feel better on a gluten free diet:
1. People felt better for avoiding wheat and gluten products because of their
high percentage of FODMAPs. He suggests that FODMAPs might be the
factor leading to the symptoms such as bloating and gut distress, rather than
gluten itself. Gibson says, 'Why
gluten has been blamed is that people do often improve with a gluten free diet
because wheat, rye and barley, the three cereals that contain gluten, all have
high amounts of FODMAPs in them.”
2. Gibson also believes people
may report improvements on a gluten free diet because it makes them quite
literally ''feel better'', even if their gastro-intestinal symptoms do not
improve. Current evidence suggests
that many patients with self-reported non-coeliac gluten sensitivity continue
to experience gastrointestinal symptoms on a gluten free diet but continue to
restrict gluten as they report 'feeling better'. Gibson suggests that 'It
may be that people with gut symptoms feel better on the gluten-free diet
because they are less depressed.
However, when considering the
involvement of FODMAPs in non-celiac gluten sensitivity, it is important to
remember that FODMAPs are found in a variety of other foods as well, like
onions, broccoli, beans, apples and milk. All of these foods can be difficult for some
people to digest and cause gastrointestinal symptoms as well, but do people
with non-celiac gluten sensitivity react to these products as well?
Recent research has revealed that gluten or wheat sensitivity
occurs in approximately 30% of people with IBS (Irritable Bowel Syndrome), a
prevalence rate that is much higher than in the general population. So should
IBS be included as part of the spectrum of gluten sensitivity disorders? While some
people with IBS may benefit from a gluten free diet it isn’t the solution for
all people with IBS, and there are other factors to uncover.
Dietitian Susan Shepherd developed the low FODMAP diet in 1999 as
a treatment for IBS, and over the last several years it has gained significant
attention among both patients and researchers for effectiveness. A study
published in June 2013 found that, in some people with gluten sensitivity and
IBS, reducing the intake of FODMAPs alleviated symptoms better than a gluten free
diet. However, other studies found that people with IBS and gluten sensitivity
reported improved symptoms on a gluten free diet, and the benefits remained
even when high FODMAP foods like beans were reintroduced.
What these studies on IBS and FODMAPs demonstrate is that what
works for one person may not work for another, and each person needs to have an individualized dietary plan that suits them. Whether the symptoms are caused by gluten or by FODMAPs the important thing for the sufferer is know which foods
affect them and to avoid those foods.
From my personal experience with my own family that makes sense. Peppermint
makes me sneeze, capsicum makes me vomit, my eldest daughter has sub-acute
lupus so has to avoid any viral infections, my second daughter is allergic to
nickel and cannot eat seafood, my third daughter has celiac disease so of cause
cannot eat gluten and my son has a skin reaction to the sun. So we are all of
the same DNA but all have our peculiarities as far as allergies etc. are
concerned. We just cater for everyone’s
needs and it is not a problem at all.
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