Amy Burkhart, MD, RD, is a board-certified emergency medicine physician and registered dietitian. She also trained in integrative medicine with Dr. Andrew Weil at the Arizona Center for Integrative Medicine. Her practice is located in Napa, CA.
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Non-Celiac Gluten Sensitivity is poorly understood and no valid test exists to diagnose it. A new study questions whether 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?
Non-celiac gluten sensitivity is not yet well-defined. It is 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 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, Fructose Malabsorption, Celiac and Lactose Intolerance look alike
The symptoms of fructose malabsorption 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?
Information on diagnosing and treating this condition can be found in my article “What is Fructose Malabsorption?”
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. FODMAPS-free food anyone?
A comprehensive list of foods containing FODMAPS is available online.