The nutrition world loves a good villain. In a world where polarity is often the preferred paradigm, the path to health is unfortunately mapped by labeling foods “good” and “bad.” And for the past decade, villain number one has been gluten. Trouble is, unless you have celiac disease, gluten probably isn’t what’s causing you to experience fatigue, bloating, constipation, diarrhea, or other digestive stress.
Approximately 3 million Americans have Celiac Disease, an autoimmune condition that causes the small intestine to react to gluten proteins. The most common reaction is diarrhea and bloating, but symptoms can also include joint inflammation, anemia, infertility, and osteoporosis in varying levels of intensity. For those with celiac disease, the only treatment is to cut out the offender: gluten.
Gluten-free diets and the sales of gluten-free products have skyrocketed in popularity since the turn of the 21st century. It seems that a perfect storm formed as low-carb diets became fashionable about the same time that the popularity of natural foods and healthy low-carb alternatives became fashionable. A recent article in Forbes estimates that gluten-free product revenue will soon eclipse $2 billion dollars.
Like I said, we love a good villain.
But, the whole gluten-free trend couldn’t possibly just be hype, right? Surely, there must be proof that gluten is bad, even for those who don’t have celiac disease. After all, nut-free products didn’t spark a trend, even though a reported 3.3 million Americans are said to have an allergy to peanuts and tree nuts.
In 2011, Peter Gibson — the Director of Gastroenterology at The Alfred Hospital in Melbourne, Australia — and a small group of colleagues decided to figure out if the growing disdain for gluten was rooted in something tangible. The question they posed was simple: Can gluten induce gastrointestinal symptoms in individuals who do not have Celiac Disease?
Gibson has made a career of studying inflammatory conditions of the small and large intestines. Simply put he’s studied the gut and how diet can control the symptoms and outcomes in chronic intestinal conditions. The 2011 double-blind randomized placebo-controlled trial followed 34 subjects and demonstrated that “’Non-celiac gluten intolerance may exist, but no clues to the mechanism were elucidated.” This conclusion was practically a life sentence for gluten.
But, in 2013, Gibson began to take another look and figure out why they were unable to identify a specific food or nutrient that was causing the symptoms associated with non-celiac gluten intolerance. 37 subjects took part in the follow-up study. All subjects were confirmed to not have celiac disease, but did meet the diagnostic criteria for non-celiac gluten intolerance (they experienced gastrointestinal symptoms after ingesting gluten).
As part of the study, the participants were first fed a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet, a diet used by Gibson and his team to treat the symptoms of IBS. Then they each randomly cycled through two weeks of three different diets that had varying levels of gluten (0-16 grams per day). The subjects reported worsening symptoms regardless of which diet they were put on. In fact, even when subjects were put back on the FODMAP diet (the diet that initially led to improved symptoms), they reported worsening symptoms.
Gibson’s research reveals that many people avoiding gluten may be doing so unnecessarily as it suggests that gluten is not necessarily the cause of the symptoms associated with the condition labeled non-celiac gluten intolerance.
The Gluten and FODMAP Connection
Wheat and other gluten-containing foods are generally considered FODMAPs and for those suffering from bloating, constipation, diarrhea, or other general digestive stress, a low FODMAP diet seemed to improve symptoms.
FODMAPs are carbohydrates and related sugar alcohols that can be cumbersome for some bodies to digest properly. “Most sugars we eat (e.g., glucose, galactose, sucrose, fructose when in the presence of glucose, and lactose in those with adequate lactase activity) and some oligosaccharides (such as malto-oligosaccharides) are very well absorbed in the small bowel. They are not FODMAPs,” says Gibson.
The slowly or poorly-digested carbohydrates pass into the large intestine, where bacteria ferment them and produce gas, which leads to bloating and other uncomfortable symptoms.
“Gluten-containing grains do cause bloating and pain in those with irritable bowel syndrome, but it’s what in them that triggers the symptoms,” says Gibson. “FODMAPs are present in gluten-containing grains. Our research suggests that the FODMAPs may trigger the symptoms, not the gluten part of proteins in those grains.”
For many, all FODMAPs do not need to be excluded completely to improve symptoms. A low FODMAP diet is often first prescribed as an elimination diet and then foods are reintroduced to identify the specific FODMAPs that an individual is sensitive to.
FODMAPs are not bad or unhealthy. Their only “offense” is they are difficult to digest in large amounts for some people.
Those on a low FODMAP diet generally avoid:
Fructans (polymers of fructose): wheat, rye, barley, onion, garlic, artichoke, sunchoke, asparagus, beets, dandelion leaves, leek, radicchio and other chicories, broccoli, Brussels sprouts, cabbage, cauliflower, and fennel
Galactans (polymers of galactose): beans and lentils
Polyols: peaches, nectarines, plums, prunes, apricots, cherries, apples, pears, avocados, blackberries, lychees, and watermelon, along with sweeteners like isomalt, maltitol, mannitol, sorbitol, and xylitol
Other FODMAPS are often simply reduced, but not necessarily excluded from a low FODMAP diet. These include foods with excess fructose (most fruits) and excess lactose (most dairy products that are not fermented). Following a low FODMAP diet is a fairly complicated dietary approach so we recommend seeking out a nutritionist with FODMAP expertise if this is something you are interested in trying.
Gluten’s rise (and likely eventual fall) as a dietary demon is just one of many examples of foods and nutrients that we as eaters have tried to write off as “bad.” As many struggle to find a successful approach to health and wellness, a magic bullet solution is enticing. But there is no one size fits all approach to health and wellness. More often than not, enjoying a balanced diet of unprocessed foods in appropriate amounts is the best place to start.