Could It Be FODMAPs Triggering Your Gut Symptoms?
It could actually be FODMAPs and not gluten that is the culprit. Wheat contains fructans which are poorly absorbed and a gluten free diet will substantially lower your FODMAP intake. Naturally gluten free grains such as rice, maize and quinoa are all low FODMAP too.
Modifying FODMAP intake is a highly effective approach for irritable bowel syndrome (IBS) and other functional bowel disorders (bloating, wind, pain). This approach can help give 3 out of 4 people control over their symptoms rather than the symptoms controlling them.
FODMAPs is an acronym for the group of sugar molecules that can be poorly digested.
Oligo-saccharides (fructans and galacto oligosaccharides/ GOS)
Di-saccharides (lactose – milk sugar)
Mono-saccharides (excess fructose)
Polyols (eg sorbitol, mannitol)
FODMAPs can be poorly absorbed in the small intestine and are then fermented by our gut bacteria in the large intestine to produce gas, and cause more water to pass through the bowel. This happens in all of us, some gas means our gut bugs are being fed! However in people with IBS this can trigger symptoms such as bloating, pain, and diarrhoea. This video shows how:
Remember when modifying your FODMAP intake portion size and the ‘additive effect’ of eating multiple higher FODMAP foods over the same day or a few days are very important.*
For example a small serve of broccoli may be tolerated but a large serve may not. Eating wheat once a day may be tolerated but including wheat/ rye more frequently may not be.
The best resource is the Monash University FODMAP diet with a comprehensive food guide and recipes. The Monash team test the FODMAP content of foods in their lab and regularly update the app.
As the FODMAP diet can seem complex and confusing, advice is best provided by a dietitian who has received training and is experienced in this area. They can help you to individualize the process and also ensure that your diet is nutritionally balanced.
The first phase is the low FODMAP diet which restricts these sugars for 2-6 weeks. The second phase is to re-challenge with some of the high FODMAP foods. Once you have identified the major triggers the third phase is to move to a long term modified FODMAP diet which allows symptom control. It is essential not get stuck in the low FODMAP phase for too long as the diet can lower levels of some of the beneficial bacteria.
The chart below will give you a good idea of common problem foods and substitutions during the diet. Eggs, fresh meat, fish and chicken are naturally low FODMAP
What About Non-Coeliac Gluten/ Wheat Sensitivity
Diagnosing NCGS remains complicated – the current research shows that it does exist but that we do not have an accurate test for it yet. It may be other non-gluten proteins in wheat (eg amylase trypsin inhibitors) that cause symptoms, the research is on-going.
The gold standard for food intolerance testing is to exclude the suspected food, followed by gradual reintroduction to see if symptoms reoccur – in research this would be blinded which of course is tricky in the real world!
Consider that it may be FODMAPs that are contributing to symptoms. If FODMAPs allow adequate control of symptoms you have your answer.
If you do feel better on a gluten free diet then naturally you are likely to stick to it but do ensure that you are not restricting your diet un-necessarily.
Lastly, remember it is vital to be properly tested for celiac disease before you eliminate gluten from your diet .