Knowing someone on the gluten-free diet is not an uncommon thing today, especially since more people are becoming aware of coeliac disease – a severe autoimmune disorder which impairs the digestion of gluten – and non-coeliac gluten sensitivity. However, few know about a subgroup of patients who experience very similar symptoms and yet test negative for coeliac disease.
Solving the mystery
FODMAPs – (Fermentable, Oligo-, Di-, Mono-saccharides And Polyols) – might be the culprit behind this mystery. According to scientists, the fructan found in these groups of carbohydrates might be the main cause of coeliac disease-like symptoms in people who test negative for the condition. FODMAPs are short-chain carbohydrates found in wheat, barley, rye and a number of other gluten products. Some people are naturally sensitive to FODMAPs and are less able to tolerate them, thus leading to gastrointestinal discomfort and increased gas production – symptoms of which are common in coeliac patients too.
Understanding the confusion
Due to the similar clinical presentations in both diseases and the high prevalence of coeliac disease in certain populations (especially with Caucasians), it is unsurprising that doctors initially mistake FODMAP sensitivity for coeliac disease. Furthermore, gluten and fructan are commonly found in similar food products, such as those that include wheat, rye and barley. It is thus easy for gluten to become the scapegoat for gastrointestinal discomfort and other related symptoms. Similarly, gluten-free foods have low FODMAP content, thus easing gastrointestinal symptoms in FODMAP patients. It is now not surprising why FODMAP patients would credit the relief of their symptoms to a gluten-free diet.
Dealing with the new information
What does all this information mean for patients with irritable bowel symptoms but test negative for coeliac disease? Has their mystery finally been resolved, and can the case now be closed? While the results mentioned above are very promising, scientists found that FODMAP only accounts for 70-75% of the undiagnosed cases. Some patients might be overly sensitive to other proteins found in wheat which have not yet been identified. Other patients might have secondary irritable bowel syndrome, in which the problem originates from another body system but presents as gastrointestinal symptoms.
For those interested in ascertaining their nutritional trigger, low-FODMAP food plans can be found online. Experimenting with both that and a gluten-free diet might shed some light on whether your condition has more to do with gluten or FODMAP presence. It's definitely something worth knowing, so why not give it a shot?