Gluten-free foods are increasingly available in stores and restaurants.
Are there any health benefits from avoiding gluten in the absence of celiac disease?
Presidential candidate Ted Cruz brought gluten into the political realm by suggesting that the military shouldn’t go soft by providing gluten-free meals.
However, celiac disease is a serious medical condition that afflicts about 1 percent of the population and requires a special diet – complete avoidance of the gluten protein found in wheat, barley and rye.
According to the Celiac Disease Foundation, 2.5 million Americans have undiagnosed celiac disease. On the other hand, many of the people who avoid gluten do not have celiac disease. Health professionals disagree over the existence of non-celiac gluten sensitivity. Recent reports suggests there may be individuals who do not have celiac disease but are indeed sensitive to substances found in grains and other foods.
A recent double-blinded study found that only a small number of people, about 3 percent to 14 percent, who think they have gluten-sensitivity, actually had adverse effects when exposed to gluten. Current research indicates that certain small hard-to-digest carbohydrates found in gluten-containing foods can trigger intestinal symptoms, like gas, bloating and diarrhea, in susceptible individuals.
These bothersome substances have a wickedly long name: fermentable oligosaccharides, disaccharides, mono-saccharides and polysaccharides (FODMAPs). FODMAPs are fermentable carbohydrates that can be difficult to digest due to their poor absorption and subsequent fermentation by gastrointestinal bacteria. FODMAPs have been shown to cause intestinal symptoms in individuals who believe that they have gluten-sensitivity but who did not respond to gluten when tested.
Common FODMAPs include fructans, found in wheat, rye, barley, garlic, onion, artichoke and inulin or chicory root extract; fructose, found in fruits, honey and high-fructose corn syrup; lactose found in dairy products; galactans found in legumes; and polyols, found in isomalt, mannitol, sorbitol, xylitol, avocado, cherries, apricots, nectarines, peaches and plums. Note that these include highly nutritious foods from several groups.
Irritable bowel syndrome, a condition that causes abdominal pain, cramps, gas and bloating, occurs in up to 20 percent of the population. Recent reports suggest that about 10 percent of the population are sensitive to FODMAPs and that a low FODMAP diet alleviates symptoms in about 75 percent of patients with IBS.
For most, FODMAPs are easily digested and they promote the growth of desirable bacteria in the intestinal tract, so consuming FODMAPs is considered beneficial for those who can tolerate them. However, those who cannot tolerate FODMAPs could consider following a FODMAP elimination diet under the guidance of a registered dietitian nutritionist (RDN).
Following a low FODMAP diet can be rather tricky but a comprehensive database of the FODMAP content of food as well as smart phone apps are available thanks to researchers in the Gastroenterology Department at Monash University in Australia, med.monash.edu.au/cecs/gastro/fodmap. Note however, the low FODMAPs diet was designed only for patients with a medical diagnosis of irritable bowel syndrome to rule out more serious health conditions and is meant to be followed only for a relatively short period of time, 2-6 weeks, after which foods should be reintroduced as tolerated.
If you suspect you suffer from non-celiac gluten sensitivity or difficulty with the ingestion of FODMAPs, you can find a RDN at the website of the American Academy of Nutrition and Dietetics at eatright.org/find-an-expert. Be sure to refine your search to include gluten intolerance or food allergies/food intolerance. Three RDNs are currently listed in the directory with an expertise in gluten and food intolerance in the Albuquerque area.
Sharon Himmelstein, Ph.D., M.N.S., R.D.N, is a member of the Academy of Nutrition and Dietetics, eatright.org, and the New Mexico Academy of Nutrition and Dietetics eatright-nm.org. She teaches nutrition at Central New Mexico Community College (CNM) in Albuquerque.