What If Gluten Sensitivity Isn’t Just About Gluten?

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Gluten sensitivity — the kind that’s not associated with celiac disease — is a mysterious thing. An estimated 18 million people don’t fit the criteria for celiac disease, the genetic disorder that erodes the small intestine and causes digestive symptoms like bloating and stomach pain. And yet consuming gluten still makes them feel awful, notes health writer Jane Brody in a two-part series on the protein for the New York Times this week. But what if gluten is only a piece of the puzzle? 

A bit buried in her second article, Brody nods to some overlooked nutrition research published last year, which indicates that for many who are currently considered to have non-celiac gluten sensitivity, gluten may not be the only thing that’s causing their health issues. The real culprit, this study suggests, may be a group of sugars represented by the somewhat unwieldy acronym FODMAPs, which Brody defines like so:

Fodmaps is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, sugars that draw water into the intestinal tract. They may be poorly digested or absorbed, and become fodder for colonic bacteria that produce gas and can cause abdominal distress.

And this is a big deal, some nutrition scientists say, because so far non-celiac gluten sensitivity has mostly been defined by what it isn’t: It’s not a wheat allergy, and it’s not celiac disease. It does result in the same gastrointestinal issues that plague celiac patients, but it’s also often accompanied by symptoms outside the gut: headache, joint pain, foggy mind.

The idea of non-celiac gluten sensitivity was established in the scientific community back in 2011, when a study published in Nature by a team of Australian researchers concluded that it “may exist.” This research was among the first to show that people who did not have celiac disease could still suffer from celiac-like symptoms after consuming gluten, including bloating, intestinal pain, and tiredness.

But many of the people in this study still experienced these symptoms long after switching to a gluten-free diet. And so the researchers decided to continue to follow these folks. They asked the participants to switch from their gluten-free diet to a diet low in FODMAPs, which means avoiding a pretty extensive list of fruits, veggies, and grains containing those sugars that are harder for some to digest. Some of those foods do contain gluten, but many do not. For more detail, here’s a list of foods considered to be high and low in FODMAPs.

And here’s their remarkable finding: All of the participants in this study reported improvement in gastrointestinal symptoms after two weeks of following the FODMAPs diet. It’s early yet, as nutrition scientists are just beginning to explore the connection between FODMAPs and celiac-like symptoms. But for many, singling out gluten may not be the answer, since the real culprit could lie elsewhere.