Low FODMAP Diet for Non-Celiac Gluten/Wheat Sensitivity

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Written by: Audrey Hummel, Bastyr University Intern

Are you among the many individuals who experience discomfort after consuming gluten or wheat, yet have tested negative for celiac disease? If so, you’re not alone. Those living with non-celiac gluten/wheat sensitivity (NCGS/NCWS) may find relief with the low FODMAP diet – a promising dietary approach that could transform the way you manage your symptoms.

Non-celiac gluten/wheat sensitivity is a condition characterized by symptomatic responses after consuming gluten-containing foods. The symptoms can include abdominal pain, bloating, diarrhea, constipation, headaches, fatigue, and brain fog. NCGS is tricky to diagnose because our bodies lack specific biomarkers for detecting the condition. It is considered an umbrella term for a wide range of symptoms. Instead of using lab tests, it is diagnosed through a gluten elimination and challenge process. Traditionally, the gluten-free diet has been used to reduce symptoms. However, in recent years, other diets have shown potential benefits for those with NCGS, with the low FODMAP diet being one of the most prominent.

How Non-Celiac Gluten/Wheat Sensitivity Differs from Celiac Disease

Non-celiac gluten-wheat sensitivity differs significantly from celiac disease in both what it does to the body and how it is diagnosed. Celiac disease is an autoimmune disorder triggered by gluten and can be diagnosed with several different lab tests. Non-celiac gluten/wheat sensitivity lacks identified serologic or immunologic tests, making it challenging to pinpoint the exact cause of the symptoms. In celiac disease, gluten is the primary culprit, whereas non-celiac gluten/wheat sensitivity may be triggered by multiple compounds, not limited to gluten alone. We are still learning more about what these compounds are and how they can cause a reaction in the body, but FODMAPs have been shown to be one of the possible triggers. Celiac disease affects approximately 1 in 100 Americans (1%), while non-celiac gluten/wheat sensitivity is estimated to impact between 1% to 13% of the population, suggesting a much higher prevalence. This highlights just how important it is to find the cause and a possible dietary solution.

What is a FODMAP?

To understand the role of the low FODMAP diet in managing NCGS, it’s essential to learn what FODMAPs are. FODMAPs, or Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, are a class of very small compounds that are rapidly fermented by gut bacteria in the large intestine. This fermentation process produces gas, which can cause symptoms such as bloating, abdominal pain, and diarrhea. FODMAPs can be found in a wide range of foods, including fruits, vegetables, legumes, grains, and dairy products. Some of the foods with the highest FODMAP content include:

  • Dairy-based milk, yogurt, and ice cream
  • Wheat-based products such as bread, cereal, and crackers
  • Beans and lentils
  • Certain vegetables such as asparagus, cauliflower, corn, mushrooms, and garlic
  • Some fruits such as apples, cherries, pears, peaches, and avocado

 

Gluten May Not Be the Culprit

Many people with non-celiac gluten/wheat sensitivity feel better when they adopt a gluten-free diet, however, some continue to experience symptoms. This could be because some individuals are sensitive to FODMAPS and their current diet is not eliminating all of the foods that are causing discomfort. Therefore, they feel a bit better when going gluten-free, but not 100%. Many gluten-free foods are high in FODMAPS, such as corn, so adopting a gluten-free diet may not be getting to the root cause of the problem.

A recent study by Skodje et al. showed this idea in action. In this study, 59 people who did not have celiac disease but were on a gluten-free diet were given a granola bar containing gluten, fructans (a type of FODMAP), or a placebo. Surprisingly, fructans caused more severe symptoms compared to gluten and the placebo. This finding raises questions about whether gluten is the sole trigger for non-celiac gluten/wheat sensitivity. Recently, the name of this condition changed from “non-celiac gluten sensitivity” to “non-celiac wheat sensitivity” to reflect the fact that the cause may not just be gluten.

Implementing the Low FODMAP Diet

There is no laboratory test to determine if someone is intolerant to FODMAPS. Instead, a FODMAP elimination diet should be done to determine which foods are causing symptoms. This should be done under the guidance of a Registered Dietitian (RD) or another healthcare professional to ensure that the diet is correctly implemented. The steps for implementing the low FODMAP diet include:

  1. Following the low FODMAP diet for 2-3 weeks while ensuring the consumption of all food groups and meeting nutritional needs.
  2. FODMAP reintroduction: Introducing one food at a time and monitoring for symptoms.
  3. FODMAP personalization: Understanding which foods can be tolerated and which ones cannot.

This process can take several months and requires lots of patience and careful monitoring of what you eat and any symptoms you experience. That is why we recommend not going it alone and seeking the support of your healthcare team and the many online resources that are available, like the ones we have listed below!

 

Potential Challenges and Considerations

While the low FODMAP diet offers hope to individuals with NCGS/NCWS, there are some important considerations and challenges to bear in mind:

  1. Not a long-term solution: The low FODMAP diet is not meant to be followed indefinitely. It is designed for the short-term relief of symptoms and to identify specific trigger foods.
  2. Impact on gut microbiome: Long-term adherence to a low FODMAP diet can negatively affect the gut microbiome, which plays a critical role in overall health.
  3. Dietary restrictions: The diet is naturally restrictive, which means many healthy foods may be eliminated. It’s important to include as much variety as possible in your diet and only exclude items long-term if necessary.

The low FODMAP diet presents a new dietary option for people struggling with non-celiac gluten/wheat sensitivity. It offers a potential solution to the often debilitating symptoms that can diminish one’s quality of life. However, it’s crucial to talk with a healthcare provider or Registered Dietitian before making any changes in your diet. They can create a plan that is best for you and your unique needs. As our understanding of non-celiac gluten/wheat sensitivity continues to evolve, embracing the possibilities of the Low FODMAP diet may empower individuals to reclaim control over their digestive health and enjoy a life free from unnecessary discomfort.

Additional Resources:

  • Monash University: The pioneering institution in creating the low FODMAP diet. Their website contains information on the diet, additional resources, and how to find a dietitian
  • Monash University App: the largest FODMAP food database available. Includes guidance on which foods are low or high FODMAP, recipes, shopping lists, and a food diary where you can track your food and symptoms
  • The Complete Low-FODMAP Diet: The Revolutionary Plan for Managing Symptoms in IBS, Disease and Other Digestive Disorders by Sue Shepherd and Peter Gibson
  • The Low-FODMAP Diet Cookbook: 150 Simple, Flavorful, Gut-Friendly Recipes to Ease the Symptoms of IBS, Celiac Disease, Crohn’s Disease, Ulcerative Colitis, and Other Digestive Disorders by Sue Shepherd
  • Patsy Catsos, RD – Fantastic website with information on following a low FODMAP diet
  • Kate Scarlata, RD  A terrific blog with recipes and information on a low FODMAP diet

References:

Mumolo MG, Rettura F, Melissari S, et al. Is Gluten the Only Culprit for Non-Celiac Gluten/Wheat Sensitivity?. Nutrients. 2020;12(12):3785. Published 2020 Dec 10. doi:10.3390/nu12123785

Skodje GI, Sarna VK, Minelle IH, et al. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology. 2018;154(3):529-539.e2. doi:10.1053/j.gastro.2017.10.040

Cárdenas-Torres FI, Cabrera-Chávez F, Figueroa-Salcido OG, Ontiveros N. Non-Celiac Gluten Sensitivity: An Update. Medicina (Kaunas). 2021;57(6):526. Published 2021 May 24. doi:10.3390/medicina57060526

Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013;145(2):320-8.e83. doi:10.1053/j.gastro.2013.04.051

Catassi C, Alaedini A, Bojarski C, et al. The Overlapping Area of Non-Celiac Gluten Sensitivity (NCGS) and Wheat-Sensitive Irritable Bowel Syndrome (IBS): An Update. Nutrients. 2017;9(11):1268. Published 2017 Nov 21. doi:10.3390/nu9111268