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Gluten or FODMAPs & Does it Matter?

November 1,2018

So you’ve given up bread and pasta and feel great! Your tummy is less bloated, the cramping has subsided, your using the toilet normally and even that annoying wind has almost gone away. It must be the gluten, right?

Well not necessarily. Current research is indicating that, in the absence of Coeliac Disease, its the Fructans (a group of short chain carbohydrate molecules)

that are actually at the root of the problem. Fructans are part of a group of molecules that make up the FODMAP acronym and are collectively found in many foods including apples, dairy, wheat, garlic and onion, just to name a few.

So why the confusion?

​As you can see below, when you eliminate the gluten containing grains, you also eliminate fructans, making it difficult to discern exactly which molecule is causing the problem. This is exactly what the researchers at Monash University’s department of Gastroenterology are trying to evaluate. At this point they are finding that, in the absence of coeliac disease, removing the fructans and not the gluten gives the best symptom relief for people who have previously reported non-coeliac gluten sensitivity.

But you feel better not eating gluten, so what does it matter if you chose to just exclude it from your diet?

After working in healthcare for the last 20 years, I am well aware that effective and safe treatment occurs when the cause of the issue is pinpointed.

While there is some cross over in a gluten free diet and a low FODMAP diet, since they are excluding or limiting different molecules not all gluten free foods are low FODMAP and not all low FODMAP foods are gluten free. From a nutrition point of view this is important, our bodies need a variety of nutrients to function well and keep us healthy, and by eating a variety of foods from different food groups, we give our body the best chance of meeting these needs. Being restrictive with your food choices unnecessarily can lead to:

  • There’s a good chance that you will miss out on an important nutrients.
  • Difficulty eating out and with social situations.
  • Risk of psychological distress related to sticking to a restrictive diet.

It stands to reason that it is mentally and physically healthiest to only limit or restrict specific foods based on your diagnosed needs, and that a correct medical diagnosis is the best way to identify what your needs are.

In this case is is Coeliac Disease or is it FODMAPs and where is the difference?

Where to next?

If you think that gluten may be causing you symptoms get tested properly for coeliac disease BEFORE you stop eating gluten containing grains. You can read more about what getting tested involves and what considerations to take for the test to give an accurate result here. It is necessary to be eating gluten at the time of being tested, an accredited practising dietitian (APD) can help you choose foods that may be more tolerable during this phase.

You can find a qualified dietitian who has a special interest in coeliac disease via the Dietitians Association of Australia website here.

If the test is positive:

  • Since coeliac disease is a genetic condition, if you have a positive diagnosis there is a chance that other members of your family may also have it and should be screened.
  • Screening for associated conditions including osteoporosis, iron deficiency and other autoimmune conditions.
  • An APD will guide you in navigating a gluten free diet. This will include identifying foods that are naturally gluten free, how to identify gluten on a food label, what nutrients you may need to be extra careful with and how to avoid cross contamination both at home and when you are eating out.

If the test is negative:

  • If your doctor is unable to identify a medical cause of your symptoms, you may be referred to a dietitian to test for food intolerances. There are many food components that may cause symptoms similar to coeliac disease including Fructans. An APD can help you to identify exactly which food components are causing your symptoms, where they are found and how strict you need to be in avoiding your trigger foods.

If you have ongoing symptoms:

  • Some people who have coeliac disease also have other food intolerances as well. Your APD can help you to identify the cause of your ongoing symptoms and how to manage them.

Beware of unorthodox testsThere are numerous tests for food allergies and intolerances, many of which are expensive and are unreliable. They may be misleading, delay correct diagnosis and lead to ineffective or even dangerous treatment. The Australasian Society of Clinical Immunology and Allergy (ASCIA) advise against the use of such tests for diagnosis or to guide medical treatment. For more information, visit the ASCIA website here.