FODMAPS SENSITIVITY OR GLUTEN SENSITIVITY?
In this interesting study, people who "self-reported" an intolerance for Gluten, but did not have Celiac Disease (a Gluten-induced AUTOIMMUNE DISEASE of the small intestine) were not only put on a Gluten Free diet, but a Low FODMAP diet as well. After two weeks, Gluten was reintroduced. Steven Ross Pomeroy, writing for Forbes ([Non-Celiac] Gluten Intolerance May Not Exist), explained how meticulous this particular study was when he wrote that, "Subjects would be provided with every single meal for the duration of the trial. Any and all potential dietary triggers for gastrointestinal symptoms would be removed, including lactose (from milk products), certain preservatives like benzoates, propionate, sulfites, and nitrites, and fermentable, poorly absorbed short-chain carbohydrates, also known as FODMAPs. And last, but not least, nine days worth of urine and fecal matter would be collected. With this new study, Gibson wasn’t messing around."
In other words, whether or not the treatment diets contained Gluten or not, had no bearing on the outcome. But obviously, there was something going on with these folks. What was the culprit? Listen to the study's conclusions. "In all participants, gastrointestinal symptoms consistently and significantly improved during reduced FODMAP intake..... In a placebo-controlled, cross-over rechallenge study, we found no evidence of specific or dose-dependent effects of gluten in patients with NCGS (Non-Celiac Gluten Sensitivity) placed diets low in FODMAPs." To put it plainly, understanding (and removing) FODMAPS may be the key to solving many mysterious cases of GI symptoms --- particularly once we realize that Gluten-containing grains (wheat, rye, and barley) contain high levels of them.
This all begs the question: Is it all FODMAPS now? Can we simply dismiss studies like the one published in the one of this year's issues of Gastroenterology Research and Practice (Gluten Sensitivity Presenting as a Neuropsychiatric Disorder)? Listen to what the authors (renowned physicians from the University of Alberta in Canada) have to say on this topic of NCGS and neurological symptoms (I am cherry-picking here). "Over the last decade, there have been increasing reports of myriad adverse reactions associated with gluten exposure. It has been hypothesized for quite some time that gluten sensitivity may also impair central nervous system functioning. Celiac disease (CD) was initially believed to be the sole source of this phenomenon. Signs and symptoms indicative of nonceliac gluten sensitivity (NCGS), in which classical serum and intestinal findings of CD may be absent, have been frequently reported of late. Clinical manifestations in patients with NCGS are characteristically triggered by gluten and are ameliorated or resolved within days to weeks of commencing a gluten-free diet. Emerging scientific literature contains several reports linking gluten sensitivity states with neuropsychiatric manifestations including autism, schizophrenia, and ataxia. A clinical review of gluten sensitivity is presented alongside a case illustrating the life-changing difference achieved by gluten elimination in a patient with a longstanding history of auditory and visual hallucinations." And while this is great information, it does not even begin to scratch the surface of the link between neurological symptoms and NCGS.
The truth is, when the authors mention 3 or 4 neurological (mostly psychological) issues related to Gluten, they are barely scratching the surface. If you begin going through my posts on Gluten Sensitivity, you will find all sorts of information linking Gluten to neurological findings (HERE, HERE, HERE, HERE, HERE, HERE, HERE, HERE, HERE, HERE, and HERE are a few of them). Will the day come that we tie the neurological findings we are currently associating with NCGS to FODMAPS? I really have no idea, but it is certainly possible via the pathway I suggested two paragraphs ago. The only thing we know for sure is that for many people, Gluten is a massive problem. And likewise, pulling chronically ill people off Gluten can make a massive (the authors above used the word "life-changing" difference in one's neurological health.
Either way you slice it, I don't think you can go wrong with an ELIMINATION DIET. There's nothing to buy and you do not go out and purchase any specialty "Gluten Free" foods for this diet. Plus, it does away with your need for (expensive) testing. And because of what I mentioned in the paragraph above, I find it to be more accurate. Furthermore, it can be modified in several different ways. If your main problem is joint pain, add NIGHTSHADES to your Elimination Diet, and if you are struggling chiefly with GI symptoms, make sure to add FODMAPS to the protocol as well.