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Going Gluten-Free: Barking Up the Wrong Tree?

Dear Friends,

More and more people are going gluten-free these days, including many who don’t even know what gluten is. A recent episode of the Jimmy Kimmel Live show featured a segment where they asked people on gluten-free diets, “What is gluten?”---in response to which they received a hilarious mix of bad guesses and sheepish “I don’t knows.” It was a nice bit of comedy, but it also underscores the general lack of good information surrounding the nation’s latest, greatest food fad. The information we do have tells us most of the people scouring menus and ingredient listings searching for the dreaded gluten are probably wasting their time, not to mention missing out on a lot of healthy whole grain foods.

What is Gluten? - Clip from Jimmy Kimmel Live on ABC

 

Gluten is a protein composite comprising two proteins—soluble gliadin and insoluble glutenin—conjoined with starch, found in wheat and related grains like rye, barley and spelt. In genetically predisposed individuals who suffer from the autoimmune condition known as celiac disease, gliadin triggers an inflammatory reaction in the small intestine, which can cause abdominal pain, cramping and bloating. Over time, the inflammation can damage the finger-like villi that line the intestine, inhibiting their ability to absorb nutrients (malabsorption), which can lead to additional health problems.

Gluten Free DietsBecause there’s no cure, it’s important for people with celiac disease to follow a strict gluten-free diet. But celiac disease is estimated to affect only about one percent of the U.S. population; so why do so many people report improvement in gastrointestinal symptoms after going gluten-free? For many so-called “gluten-intolerant” people, the real culprit may not be the gluten they’ve been so assiduously avoiding, but rather a group of short-chain carbohydrates and sugar alcohols known as FODMAPS (Fermentable, Oligo-, Di-, Mono-saccharides and Polyols). FODMAPS commonly found in foods include fructose, lactose, fructo- and galacto-oligosaccharides (fructans and galactans) and sugar alcohols (polyols) such as maltitol, mannitol, sorbitol and xylitol.        

FODMAPS can contribute to the symptoms of irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGID) thanks to a combination of three functional properties: (1) they are poorly absorbed in the small intestine; (2) they are small, and thus osmotically active, molecules; and (3) they are rapidly fermented by gut bacteria. FODMAPS not absorbed in the small intestine proceed to the large intestine, where their osmotic properties can increase fecal liquidity, causing loose stools, while rapid bacterial fermentation releases hydrogen, which can cause gassiness, flatulence and bloating. Researchers emphasize that FODMAPS do not cause the underlying FGID, but that they provide an avenue toward reducing symptoms in susceptible individuals.

Numerous studies have shown low-FODMAP diets to reduce FGID symptoms, but the most effective approach is typically one tailored to the individual patient. While some FODMAPS (oligosaccharides and polyols) are poorly absorbed by all people, others, such as fructose and lactose, can vary widely in their degree of malabsorption between individuals. The ideal approach requires cooperation between a physician, who can diagnose FGID and evaluate fructose and lactose malabsorption via breath hydrogen tests; and an experienced dietician, who can work with the patient to develop an individualized low-FODMAP diet plan.   

As always, I wish you the very best of health,

Lee

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