The gluten free industry has exploded in the past decade. While coeliac disease has been diagnosed under various names for over a century, there are increasing numbers of people diagnosed (or self-diagnosing) as suffering from non-coeliac gluten sensitivity. Coeliac disease only effects around one per cent of the population, but for every person who has been clinically diagnosed another twenty people describe themselves as gluten intolerant.
Some studies report that non-coeliac gluten sensitivity affects 5-10 per cent of the population. Yet Professor Peter Gibson, Director of Gastroenterology at Alfred and Monash University, sees little evidence of this. He runs a large research program and works in the overlapping fields of inflammatory bowel disease, coeliac disease and irritable bowel syndrome. A major focus of his work is the use of diet to control gut symptoms and influence outcomes in chronic intestinal conditions.
Earlier this year, he ran a study on thirty individuals with typical gluten sensitive gut symptoms. They were all fed a rotating diet of controlled meals. The first group had all gastro triggers ( lactose, preservatives, carbs) removed, the second group had added gluten, and the third included an added placebo. All the test subjects reported the symptoms associated with gluten sensitivity.
"We found no evidence at all that in this group had a specific induction of symptoms when they had gluten... We found no evidence of non-coeliac gluten sensitivity."
It has been suggested that the culprit may not be the protein gluten, but the FODMAP family of carbohydrates, that is responsible for the symptoms commonly associated with gluten intolerance. As FODMAPS exist in many carbohydrates that contain gluten, eating a gluten-free diet will usually greatly diminish, if not entirely elimate, the FODMAPS ingested.
So, if you're a sufferer of gluten-intolerance, or you have non-specific IBS symptoms that a gluten-free diet has not entirely eliminated, here's some information on it.
What is coeliac disease?
Coeliac disease describes the abnormal reaction of the immune system to gluten (a protein found in wheat, rye, barley and oats), causing small bowel damage. The tiny, finger-like projections which line the bowel (villi) become inflamed and flattened. This is referred to as villous atrophy. Villous atrophy reduces the surface area of the bowel available for nutrient absorption, which can lead to various gastrointestinal and malabsorptive symptoms. Symptoms can also be caused by inflammation in other parts of the body.
What is IBS?
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder (FGID) affecting one in seven Australian adults and is also common in the USA, Europe and many Asian countries. This condition is characterised by chronic and relapsing symptoms; lower abdominal pain and discomfort, bloating, wind, distension and altered bowel habit (ranging from diarrhoea to constipation) but with no abnormal pathology. The diagnosis of IBS/FGID should be made by a medical practitioner.
What are FODMAPS?
FODMAP stands for:
Fermentable The process through which gut bacteria degrade undigested carbohydrate to produce gases (hydrogen, methane and carbon dioxide)
Oligo-saccharides Fructo-oligosaccharides (FOS) found in; wheat, rye, onions and garlic
Galacto-oligosaccharides (GOS) found in ; legumes/pulses
Disaccharides Lactose found in; milk, soft cheese, yoghurts
Mono-saccharide Fructose (in excess of glucose) found in honey, apples, high fructose corn syrups
Polyols Sugar polyols (eg. sorbitol, mannitol) found in some fruit and vegetables and used as artificial sweeteners
WHAT FOODS HAVE FODMAPS?
Here is a non-exhaustive list of high-FODMAP foods. As you can see, the usual gluten suspects of wheat, rye, and barley appear. The list also includes many high-lactose and high fructose foods, so particularly for those who identify as both gluten, fructose and lactose intolerant, the real culprit might be FODMAPS.
Excess Fructose: Honey, Apples, Mango, Pear, Watermelon, High Fructose Corn Syrup,
Fructans: Artichokes (Globe), Artichokes(Jerusalem), Garlic (in large amounts), Leek, Onion (brown, white, Spanish, onion powder), Spring Onion (white part), Shallots, Wheat (in large amounts), Rye (in large amounts), Barley (in large amounts), Inulin, Fructo-oligosaccharides.
Lactose: Milk, icecream, custard, dairy desserts, condensed and evaporated milk, milk powder, yoghurt, soft unripened cheeses (eg. ricotta, cottage, cream, marscarpone).
Galacto-Oligosaccharides (GOS): Legume beans (eg. baked beans, kidney beans, bortolotti beans), Lentils, Chickpeas
Polyols: Apples, Apricots, Avocado, Cherries, Nectarines, Pears, Plums, Prunes, Mushrooms, sorbitol (420), mannitol (421), xylitol (967), maltitol (965) and isomalt (953)
Research in this area is still in its infancy. For more information, here is the website for Monash University.