Dietary constituents called “FODMAPs” complicate the idea of
nonceliac gluten sensitivity.
Some people without celiac disease report gastrointestinal intolerance
to gluten-containing foods. In 2011, Australian researchers conducted
a controlled-diet study that boosted the case for “nonceliac gluten
sensitivity” (NEJM JW Gen Med Apr 5 2011). Now, the same group has
explored whether “FODMAPs” (Fermentable, Oligo-, Di-,
Monosaccharides, And Polyols) might confound the perceived response to
a gluten-free diet. FODMAPs are fermentable, poorly absorbed, short-
chain carbohydrates that include fructose, lactose, fructans (found in
wheat), galactans, and polyol sweeteners.
The trial included 37 patients with irritable bowel syndrome who
reported gluten sensitivity, and whose evaluations for celiac disease
were negative. During a 2-week run-in period, all patients followed a
gluten-free, low-FODMAP diet. Then, in a randomized, double-blind,
crossover format, each patient received high-gluten, low-gluten, and
no-gluten diets (1 week for each diet, separated by 2-week washout
During the low-FODMAP run-in period, mean symptom scores improved
significantly. However, symptoms worsened during each of the three
double-blind treatments — with no differences between the high-
gluten, low-gluten, and no-gluten periods. Twenty-two patients
repeated the whole study with 3-day (rather than 7-day) food
challenges, and with dairy products and chemical food additives also
eliminated from their diets. Again, symptoms worsened just as much
with the no-gluten diet as with the gluten-containing diets.
In this study of nonceliac patients who reported previous gluten
sensitivity, a gluten-containing diet was no more likely than a no-
gluten diet to worsen symptoms in the presence of a low-FODMAP diet.
Because many gluten-containing foods also are high in FODMAPs, the
authors speculate that improved symptoms with a gluten-free diet
actually might reflect simultaneous reduction in FODMAP intake.
However, our understanding of nonceliac gluten sensitivity remains
Biesiekierski JR et al. 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 Aug; 145:320. (http://dx.doi.org/10.1053/j.gastro.2013.04.051
) PubMed abstract (Free)Web of Science
Allan S. Brett, MD reviewing Biesiekierski JR et al. Gastroenterology