New research suggests that for many people who think they have gluten intolerance, the gastrointestinal symptoms are caused by fermentable carbohydrates.
When you’re dealing with GI issues after eating bread and pasta, it’s easy to point the finger at gluten. This protein complex has morphed into a nutritional scapegoat, with plenty of people putting themselves on gluten-free diets to try to turn things around.
But new research published in The Lancet, suggests that gluten is being unfairly targeted by the 10% of people who think they have a gluten intolerance. Known in the medical community as 'non-celiac gluten sensitivity,” gluten intolerance or gluten sensitivity is different from having Celiac disease, a chronic autoimmune disease that damages the small intestine when patients eat gluten. For people with Celiac disease, a gluten-free diet is crucial and can even be life-saving. People who think they have a gluten intolerance don’t experience that small intestine damage, but they’ll usually deal with uncomfortable symptoms like bloating and diarrhea. On the flip side, those symptoms will go away when they cut out gluten. In theory, it makes sense to point the finger at gluten. If you feel like you get a reaction when you eat foods with gluten, it’s fair to have questions and concerns. Here’s what research suggests could actually be behind those symptoms. There could be a few things fueling those symptoms. For study, researchers analyzed randomized controlled trials that had people who reported having a gluten sensitivity or intolerance eat foods containing gluten or a placebo. The researchers discovered that only a small percentage of people who claimed to have a gluten sensitivity actually reacted to gluten—16% to 30%, depending on the trial. “It’s a major shift in how we understand so-called ‘gluten sensitivity,’” Jessica Biesiekierski, PhD, lead study author and head of Human Nutrition at The University of Melbourne, tells SELF. So, what’s behind the symptoms people experience? There could be a few things, based on the findings. The researchers discovered that the gastrointestinal symptoms are largely caused by fermentable carbohydrates , which are also known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols . “Fermentable carbohydrates are broken down by bacteria in the gut,” Scott Keatley, RD, co-owner of Keatley Medical Nutrition Therapy who was not involved in the study, tells SELF. “When those bacteria digest them, they produce gas. At the same time, these carbs pull water into the intestines. If someone has a sensitive gut or altered gut–brain signaling, the normal amounts of gas and stretching can feel like pain, bloating, cramping, or urgency.” But the research team found that there also may be what’s called a “nocebo” effect at play. Meaning, if you think gluten will cause you to have symptoms like bloating or diarrhea, it could happen. What should you do if you’re having symptoms? While it’s easy to swear off gluten when your GI tract feels off, experts say you may be weeding out bread, pasta, and other foods unnecessarily. “Unless you have Celiac disease or wheat allergy, there’s usually no need to avoid gluten,” Dr. Biesiekierski says. Again, some people—up to 30%—without Celiac disease who think they have a gluten sensitivity do have a reaction to gluten. But it’s tricky to assume this is what’s going on without consulting a healthcare provider first. “I have a lot of patients who come to me who are concerned that they have gluten sensitivity,” Sumona Bhattacharya, MD, an inflammatory bowel disease specialist, gastroenterologist, and assistant professor at the George Washington University School of Medicine, tells SELF. When that happens, Dr. Bhattacharya says she will look into the possibility of Celiac disease, including asking about family history of the disease, and asking patients to take a blood test for Celiac disease. “If the results are normal, unless someone has a high suspicion for Celiac disease, we don’t do additional testing,” she says. From there, she may look into the possibility of other gastrointestinal disorders and thyroid disease, along with sensitivities to high-FODMAP foods. But she doesn’t recommend just removing gluten from your diet before you can be tested for underlying health conditions. If you’re having symptoms like unintentional weight loss, persistent diarrhea, blood in your poop, anemia, severe stomach pain, or are waking up at night due to GI symptoms, Keatley says you’ll want to see a healthcare professional sooner rather than later. “Those symptoms need medical evaluation because they suggest something more significant than a food tolerance issue,” he says. Regardless, you need medical guidance to navigate GI symptoms that don’t have a clear cause. “If symptoms are strong enough that you’re cutting out major food groups or feeling anxious about eating, that’s a good time to involve a physician so you’re not trying to figure it out alone,” Keatley says. Related: 4 RD-Approved Nutrition Apps That Won’t Make You Hate Yourself How Sugar Alcohols Might Be Messing With Your Gut How We Lost the Plot on Protein Get more of SELF’s great fitness and nutrition reporting delivered right to your inbox .
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