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Gluten intolerance or low FODMAPs?

June 18, 2014 Uma Pisharody, MD, FAAP

Despite test results that show no evidence of their children having neither any detectable allergies to wheat nor any signs of celiac disease, many parents choose to have their children follow a gluten-free diet.  This is because of convincing stories of how gluten (a protein found in wheat and other grains) seems to cause their kids to have belly aches, nausea, bloating and a variety of other symptoms.  

For years, this was hard to explain without a scientific explanation.   Gastroenterologists like me had a hard time supporting families who wanted to follow gluten free diets, without a good “medical reason”.  Then, in 2011, researchers from Australia conducted a double-blind, randomized, placebo-controlled, rechallenge trial in nearly 3 dozen patients (none of whom had celiac disease or wheat allergy), all of whom described worsening symptoms when unknowingly ingesting small amounts of gluten.  The results of this study described a condition termed, “Non-celiac gluten intolerance”.    It was after reading this landmark study that many physicians, including myself, began to validate parents’ concerns about gluten being the culprit behind their children’s gastrointestinal (GI) problems.

But then in 2013, just as word of non-celiac gluten intolerance was gaining popularity amongst physicians like me, the exact same group of researchers from Australia published a follow-up study on a similar set of about 3 dozen patients.  The findings of this 2nd study showed that instead of gluten being the true culprit, the reason for the patients’ symptoms in fact, had nothing to do with gluten at all!  The researchers were able to show that if their patients removed a variety of carbohydrates (known as FODMAPs, short-chain carbohydrate molecules that are relatively hard to completely digest, thus often  causing bloating, gas, pain, diarrhea), it made no difference whether or not they ingested gluten!

I bring up this issue to highlight a concern I blogged about earlier, namely, my worry that sometimes, with the removal of one type of food from our diet, we unintentionally remove something else, which then leads to unnecessary confusion and even more dietary restrictions.  In addition, restrictive diets risk causing malnutrition, which is particularly worrisome when it comes to children, in whom diet plays such a vital role in normal growth and development.

If you have questions about your child’s GI complaints, diet, or nutrition, the pediatric gastroenterology team at Swedish is here to offer help and support.

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