Gluten-free diets are more popular than ever, with nearly 30% of adults now limiting their intake or avoiding gluten entirely.1Priyanka P, Gayam S, Kupec JT. The role of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet in nonceliac gluten sensitivity. Gastroenterol Res Pract. 2018;2018:1561476. https://doi.org/10.1155/2018/1561476 Gluten is the most abundant natural protein in grains such as wheat, rye, barley, and spelt. It’s also a surprise ingredient in condiments like soy sauce, malt vinegar, and salad dressing. While some people have no problems with gluten, others may experience digestive issues, abdominal pain, rashes, and brain fog.2Abdi F, Zuberi S, Blom JJ, Armstrong D, Pinto-Sanchez MI. Nutritional considerations in celiac disease and non-celiac gluten/wheat sensitivity. Nutrients. 2023;15(6):1475. https://doi.org/10.3390/nu15061475 Diet modifications for gluten intolerance abound but aren’t always necessary. Before cutting bread and pasta from your diet, it’s important to understand that gluten isn’t always the culprit for gastrointestinal woes.
Celiac Disease vs. Gluten Intolerance
Celiac disease is an autoimmune condition that can cause severe abdominal pain and discomfort. In addition to irritating the intestines, people with celiac disease may not sufficiently absorb nutrients from certain foods. Gluten sensitivity or intolerance is common but doesn’t necessarily indicate celiac disease. Digestive symptoms (stomach pain, diarrhea, constipation, bloating) are often similar; however, people with nonceliac gluten sensitivity (NCGS) may also experience headaches, brain fog, rashes, fatigue, anemia, and joint pain.3Losurdo G, Principi M, Iannone A, et al. Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm. World J Gastroenterol. 2018;24(14):1521-1530. https://doi.org/10.3748/wjg.v24.i14.1521
Although blood tests and biopsies for celiac can confirm the disease, NCGS is harder to diagnose. If you regularly experience gastrointestinal and other symptoms after eating gluten (and doctors have ruled out celiac disease), NCGS may be responsible. Researchers suspect NCGS is more common than celiac disease.1Priyanka P, Gayam S, Kupec JT. The role of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet in nonceliac gluten sensitivity. Gastroenterol Res Pract. 2018;2018:1561476. https://doi.org/10.1155/2018/1561476
Nonceliac Wheat Sensitivity
Gluten isn’t the only wheat component that contributes to digestive complications and mental fatigue. Experts note the need to recategorize nonceliac gluten sensitivity to nonceliac wheat sensitivity (NCWS), which affects up to 13% of the general population. Recent research shows that eating foods with hard-to-digest fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) and amylase-trypsin inhibitors (ATIs) may trigger symptoms indistinguishable from NCGS.4Catassi C, Catassi G, Naspi L. Nonceliac gluten sensitivity. Curr Opin Clin Nutr Metab Care. 2023;26(5):490-494. https://doi.org/10.1097/MCO.0000000000000925
Wheat is a primary source of FODMAPs, which, like gluten, can cause abdominal pain, gas, and bloating. Although ATIs make up only 2% to 4% of the proteins in wheat, they have also been known to induce digestive distress.4Catassi C, Catassi G, Naspi L. Nonceliac gluten sensitivity. Curr Opin Clin Nutr Metab Care. 2023;26(5):490-494. https://doi.org/10.1097/MCO.0000000000000925
Eliminating Gluten and Other Sources of GI Distress
The first step is determining whether gluten sensitivity or intolerance is at play. Try removing suspected foods from your diet for five to six weeks, then reintroducing them—one at a time. Symptoms such as gas, bloating, abdominal pain, headaches, changes in stool, trouble concentrating, and skin reactions may all indicate inflammation—one of your body’s natural responses to foods it may not tolerate well. Naturopathic doctors can also test for food sensitivities and suggest diet modifications.
The Gluten-Free Diet
Diets eliminating gluten reduce digestive and non-digestive symptoms for most people with a sensitivity or intolerance. But there are health considerations when going gluten free, such as a potential lack of certain vitamins and minerals.
Options in the gluten-free section of your local grocery store have likely expanded over the past few years. Because vitamins and minerals are not always added back to these products (as they commonly are with wheat and other foods produced in the United States), micronutrient deficiencies are possible.2Abdi F, Zuberi S, Blom JJ, Armstrong D, Pinto-Sanchez MI. Nutritional considerations in celiac disease and non-celiac gluten/wheat sensitivity. Nutrients. 2023;15(6):1475. https://doi.org/10.3390/nu15061475 Some products are also higher in calories, simple carbs, and saturated fats.
An ideal gluten-free diet incorporates mostly fresh, unprocessed foods, while ensuring sufficient nutrients like protein, iron, calcium, zinc, copper, and vitamins D, B, A, and E.5Aljada B, Zohni A, El-Matary W. The gluten-free diet for celiac disease and beyond. Nutrients. 2021;13(11):3993. Published November 9, 2021. https://doi.org/10.3390/nu13113993 Fruits, vegetables, legumes, most dairy products, and meat are all naturally free of gluten.
Start by diversifying your grain portfolio. Try swapping wheat, rye, kamut, and spelt with these naturally gluten-free alternatives:
- Rice
- Corn
- Tapioca
- Millet
- Sorghum
- Teff
- Buckwheat
- Quinoa
Although oats are naturally gluten free, they are often processed in the same facilities as foods that contain gluten. Some products might not list gluten as an ingredient but may become contaminated during manufacturing.2Abdi F, Zuberi S, Blom JJ, Armstrong D, Pinto-Sanchez MI. Nutritional considerations in celiac disease and non-celiac gluten/wheat sensitivity. Nutrients. 2023;15(6):1475. https://doi.org/10.3390/nu15061475 Scan the label for terms like “pure” and “certified gluten-free” to be sure. Surprising sources of gluten include sauces, prepared soups, ice cream, sausages, candy, desserts, and fruit nectars.
The Low FODMAP Diet
More people with irritable bowel syndrome and various wheat sensitivities are trying a low FODMAP diet. FODMAPs include sugar alcohols and other sweeteners: fructose, lactose, fructans, galactans, xylitol, sorbitol, maltitol, and mannitol.1Priyanka P, Gayam S, Kupec JT. The role of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet in nonceliac gluten sensitivity. Gastroenterol Res Pract. 2018;2018:1561476. https://doi.org/10.1155/2018/1561476
Bacteria quickly ferment FODMAPs in the intestines, causing digestive distress (bloating, gas). Low FODMAP diets may improve vitality while reducing bloating, abdominal pain, fatigue, and depression.1Priyanka P, Gayam S, Kupec JT. The role of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet in nonceliac gluten sensitivity. Gastroenterol Res Pract. 2018;2018:1561476. https://doi.org/10.1155/2018/1561476
A Blended FODMAP–Gluten-Free Approach
For people with NCWS, combining a low FODMAP and gluten-free diet may more effectively alleviate digestive and non-digestive symptoms.1Priyanka P, Gayam S, Kupec JT. The role of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet in nonceliac gluten sensitivity. Gastroenterol Res Pract. 2018;2018:1561476. https://doi.org/10.1155/2018/1561476
Why do these diets work better together? Although plenty of people find relief with an exclusively gluten-free eating plan, this doesn’t work for everyone. When symptoms persist, FODMAP sensitivity could be responsible.
Because gluten-free diets are often high in FODMAPs, distinguishing gluten intolerance from FODMAP sensitivity can be challenging. Lactose, fructan, and sucrose—all FODMAPs—are common additives in gluten-free flour.
Before trying a low FODMAP diet, consult your healthcare practitioner, who can also help determine whether you may be sensitive to gluten, FODMAPs, or both.4Catassi C, Catassi G, Naspi L. Nonceliac gluten sensitivity. Curr Opin Clin Nutr Metab Care. 2023;26(5):490-494. https://doi.org/10.1097/MCO.0000000000000925 A low FODMAP diet is not a permanent change, but it can be part of an elimination and reintroduction process to determine which foods (if any) cause a reaction.1Priyanka P, Gayam S, Kupec JT. The role of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet in nonceliac gluten sensitivity. Gastroenterol Res Pract. 2018;2018:1561476. https://doi.org/10.1155/2018/1561476
Temporarily replace these foods:
- Lactose: soft cheeses, milk, cream, yogurt, ice cream
- Fructans: wheat (pasta, bread, couscous), barley, broccoli, artichokes
- Galactooligosaccharides (GOS): lentils, chickpeas, dried beans
- Polyols: artificial sweeteners, apples, cherries, cauliflower, mushrooms
with these foods:
- Hard cheeses; lactose-free products made with rice, almond, or coconut
- Rice, gluten- and rye-free bread and pasta, quinoa, oats, oat bran, corn, buckwheat, popcorn, potato
- Oranges, strawberries, cantaloupe, lemons, limes
- Peas, celery, carrots, spinach, lettuce, green peppers, green beans, bean sprouts, turnips, turnip greens, cucumbers
- Almonds (in small amounts), peanuts, walnuts
- Beef, pork, chicken, eggs, tofu6Fedewa A, Rao SS. Dietary fructose intolerance, fructan intolerance and FODMAPs. Curr Gastroenterol Rep. 2014;16(1):370. https://doi.org/10.1007/s11894-013-0370-0
Nutritional Supplements to Reduce Digestive Symptoms
Of course, accidental gluten ingestion happens from time to time. What can you do to diminish the inevitable bloating and stomach pain? Supplemental enzymes may help break down gluten early in the digestive process, preventing a certain amount from reaching your intestines and potentially limiting adverse reactions.4Catassi C, Catassi G, Naspi L. Nonceliac gluten sensitivity. Curr Opin Clin Nutr Metab Care. 2023;26(5):490-494. https://doi.org/10.1097/MCO.0000000000000925
The Potential Link Between Glyphosate and Gluten Intolerance
Recent research has questioned wheat cultivation practices that could contribute to digestive and cognitive symptoms. As it turns out, how wheat is grown matters.
Wheat crops are commonly treated with glyphosate, a popular herbicide (weed killer), before harvest. Glyphosate has come under fire in recent years as a possible carcinogen.7Lehman PC, Cady N, Ghimire S, et al. Low-dose glyphosate exposure alters gut microbiota composition and modulates gut homeostasis. Environ Toxicol Pharmacol. 2023;100:104149. https://doi.org/10.1016/j.etap.2023.104149
Whether glyphosate is harmful to people has been widely debated. Once thought to impede amino acid production in only plants and microorganisms (like bacteria)7Lehman PC, Cady N, Ghimire S, et al. Low-dose glyphosate exposure alters gut microbiota composition and modulates gut homeostasis. Environ Toxicol Pharmacol. 2023;100:104149. https://doi.org/10.1016/j.etap.2023.104149,8Barnett JA, Gibson DL. Separating the empirical wheat from the pseudoscientific chaff: a critical review of the literature surrounding glyphosate, dysbiosis and wheat-sensitivity. Front Microbiol. 2020;11:556729. https://doi.org/10.3389/fmicb.2020.556729, environmental accumulation has heightened concerns about potential human side effects. Some European countries, such as Italy, have banned pre-harvest glyphosate use, while France and Germany plan to ban the chemical entirely.8Barnett JA, Gibson DL. Separating the empirical wheat from the pseudoscientific chaff: a critical review of the literature surrounding glyphosate, dysbiosis and wheat-sensitivity. Front Microbiol. 2020;11:556729. https://doi.org/10.3389/fmicb.2020.556729
Bacteria influence nearly all aspects of human health. The gut microbiome houses trillions of microorganisms that affect numerous bodily systems: hormone regulation, immunity, and more. Because glyphosate may interfere with good gut bacteria, it may also allow harmful bacteria, such as E. coli and S. aureus, to thrive. The resulting imbalance could lead to inflammation, obesity, abdominal pain, diarrhea, acid reflux, anxiety, and depression. Some research suggests glyphosate-induced dysbiosis is a risk factor for celiac disease in predisposed people.8Barnett JA, Gibson DL. Separating the empirical wheat from the pseudoscientific chaff: a critical review of the literature surrounding glyphosate, dysbiosis and wheat-sensitivity. Front Microbiol. 2020;11:556729. https://doi.org/10.3389/fmicb.2020.556729,9Lerner A, Arleevskaya M, Schmiedl A, Matthias T. Microbes and viruses are bugging the gut in celiac disease. Are they friends or foes? Front Microbiol. 2017;8:1392. Published August 2, 2017. https://doi.org/10.3389/fmicb.2017.01392
Eliminating wheat does not guarantee zero glyphosate exposure, as chemical residues appear in many crops, including legumes, corn, and soy. However, wheat products tend to contain higher herbicide residues post-processing, accounting for a significant portion of the average North American’s dietary glyphosate exposure.8Barnett JA, Gibson DL. Separating the empirical wheat from the pseudoscientific chaff: a critical review of the literature surrounding glyphosate, dysbiosis and wheat-sensitivity. Front Microbiol. 2020;11:556729. https://doi.org/10.3389/fmicb.2020.556729 The Environmental Protection Agency reports glyphosate is not likely carcinogenic to people “at doses relevant to human health risk assessments.”10Glyphosate. Environmental Protection Agency. Updated September 11, 2023. Accessed February 14, 2024. https://www.epa.gov/ingredients-used-pesticide-products/glyphosate#:~:text=No%20evidence%20that%20glyphosate%20causes,Research%20for%20Cancer%20(IARC) More research is needed to understand exactly how glyphosate affects the body.
Footnotes
- 1Priyanka P, Gayam S, Kupec JT. The role of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet in nonceliac gluten sensitivity. Gastroenterol Res Pract. 2018;2018:1561476. https://doi.org/10.1155/2018/1561476
- 2Abdi F, Zuberi S, Blom JJ, Armstrong D, Pinto-Sanchez MI. Nutritional considerations in celiac disease and non-celiac gluten/wheat sensitivity. Nutrients. 2023;15(6):1475. https://doi.org/10.3390/nu15061475
- 3Losurdo G, Principi M, Iannone A, et al. Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm. World J Gastroenterol. 2018;24(14):1521-1530. https://doi.org/10.3748/wjg.v24.i14.1521
- 4Catassi C, Catassi G, Naspi L. Nonceliac gluten sensitivity. Curr Opin Clin Nutr Metab Care. 2023;26(5):490-494. https://doi.org/10.1097/MCO.0000000000000925
- 5Aljada B, Zohni A, El-Matary W. The gluten-free diet for celiac disease and beyond. Nutrients. 2021;13(11):3993. Published November 9, 2021. https://doi.org/10.3390/nu13113993
- 6Fedewa A, Rao SS. Dietary fructose intolerance, fructan intolerance and FODMAPs. Curr Gastroenterol Rep. 2014;16(1):370. https://doi.org/10.1007/s11894-013-0370-0
- 7Lehman PC, Cady N, Ghimire S, et al. Low-dose glyphosate exposure alters gut microbiota composition and modulates gut homeostasis. Environ Toxicol Pharmacol. 2023;100:104149. https://doi.org/10.1016/j.etap.2023.104149
- 8Barnett JA, Gibson DL. Separating the empirical wheat from the pseudoscientific chaff: a critical review of the literature surrounding glyphosate, dysbiosis and wheat-sensitivity. Front Microbiol. 2020;11:556729. https://doi.org/10.3389/fmicb.2020.556729
- 9Lerner A, Arleevskaya M, Schmiedl A, Matthias T. Microbes and viruses are bugging the gut in celiac disease. Are they friends or foes? Front Microbiol. 2017;8:1392. Published August 2, 2017. https://doi.org/10.3389/fmicb.2017.01392
- 10Glyphosate. Environmental Protection Agency. Updated September 11, 2023. Accessed February 14, 2024. https://www.epa.gov/ingredients-used-pesticide-products/glyphosate#:~:text=No%20evidence%20that%20glyphosate%20causes,Research%20for%20Cancer%20(IARC)