Nonceliac Gluten Sensitivity (Intolerance)

  • Medical Author:
    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical Editor: Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)
    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Dr. Anand received MBBS degree from Medical College Amritsar, University of Punjab. He completed his Internal Medicine residency at the Postgraduate Institute of medical Education and Research, Chandigarh, India. He was trained in the field of Gastroenterology and obtained the DPhil degree. Dr. Anand is board-certified in Internal Medicine and Gastroenterology.

woman with abdominal pain

Quick GuideGluten-Free Diet

Gluten-Free Diet

What are FODMAPs?

There is another dietary intolerance that can cause gastrointestinal symptoms, the inability to digest FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols). FODMAPs are sugars or sugar-related molecules that are found in fruits and vegetables. The most common example of a FODMAP is fructose, a common, plant-derived food-sweetener. FODMAPs in some individuals are poorly digested and absorbed. They pass through the small intestine and enter the colon where bacteria specific to the colon break them down into gas and other chemicals that can give rise to gastrointestinal symptoms, just like with the lactose in milk in individuals who are lactose intolerant. I am beginning to see an increasing number of patients with self-diagnosed FODMAP intolerance based on the response of reduction of symptoms to the elimination of FODMAPs from their diets. FODMAP intolerance probably is a real entity made more likely by recent changes in dietary patterns which include more fruits and vegetables AND dietary sweeteners. Of course, just as with gluten sensitivity, there is a likelihood of a placebo response to the elimination of dietary FODMAPs.

What is bacterial overgrowth?

Then there is another condition to consider, bacterial overgrowth of the small intestine, a condition in which the bacteria normally found only in the colon move up into the small intestine. Looked at simply, as the bacteria moves from the colon into the small intestine (where they don't normally reside), they are able to get to the food within the small intestine (in particular sugars and carbohydrates), before these can be fully digested and absorbed. They then produce gas and the other chemicals that they normally produce in the colon. As a result, the production of gas and chemicals is greater than normal. Since a gluten-free diet is low in carbohydrates, a gluten-free diet may also reduce symptoms caused by bacterial overgrowth simply because it contains fewer carbohydrates. Bacterial overgrowth clearly exists, but it is difficult to study and remains rather unclear as a cause of gastrointestinal symptoms including IBS. Theoretically, the symptoms of bacterial overgrowth could be aggravated by FODMAP intolerance. Moreover, FODMAP intolerance could be due entirely to bacterial overgrowth or to the presence of specific types of bacteria in the intestine.

Medically Reviewed by a Doctor on 5/4/2015

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