Have we got it all wrong about gluten?

So you think you’re gluten intolerant? It might go against the grain, but a growing body of research suggests that gluten might not be the cause of your gut problems at all.

Researchers at King’s College London, working with leaders in the field at Melbourne’s Monash University, believe that types of carbohydrates known as Fodmaps are the likely cause of chronic gut pain and other symptoms often attributed to gluten intolerance.

Standing for Fermentable Oligo-Di-Monosaccharides and Polyols, Fodmaps are types of carbohydrates that are poorly absorbed in the small intestine and researchers now believe are responsible for the stomach pains, bloating, wind and altered bowel habits experienced by those suffering the symptoms of IBS.

Although Fodmaps are found in many foods – legumes, pulses, cow’s milk, soft cheese, yoghurt, and fruit and vegetables including apples, mangoes, onions and garlic just to name a few – they are also present in some foods that contain gluten. So while wheat-based bread, pasta and cereals, for example, might trigger gut symptoms, Fodmaps – not gluten – are the likely culprits, researchers believe.

Researchers here and in Australia now claim a 70 per cent success rate using a low-Fodmap diet to treat the symptoms of Irritable Bowel Syndrome (IBS) and similar gut conditions that have no apparent cause. Although a relatively new concept in the UK, the chances are you will soon be hearing more about it. The National Institute for Health Care and Excellence (NICE) is considering making the low-Fodmap diet a recognised treatment in the UK for the first time.

But experts are warning food faddists not to jump on low-Fodmap diet as their new bandwagon. Although commonly referred to as a diet, experts stress it’s not a long-term eating regime but a diagnostic tool for qualified dietitians only.

According to Dr Miranda Lomer, Senior Consultant Dietitian at King’s College London, the low-Fodmap diet has been “extremely successful” in treating the symptoms of IBS and other gut conditions by identifying, through a process of elimination, particular problem foods. Treatment involves placing patients on a strict low-Fodmap diet for 4–8 weeks, after which foods are gradually reintroduced and monitored over 2–3 months to identify those that trigger symptoms. Sufferers can then remove these foods from their diets long-term.

Dr Lomer said in recent years there had been an increase in the number of people self-diagnosing gluten intolerance and needlessly placing themselves on gluten-free diets without proper medical advice. She said only people with coeliac disease – an autoimmune condition that causes gut inflammation when gluten is ingested and affects 1 per centof the population – needed to go gluten-free. Yet an estimated one in five of the population now buys gluten-free food, contributing to a market worth £238 million in the UK last year (up 15 per cent on the year before) and $2.6 billion in the US.

“It’s like a fad but there’s no hard evidence behind it,” Dr Lomer said. “The most important thing is to have a healthy and varied diet, to exercise and avoid processed foods and stress.”

Many people insist that a gluten-free diet relieves their symptoms. However, researchers at Monash University, who are working to identify and quantify the Foodmaps in different foods, have shown the issue is not clear-cut. Some gluten-free products are suitable for a low-Fodmap diet – those made with rice flour or quinoa, for example. Other gluten-free products, however, also contain troublesome high-Fodmap ingredients like honey or apple. In addition, some foods that are commonly avoided on gluten-free diets – spelt, oats and soy sauce for example – are low in Fodmaps and don’t need to be restricted at all.

But aside from the cost and food restrictions, the bigger concern is whether needlessly going gluten-free could actually be harmful.

“Possibly: we don’t have the answers yet,” Dr Lomer said. “But why put yourself in that situation? A gluten-free diet can cost so much more, it’s extremely restrictive and we need to understand a lot more about gut bacteria before we know what impact a gluten-free diet has.”

Worst of all, some people who diagnose themselves as gluten intolerant might be leaving potentially serious health problems unchecked.

“Anyone with symptoms needs to go to their GP first for a proper diagnosis, that’s crucial,” Dr Lomer said. “All the proper tests need to be done to rule out anything more sinister like coeliac disease or cancer. Once that has happened a low-Fodmap diet might be suitable to try with a trained dietitian.”

King’s is training dietitians in the low-Fodmap treatment – more than 600 have trained so far – but Dr Lomer is concerned they might not be able to meet the demand when the success of the Fodmap approach becomes better known among the public and GPs. She says overuse of antibiotics and increased stress levels appear to be contributing to the rising prevalence of gut problems – between 10-15 per cent now suffer symptoms of IBS or similar, according to the International Foundation for Functional Gastrointestinal Disorders.

“We push our bodies too far,” Dr Lomer said. “For some people, stress and anxiety are as much of a problem for their gut as their diet.”