Does a low FODMAP diet benefit someone with Celiac Disease?

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While many patients with Celiac disease will experience symptom improvements while following a strict gluten-free diet, a portion will continue to experience GI symptoms. This can likely be attributed to the fact that Celiac disease and IBS share a wide range of symptoms, including abdominal discomfort and bloating. People newly diagnosed with Celiac should work closely alongside a dietician to ensure that small amounts of gluten aren’t sneaking into their gluten-free diet. The FODMAP diet has gained traction over the last 5 years, with benefits becoming more and more clear as research progresses. Studies have shown that a low FODMAP diet can be beneficial to those with Celiac disease who experience IBS-like symptoms (Beyond Celiac, 2018; Roncorino et al., 2018). It is worth noting that continuing symptoms may also be associated with factors unrelated to food, such as stress or emotions.

What is Celiac Disease?

Celiac Disease is an autoimmune disorder that occurs in genetically predisposed people (an immediate family member having the disease lends to a 1 in 10 chance for others in the family developing it as well). Since the cause of Celiac is not yet fully understood, it is important to seek testing if symptoms are present. Worldwide the disease affects 1 in 100 people, so it’s more prevalent than you would think.

Celiac is an autoimmune disorder in which the immune system perceives a dietary protein called gluten to be a foreign substance. It is important to note that Celiac is not a food allergy – it is classified as an autoimmune disorder because the presence of gluten merely acts as a trigger which causes the body to damage its own tissues (Canadian Digestive Health Foundation, n.d.). Even though it is a simple protein found in wheat, rye, and barley, it is seen as an invader. The immune system creates antibodies to fight off the invader, resulting in damage to the lining of the small intestine. More specifically, these attacks damage the villi (small, finger-like projections that allow us to best absorb nutrients from food). This vicious cycle means that a person may not be getting what they need from the food they eat, alongside severe discomfort (Beyond Celiac, 2018).

What are FODMAPs?

Let’s breakdown the acronym. FODMAP stands for fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. In super simple terms, FODMAPs are high in fermentable carbohydrates. Wheat and rye both have gluten but are included in the list of high FODMAP foods because they contain a FODMAP called fructan. It is important to remember that foods without gluten are also on the list, like legumes, onions, and dairy products.

FODMAP

Carbohydrates belonging to this food group can cause gas, bloating, and stomach pain. These foods either ferment in the gut causing gas, or pull water into the gut, causing stretch which triggers pain and a change in bowel habits in some individuals.

While many people have some difficulty digesting FODMAPs, people with IBS or other issues are especially susceptible to side effects surrounding consumption of these foods. In fact, 70% of IBS sufferers who adopted a low FODMAP diet experienced significant improvement of symptoms (Celiac Disease Foundation, 2017). It is important to note that the low FODMAP diet is to be used as a short-term elimination diet alongside the help of a registered dietician.

What is the relationship between Celiac disease and FODMAPs?

As seen in various studies, removing FODMAPs from the diet of anyone suffering from IBS-like symptoms (including Celiac patients) can result in a significant reduction in digestive symptoms (Schär Gluten-Free, n.d.). Since many people with Celiac disease will still experience IBS-like symptoms due to the overlap between the two conditions, the benefits from following a low FODMAP diet can greatly improve the quality of life for someone with Celiac (though some symptoms may still remain as a result of factors unrelated to food). When adhered to as a short-term elimination diet, the low FODMAP diet can reduce negative digestive symptoms like bloating, gas, and stomach pain in individuals with Celiac disease, in addition to helping with regular digestion and bowel movements.

Best foods for a low FODMAP Diet

Generally, many of the best low FODMAP foods are whole, natural, and unprocessed. An assessment by a registered dietician will help determine which (if any) eliminations are necessary. Simple substitutions can be made to replace high FODMAP foods, like switching to lactose-free dairy products and milk and aiming for gluten-free breads and pasta. Essentially, the diet should aim to replace high FODMAP foods with low FODMAP alternatives, thus managing the total FODMAP load at each meal. A registered dietician can help guide food substitutions, swapping out one food for another, while ensuring adequate nutrition. The following is a list of some low FODMAP choices:

  • Meat, poultry, fish, and eggs
  • All fats and oils
  • Some nuts and seeds
  • Most herbs and spices
  • Low-fructose fruits (bananas, kiwis, most melons, most berries, citrus)
  • Natural sweeteners (maple syrup, molasses, stevia)
  • Lactose-free dairy products
  • Hard cheeses and aged soft cheeses in certain portions (like brie and camembert)
  • Leafy green vegetables
  • Gluten-free grains (like corn, oats, rice, sorghum, quinoa, tapioca)
  • Uncarbonated beverages (water, some teas, coffee)

When looking for low FODMAP convenience foods, Schär and its extended range of products are all great choices. Check them out here. Schär began testing under the Monash Certification Program to help people shop confidently. Even brands like Kellogg’s, Vegemite, Baker’s Delight, and Freedom Foods Group Limited have followed suit and joined ranks with Schär as being certified low FODMAP brands.

How do I begin the FODMAP diet?

It’s always important to consult a registered dietician before trying anything new! The first phase is an elimination diet, removing all foods high in FODMAP for 2-6 weeks. If you feel significantly better during that time, then certain FODMAPs might be affecting you, which brings us to the second phase. This phase involves a slow reintroduction of foods by type, or group. For example, the lactose group can be introduced (things like milk and cottage cheese). If this introduction doesn’t cause any problems, then another FODMAP group is introduced (always one group at a time).

Once the trigger group(s) have been confirmed, a person can carry on their life as normal, making sure they are reducing the certain foods that are problematic.

Other things to Consider

It is important to mention that research is constantly ongoing, and information is dynamic and often changing. While more studies on FODMAP diets are necessary (especially with larger sample sizes and longer durations), the diet is definitively a step in the right direction for those who suffer from gastrointestinal symptoms (whether the cause is IBS, Celiac, or other).

It’s worth noting that a registered dietician can help determine if the timing is right for attempting a low FODMAP diet, as it may not be ideal for newly diagnosed patients with Celiac working towards a gluten-free diet.

It is especially important that each patient works alongside a dietician in order to ensure that an individualized strategy is attained, and nutrient deficiencies are avoided.

References

Beyond Celiac. (2015, October 28). What are FODMAPs and what’s the connection to Celiac Disease and gluten sensitivity? https://www.beyondceliac.org/celiac-news/what-are-fodmaps-and-whats-the-connection-to-celiac-disease-and-gluten-sensitivity/

Canadian Digestive Health Foundation (n.d.). Understanding FODMAPS. https://cdhf.ca/health-lifestyle/understanding-fodmaps/

Canadian Digestive Health Foundation (n.d.). What is Celiac Disease? https://cdhf.ca/digestive-disorders/celiac-disease/overview/

Celiac Disease Foundation. (2017, October 30). Is a low-FODMAP diet the next big thing? https://celiac.org/about-the-foundation/featured-news/2017/10/low-fodmap-diet-next-big-thing/

Roncoroni, L., Elli, L., Doneda, L., Bascuñán, K. A., Vecchi, M., Morreale, F., Scricciolo, A., Lombardo, V., & Pellegrini, N. (2018). A Retrospective Study on Dietary FODMAP Intake in Celiac Patients Following a Gluten-Free Diet. Nutrients10(11), 1769. https://www.doi.org/10.3390/nu10111769

Schär Gluten-Free. (n.d). Schär favourites officially certified as Low FODMAP. https://www.schaer.com/en-ca/a/schar-fodmap-certified