whole grains

Is It the Gluten or the FODMAPs? – A Confusion, Explained

A common misconception about the low FODMAP diet is that it is a gluten-free diet. This is understandable as gluten-containing grains - wheat, barley, and rye - are greatly reduced or avoided during the elimination phase. For some people, these foods trigger common digestive symptoms (gas, bloating, abdominal pain, constipation or diarrhea). What is it in these foods that is responsible for the symptoms? Let’s dig in.

Gluten vs Fructans

Gluten is the main protein in wheat, barley and rye and needs to be avoided by people diagnosed with celiac disease. People with non-celiac gluten sensitivity (NCGS), a newly recognized condition that occurs when someone has a reaction from eating gluten but does not have celiac disease or a wheat allergy, also feel better when avoiding these grains and their products. These conditions are typically diagnosed by a gastroenterologist. Finally, people with a wheat allergy need to avoid all varieties of wheat (including spelt, kamut, einkorn, farro/emmer and triticale).

Fructans are a type of carbohydrate in gluten-containing grains, one of the FODMAPs (within the larger category of oligosaccharides, the “O” in FODMAP – more on this topic in a future article of my FODMAP Series). The common confusion comes from the fact that both gluten and fructans co-exist in wheat, barley and rye. The reason why these grains are reduced in the low FODMAP diet is that the fructans are poorly digested in people with IBS and may trigger symptoms. During the elimination phase, gluten-free grains like rice, quinoa, buckwheat and millet become a staple but small amounts of wheat can still be included. The main wheat-containing food allowed is true sourdough bread, as the fructans have been “digested” by the live cultures during a long process of fermentation, which reduces the fructan content of the bread. Soy sauce and even one small slice of regular wheat bread are usually tolerated and considered low FODMAP. In conclusion, the low FODMAP diet is not a gluten-free diet.

Not all gluten-free products are low FODMAP

During the elimination phase of the low FODMAP diet people rely on gluten-free grains and some gluten-free alternatives to bread, pasta, crackers and cookies assuming these are low in FODMAPs. It is important to point out that not all these packaged products are necessarily low in FODMAPs. When looking at a gluten-free product you need to become an expert label reader. Although the main flours used are low FODMAP (rice, tapioca, cassava), there are very often high FODMAP ingredients such as honey, agave, pear or apple juice (used as sweeteners), inulin or chicory (added to increase the fiber content) and others.

Take home message

Many people report feeling better on a gluten-free diet but don’t necessarily know why. Is it because they are sensitive to gluten, or the fructans? If you are one of them, I strongly encourage you to get a proper diagnosis first. If celiac disease or NCGS are diagnosed, then you will know that you need to avoid gluten-containing grains and their products. If you are found to have a wheat allergy, you will need to avoid all wheat products.

If you don’t have any of these conditions or continue to have symptoms on a gluten-free diet, the fructans (FODMAPs) may be to blame. Working with a dietitian to identify the source of the problem may help you liberalize your diet and find that you don’t need to unnecessarily avoid all gluten-containing grains and products. Interestingly, a recent study from Monash University (Biesiekierski et al, Gastroenterology 2013) found that only a small percentage of the subjects who had both IBS and NCGS were indeed sensitive to gluten (8%) but all felt better while eating a low FODMAP diet, suggesting that the FODMAPs had the greatest impact in their digestive symptoms.

5 Tips to Eat More Fiber on a Low FODMAP Diet

We all know fiber is a good thing. We keep reading articles about it in magazines and see packaged foods boasting "high fiber" claims in bold letters. Indeed, fiber has several health benefits: it helps our intestines function regularly and may help lowering cholesterol and blood sugar levels. 

People with IBS need to be careful about the amounts and types of fiber they eat so not to experience unwanted symptoms. Certain fibers are rapidly fermented in the large intestine and may lead to bloating, abdominal pain and excess gas. A few examples of foods that contain these types of fiber are onions, artichokes, wheat, and beans. These are the fibers a low FODMAP diet is designed to minimize.

Other types of fiber are slowly fermented and better tolerated, for example, the fiber in brown rice, kiwis, raspberries, carrots, and chia seeds.

How much fiber do we need? According to the Dietary Guidelines for Americans, and adequate fiber intake is 25 g per day for women and 38 g per day for men up to the age of 50 (a little less for older people). This is, however, for the general (healthy) population (sadly, most Americans consume too little fiber, an average of 15 g per day). Monash University recommends people with IBS eat between 25 and 30 g of fiber per day.

Here are 5 tips to eat more fiber:

1.     Don't be afraid to consume some fiber. Remember, this is a low FODMAP diet, now a zero FODMAP diet. On the other hand, don’t overdo it. Depending on your IBS subtype and symptoms (diarrhea or constipation), you might need to be on the low or high end of those recommendations. As you increase your fiber intake, make sure to also drink enough water during the day.

2.     Be sure to choose low FODMAP whole grains (brown rice, millet, quinoa) and don't limit yourself to the "white" stuff. There is a tendency for people to gravitate towards either avoiding grains altogether or mostly eat white rice, white-rice flour based products (crackers, gluten-free bread). By including more whole grains, in addition to the fiber (2-4 grams per cup of cooked brown rice, quinoa, quinoa-corn pasta or millet), you will get other important nutrients as well.

3.     Choose a variety of low FODMAP fruits and vegetables (keep the skin on) in small portions (1/2 cup is a good benchmark and will provide 2-4 grams of fiber) and spread them out throughout the day. Try some of these:

  • Fruit: raspberries, blueberries, strawberries, kiwifruit, oranges

  • Vegetables: carrots, radishes, kale, Swiss chard, eggplant

4.     Some canned legumes are ok even during the elimination phase (rinse and drain first). Try up to ½ cup per meal or snack (5-8 grams of fiber):

  • Lentils (great in soup, salads or chili)

  • Chickpeas (they are delicious roasted as a snack or sprinkled on salads)

  • Fresh or frozen edamame (boiled and rinsed)

5.     Don’t forget the nuts and seeds. In small amounts, these can contribute good amounts of fiber without triggering symptoms. Try up to 2 tablespoons per meal or snack (1-2 grams of fiber in most nuts/seeds; 10 grams in chia seeds):

  • Nuts: almonds or walnuts – great sprinkled on hot rice/quinoa cereal for breakfast

  • Seeds: pumpkin seeds (good by themselves or as topping for tacos) and chia seeds (in a smoothie or as chia pudding – see my recipe for Cocoa Chia Pudding below - who thought that eating more fiber could look like this?)

Finally, if you feel you need a fiber supplement, consult a dietitian before trying one on your own. If you choose the wrong fiber, you may make your symptoms worse. An expert dietitian can recommend one most suitable to your IBS subtype.

AdobeStock_Chocolate chia pudding.jpeg

Cocoa Chia Pudding

Ingredients

1 ½ cups unsweetened almond milk

¼ cup chia seeds

1 tablespoon unsweetened cocoa or raw cacao powder

1 packet powdered stevia (1 g)

1 teaspoon vanilla extract

A few chocolate shavings or 2-3 raspberries per serving to top (optional)

Procedure

1.     Combine the almond milk, chia seeds, cocoa, stevia, and vanilla extract in a bowl. Whisk until well combined and the mixture begins to thicken. Cover the bowl with plastic wrap and let sit in the refrigerator overnight or for 6-8 hours.

2.     When the pudding has set, give it one more stir, then portion into single-serve bowls. Alternatively, heat up in the microwave for a warm pudding.

3.     You can top with a small amount of shaved chocolate or 2-3 raspberries per serving, if desired.

Yield: 2 servings

Storage: Store in the refrigerator in an airtight container for up to 4 days.

Author: Antonella Dewell, Registered Dietitian Nutritionist & Natural Chef