Wheat- or Gluten Sensitive-IBS, FODMAPs or NCGS?

I’ve recently been chuntering at the computer on seeing all these articles about non-coeliac gluten sensitivity (NCGS) being a wheat- sensitive IBS or FODMAPs problem. It’s good that mainstream peeps are finally realising not all IBSs are caused by the same things and – shock, horror! – that food is involved, but I thought it was about time I waded in and gave my view on it.

In essence, I think this: some NCGSs have gut symptoms only, some have no gut symptoms at all and many have both gut and non-gut symptoms.

Ergo not everyone who has NCGS has gut problems. In fact, we know that most issues are extra-intestinal and certainly neurological. Many experts even believe that, had we found Coeliac Disease now, it would have been classified as a neurological disorder rather than a gut one. I know! (See the free Gluten Summit here for more on that).

For those people who do have IBS-type symptoms of bloating, cramping, wind, upset bowel movements etc, they would probably do well on a wheat-free and/or a low FODMAPs diet. They may also need a traditional gluten free or TrulyGlutenFree grain and dairy free diet if they turn out to have NCGS (non-coeliac gluten sensitivity). However, it may be a simple matter of not being able to digest those foods well enough so I always start with stomach acid and digestive enzymes to help break the foods down. That alone will solve it for some people. (Check the free master list for grain and dairy free versions, of course…)

For those people who have IBS-type symptoms and suspect or (more likely) know to their cost that gluten foods affect them, they may also need a gluten free diet (GFD). In this case, you test for coeliac disease first – before removing any gluten. To do this, use a mainstream test or, better, Cyrex 3, which has far more gluten fractions in it and/or a gluten gene test that looks for all four DQ genes involved in gluten related disorders. If any of that is positive: a GFD is needed.  If negative, diet trial to see if it is wheat-only, gluten-only and/or sensitivity to FODMAP foods (and if it is the latter, check for SIBO). If you don’t get well on a standard GFD, do Cyrex 4 to check cross-reactive and common substitute foods; you may need to be TrulyGlutenFree ie. grain and dairy free). You can see all the Cyrex tests here.

For those people who suspect/know that gluten affects them, but they don’t have gut symptoms – or they have gut symptoms as well as other non-gut ones, they need a GFD or a TGF diet approach, which will remove some FODMAP foods anyway. If those approaches don’t resolve the gut symptoms, try acid and enzymes as above as well. If still getting symptoms, you may need more FODMAPs food removal (and again, look for SIBO). If still not enough help, look at histamines and even as far as the AIP (autoimmune protocol).

I’m actually trying to draw a flow chart for you to illustrate the kind of testing routes you might go with this; it is taking more time than I thought to work it out; it is SO not that simple, is it?! However, I thought this might help in the meantime since there is a lot about it in the media currently. Much of this is discussed in depth in the Gluten Plan, which you can see here.

I hope that makes some sense for now! Essentially, the reports may well be true for some, but certainly not for everyone. For some people with gut symptoms, they may be wheat-sensitive, which I used to find an awful lot. Many may simply not be able to digest foods down well enough – again, I see it a lot. However, more and more, I am finding it is more complex now and they could be gluten-sensitive, have undiagnosed coeliac disease or NCGS, are fermenting FODMAP type foods too much, which may be because of a SIBO infection or a carbohydrate intolerance, or they might have all of those issues! Trust me: it ain’t as simple as a wheat-sensitive IBS in many cases, but it’s a good place to start!

4 Replies to “Wheat- or Gluten Sensitive-IBS, FODMAPs or NCGS?”

  1. Hi Alex! I think, to be honest, it is as it ever was: medics are trying to get people into little boxes and the truth will be that people have all and more of those problems depending on their individual biochemistry and epigenetics etc. I think once the gut is compromised, the pathology can go down several different routes and they often inter-react and exacerbate each other. For example, we now know that someone with a FODMAP problem may well have a carbohydrate intolerance which exacerbates SIBO – and we know that SIBO destroys the DAO enzymes on the top of the villi which leads to histamine problems, so you have a multi-factorial problem! It’s a minefield.

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