I have been gluten free for over a year, but still have symptoms when I eat too much sugar. Is this affiliated with CD at all?
I am assuming that you do not have diabetes in answering this question.
It is not uncommon for patients with celiac disease (and/or other gastrointestinal disorders) to experience symptoms when they ingest poorly absorbed sugars (carbohydrates), known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). FODMAPs pass through the digestive tract and reach the colon undigested where they are fermented by the bacteria there, resulting in gas, cramping, loose stool or diarrhea. FODMAPs include fructose (apples, pears, honey, corn syrup, to name a few), fructans (wheat, rye, garlic, onions), galactans (cabbage, legumes such as lentils), lactose (milk, milk products), and polyol sweeteners (sorbitol, xylitol, mannitol, and isomalt, and the foods that contain them, such as sugar-free products).
Generally, when someone comes into clinic complaining of gas, cramps, loose stool or diarrhea, and it is evident that he/she is not ingesting gluten, I think of FODMAPs as a possible cause of the GI distress. There are specific breath tests for lactose and fructose that can be done in the clinic. They involve drinking a sugar solution and then breathing into a device every 30 minutes for about 2.5 hours. If the sugars are not being absorbed properly, there will be a rise in hydrogen or methane resulting from the fermentation of the sugar by the bacteria in the colon. Some people choose to take this test; others choose to do a trial of a low FODMAPs diet at home. This trial involves avoiding the major FODMAPs for a period of 6-8 weeks. If symptoms improve, FODMAPs are slowly retrialed in small amounts to test the tolerance of the intestinal tract after the healing period. If symptoms do not improve, then it is likely that the low FODMAP diet will not be of much use. Of note, sometimes a person’s symptoms will not improve on the diet but when he/she reintroduces the FODMAPs, the symptoms are worse. In this case, the diet may still be helpful. Most people find, over time, that they can return to eating small amounts of these “problem” foods.
If you feel that absorption of sugars might be an issue for you, it is recommended to discuss the possibility of breath testing or home trial testing with your doctor or gastroenterologist. If you trial a low FODMAPs diet, it is best done under the supervision of a dietitian who will ensure you maintain a healthy and balanced diet during and after your trial. A dietitian will also likely be able to assess which particular FODMAPs are giving you trouble so that you may not need to avoid all of them.
You might also like to read the Q & A from Sarah, where I discuss FODMAPs a bit more.
Melinda Dennis, MS, RD, LDN
Melinda Dennis, MS, RD, LDN and Daniel Leffler, MD, MS. Malabsorption of Fructose, Lactose, and Related Carbohydrates in Real Life with Celiac Disease. American Gastroenterology Advisory Press, Bethesda, MD, 2010.
Barrett JS, Gibson PR. Clinical ramifications of malabsorption of fructose and other short-chain carbohydrates. Pract Gastroenterol 2007;XXXI(8):51-65.
Gibson PR, Newnham E, Barrett JS, Shepherd, S, Muir JG. Fructose malabsorption and the bigger picture (review). Aliment Pharmacol Ther 2007;25:349-63.