Does FODZYME target gluten? Can FODZYME help those with celiac disease or other gluten-related conditions?Updated 4 months ago

FODZYME targets the FODMAPs fructan, GOS and lactose; not the protein gluten, which is found in cereal grains like wheat, barley and rye. A review of the difference between gluten and fructan can be helpful to guide considerations on whether FODZYME may be suitable for those experiencing digestive issues related to gluten-containing grains:

Wheat, barley and rye: these grains are made up of carbohydrates, proteins, and fats. They contain various types of proteins, but the most common one discussed is gluten, which makes up about 70-80% of wheat's protein content. Other proteins in wheat, including Amylase Trypsin Inhibitors or ATIs, which make up about 4% of the protein content [1]. Wheat, barley and rye are also high in a type of carbohydrate called fructans, which are a category of oligosaccharides defined based on their structure. Fructans are short chains of fructose units with a glucose molecule at the end of the chain. Fructans with more than 10 fructose units are called inulins, which are highly fermentable. Fructans offer significant health benefits, as they supply nutrients to gut microbes.

Celiac Disease: an autoimmune condition where the body’s immune system responds by attacking the small intestine when gluten is consumed. The only treatment for celiac disease is lifelong elimination of gluten.

Wheat Allergy: an immune response to one or more of the proteins in wheat, which triggers both gastrointestinal (GI) and non-GI symptoms. Symptoms may include hives, a runny nose, headaches, asthma and anaphylaxis. Lifelong elimination of gluten is also required for wheat allergy.

Fructan Intolerance: an intolerance to the fructan carbohydrate, a type of high FODMAP 

oligosaccharide fiber found in wheat, barley and rye. The body does not digest oligosacharides, such as fructans, and the small intestine only absorbs about 5-15% of them [2]. Fructans mainly arrive intact in the large intestine (colon), where they are fermented and draw water into the colon. For those with irritable bowel syndrome (IBS), fructans often cause symptoms of bloating, diarrhea and other digestive issues [2]. Fructan tolerance levels vary by individual and there are several strategies and tools to support fructan tolerance (such as use of digestive enzymes like FODZYME with triggering foods).

Non-Celiac Gluten Sensitivity: After celiac disease and wheat allergy have been ruled out, a diagnosis of non-celiac gluten sensitivity may be considered. While research is ongoing, there is some evidence to suggest that ATIs, a type of protein in wheat, may trigger a pro-inflammatory adaptive immune response resulting in both GI and non-GI symptoms, such as brain fog, joint pain and fatigue, hours to days following gluten intake. Non-celiac gluten sensitivity does not have a specific biomarker, therefore, celiac disease, wheat allergy, and fructan intolerance should be ruled out prior to diagnosis and transition to a gluten-free diet [3].

Gluten-Free Diet: as FODMAP awareness and testing methods grow, there is increasing clinical evidence that a reduction in dietary fructans when following a GFD may be responsible for the improvement in GI symptoms for those with IBS. Research on the gluten-free diet (GFD) suggests that it may reduce diarrhea, abdominal pain, and bloating in those with IBS, but this is likely due to the reduction in fructan intake that simultaneously occurs when eliminating gluten-containing grains such as wheat, barley, and rye. Studies comparing the effect of FODMAPs, gluten, or placebo on IBS symptoms have shown gluten in the absence of wheat or other fructan-containing grains like barley is not associated with symptoms. This suggests that fructan, rather gluten, is likely responsible for symptoms in those with IBS [4,5]. A GFD imposes significant social, financial and psychological burden and should only be followed when stricly necessary [6].

Low FODMAP Diet: up to 86% of those with IBS experience relief with the low FODMAP diet and research shows fructans are the most common FODMAP trigger in IBS [7,8]. When following a low FODMAP diet, a gluten trial can be conducted to confirm a fructan intolerance and to rule out gluten intolerance. This consists of consumption of a low FODMAP source of gluten, such as real, traditionally fermented sourdough bread made with wheat flour. If no symptoms occur following consumption of a low FODMAP gluten-containing food, then gluten is likely not the trigger for GI symptoms and fructan intolerance can be confirmed [9].

Conclusion

Wheat, barley and rye contain both the protein gluten, as well as the carbohydrate fructan. After celiac disease and wheat allergy have been ruled out, evidence shows the majority of those who experience GI discomfort following intake of gluten-containing grains are in fact experiencing an intolerance to fructans, not gluten. For those with fructan intolerance, FODZYME can support tolerance to high FODMAP, gluten-containing grains such as wheat, barley and rye. 

If using FODZYME, those with celiac disease and wheat allergy should remain on a strict GFD and those with non-celiac gluten-related conditions will want to limit gluten intake as tolerated. 

FODZYME itself is gluten-free.

References:

1. Leibniz-Institut für Lebensmittel-Systembiologie an der TU München. (2020, August 11). Gluten in wheat: What has changed during 120 years of breeding?. ScienceDaily. Retrieved July 19, 2021 from www.sciencedaily.com/releases/2020/08/200811120112.htm
2. Fedewa, A., & Rao, S. S. (2014). Dietary fructose intolerance, fructan intolerance and FODMAPs. Current gastroenterology reports, 16(1), 370. https://doi.org/10.1007/s11894-013-0370-0 – 4
3. Schuppan, D., Pickert, G., Ashfaq-Khan, M., & Zevallos, V. (2015). Non-celiac wheat sensitivity: differential diagnosis, triggers and implications. Best practice & research. Clinical gastroenterology, 29(3), 469–476. https://doi.org/10.1016/j.bpg.2015.04.002
4. Nordin E., Brunius C., Landberg R., Hellström P.M. Fermentable Oligo-, Di-, Monosaccharides, and Polyols (FODMAPs), but Not Gluten, Elicit Modest Symptoms of Irritable Bowel Syndrome: A Double-Blind, Placebo-Controlled, Randomized Three-Way Crossover Trial. Am. J. Clin. Nutr. 2022;115:344–352. doi: 10.1093/ajcn/nqab337.
5. Skodje G.I., Sarna V.K., Minelle I.H., Rolfsen K.L., Muir J.G., Gibson P.R., Veierød M.B., Henriksen C., Lundin K.E.A. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology. 2018;154:529–539.e2. doi: 10.1053/j.gastro.2017.10.040.
6. Lee AR, Wolf RL, Lebwohl B, Ciaccio EJ, Green PHR. Persistent Economic Burden of the Gluten Free Diet. Nutrients. 2019;11(2):399. Published 2019 Feb 14. doi:10.3390/nu11020399
7. Liu, J., Chey, W. D., Haller, E., & Eswaran, S. (2020). Low-FODMAP Diet for Irritable Bowel Syndrome: What We Know and What We Have Yet to Learn. Annual review of medicine, 71, 303–314. https://doi.org/10.1146/annurev-med-050218-013625
8. Van den Houte K, Colomier E, Routhiaux K, et al. Efficacy and findings of a blinded randomized reintroduction phase for the low FODMAP diet in Irritable Bowel Syndrome. Gastroenterology. Published online February 22, 2024. doi:10.1053/j.gastro.2024.02.008.
9. Barone, M., Gemello, E., Viggiani, M. T., Cristofori, F., Renna, C., Iannone, A., Di Leo, A., & Francavilla, R. (2020). Evaluation of Non-Celiac Gluten Sensitivity in Patients with Previous Diagnosis of Irritable Bowel Syndrome: A Randomized Double-Blind Placebo-Controlled Crossover Trial. Nutrients, 12(3), 705. https://doi.org/10.3390/nu12030705