 Hi, this is Dr. Ruscio and let's discuss what to do if you've gone gluten-free, but you're not fully feeling better from doing that. And good news, essentially, there may be a different diet, the low FODMAP diet, that can help improve the symptoms that may not have improved from going on a gluten-free diet. And a group of researchers recently wanted to assess what type of benefit this type of diet, this low FODMAP diet, may have compared to going gluten-free. In patients with celiac, or I'm sorry, with non-glued, non-celiac gluten sensitivity, or more plainly termed gluten sensitivity, those who are not documented as celiac. So let's talk about this study and some of the important findings that it illustrates. The study title, I'll put the abstract up here on the screen, fruit tan, which is a component, a food component that is restricted on a low FODMAP diet. Fruit tan, rather than gluten, induces symptoms in patients with self-reported, non-celiac gluten sensitivity. This was a study in 59 individuals who had elected to put themselves on a gluten-free diet. And these researchers wanted to see if we give them in a randomized controlled fashion. So no one knows what the subjects are taking, so it's the void of placebo effect. What will happen if we give participants either gluten, fruit tan, or placebo? And as you see here, the overall symptom scores differ significantly during gluten, fruit tan, and placebo challenges. And to continue, there is significantly greater symptomatic reactions to fruit tans than to gluten or to placebo. And if you see here, from the data table in the study, 13 participants had an increase in symptoms after gluten ingestion, 24 after fruit tan ingestion, and 22 after consuming placebo. So one, this shows you how important placebo effect is and why we should be careful when someone says, oh, something helped me. We have to be careful, and that thing may have helped that person, but we want to be careful not to get overly wrapped up in anecdote because placebo, especially when it pertains to digestive symptoms, is a powerful force. Some studies estimate a 45% impact from the placebo effect in controlled studies, so much higher if you're doing this in a non-controlled fashion. But here what we're seeing is clearly a higher amount of reactivity to the fruit tans than to the gluten. And so they continue, there was no difference in symptom scores between gluten and placebo groups. And so they conclude, and I'll quote for you, in a randomized, double-blind, placebo-controlled crossover study of individuals with self-reported non-celiac gluten sensitivity, we found fruit tans to induce symptoms. So what do you do with this? Well, firstly, if you think you're non-celiac gluten sensitive, you very well may be, but you also might actually be sensitive to FODMAPs. So try a low FODMAP diet to determine this. A low FODMAP diet will remove the fruit tans that was noted in this study that can be problematic, and that can aggravate the gut. And give yourself about two to four weeks on the low FODMAP diet, and if you don't see any improvement, then move on. If you do see improvement, ride that way for one to two months, and then try to reintroduce some of the foods that you were avoiding on the low FODMAP diet. You will likely find that many of these foods are okay, but there may be a few that you have to be careful with. And finally, you might also be gluten sensitive, so listen to your body. It's possible that someone may have both of these. We've discussed in other videos in the past how there is legitimacy to non-celiac gluten sensitivity, even though it has been attacked. Now I understand why it has been attacked, because there is certainly overzealousness with recommendations for gluten-free diets, which can be damaging. It's on the one hand helpful to get someone to a gluten-free diet who needs it, great. But when we try to make everyone eat as if they had celiac disease, that creates an overzealous recommendation that does have social and psychological implications to it. And I see it with my patients in the clinic every week. Some people are afraid to go out, afraid to eat off plan, they're withdrawing from social activities because they've been indoctrinated into thinking that they have to live like they have celiac disease. And for many of these patients, not for all, but for many, they're actually able to eat some gluten without any problems, especially after we clean up their gut and repair problems like FODMAP sensitivities. And then they can get back to going out and having some fun. It's not to say we would want to make gluten a dietary staple on these folks, but certainly giving someone the freedom to be able to eat off plan without some severe repercussions is very nice or get them to the point where psychologically they understand that they can eat off plan without having to be fearful of any repercussions. So the gluten-free diet can definitely be helpful. There are some people who are very sensitive, yes, and they should avoid gluten very strictly, especially if you have celiac. There are many who can tolerate some gluten, and there are some that have no problems with gluten at all. And in some of these cases, the underlying provocating factor may actually be fructans which can be avoided in a low FODMAP diet. So remember, if you've gone gluten-free and that's either not helping you at all or it's only partially helping, another dietary consideration that is easy to do and you can evaluate in a two to four week experiment would be a low FODMAP diet. Now, if the low FODMAP diet doesn't help, there are other things you may want to look into like bacterial overgrowth, fungal overgrowth, other inflammatory issues in the gut, and I'm happy to say that in my new book, Healthy Gut, Healthy You, a plan for going through all of this will be laid out. So if you go through the low FODMAP diet and you're still kind of struggling, go to or just look up the book Healthy Gut, Healthy You. You can go to DrRusho.com slash gut book to learn more about that. But in any case, remember, if you've gone gluten-free and it's only partially helping, there's another dietary step of a few potentials. But another one that is definitely worth a primary consideration, which would be the low FODMAP diet. Okay, this is DrRusho, and I hope this information helps you get healthy and get back to your life. Thanks.