Gluten Sensitivity? Or Fructan Intolerance?
Millions of people voluntarily avoid gluten, a protein found in wheat-based foods like bread, cereal and pasta. Individuals with a wheat allergy, known as celiac disease (just about 1% of the population) and certain other autoimmune conditions can get very sick if they consume gluten.
However, an additional 12% of people report digestive symptoms after eating foods that contain gluten, DESPITE their not having a wheat allergy or celiac disease. New research from Norway suggests it’s not gluten that causes issues for these people… it’s a type of FODMAP called a fructan.
What Is A Fructan and Fructan Intolerance?
Fructans are a type of short-chain carbohydrate often referred to as FODMAPs. They can cause unpleasant digestive symptoms for sensitive people, especially those with IBS (Irritable Bowel Syndrome) or IBD (Inflammatory Bowel Disease)
Fructans can be found in foods like:
· wheat, barley and rye
· dried fruit like raisins, dates and prunes
Fructans are a type of short-chain carbohydrate often referred to as FODMAPs. They can cause unpleasant digestive symptoms for sensitive people, especially those with a lactose intolerance who eat dairy. While a food allergy involves the immune system, an intolerance involves the GI tract, meaning you will experience a host of negative digestive symptoms such as gas, bloating, loose stools or diarrhea, and stomach cramping.
Non-Celiac Gluten Sensitivity (NCGS)
Non-celiac gluten sensitivity (NCGS) or “gluten intolerance” is the term used to describe those who react negatively to wheat foods but don’t have celiac disease. NCGS is a real thing, but about 4 in 5 people who think they have it ... ACTUALLY don’t.
A recent review study of data from 1312 adults found that only 16% of those who respond positively to a gluten-free diet actually have a gluten sensitivity.
(STUDY HERE: https://www.ncbi.nlm.nih.gov/pubmed/27523634)
The remainder of people have other sensitivities or a "nocebo" response to gluten, which means they react to non-gluten foods as well.
In other words- people "think" they have a gluten intolerance, when in reality, they don't. Personally, I have run into this A LOT within my coaching practice, people THINK that they need to avoid gluten and really, they are just unnecessarily restricting themselves.
FODMAP researchers suspected that these people might actually be sensitive to fructans, as they are found in many foods with gluten, such as bread and pasta, and interestingly enough, a new study confirms this theory. A Norwegian study published in Gastroenterology looked at 59 people who did not have celiac disease yet found digestive relief with a gluten-free diet.
(STUDY CAN BE FOUND HERE: https://www.ncbi.nlm.nih.gov/pubmed/29102613)
Subjects were randomly assigned to eat seemingly identical muesli bars with either gluten, fructans, or neither (placebo) for seven days. They then crossed over into a different group, until they had completed all three bar diets and recorded their digestive symptoms. Researchers found that symptoms of IBS, especially bloating, were 15% worse after eating the fructan muesli bar compared to placebo.
Interestingly, the gluten bar had no effect on symptoms, which suggests gluten is not the culprit after all. The lead author of the study believes that these findings strongly support the idea that fructans in wheat are the trigger of unfavorable digestive symptoms, not gluten. It also helps explain why researchers have been left stumped trying to figure out how gluten causes issues for non-celiacs.
It’s Not The Gluten, But Gluten-Free May Still Help You
The reason a gluten-free diet likely helps you feel better – even though you aren’t sensitive to gluten – is simple: gluten-free grains are automatically low in FODMAPS (including fructans). Likewise, the removal of gluten from wheat also removes the majority of FODMAPs. That’s why low FODMAP diet programs are gluten-free.
So by choosing gluten-free breads, pastas and cereal, people have inadvertently been reducing their consumption of fructans as well, which leads to symptom relief. For this reason avoiding gluten can still be useful for those with fructan intolerance. HOWEVER, a gluten-free diet may be overly restrictive of gluten-containing foods that are low in fructans. For example, sourdough bread has gluten but its fermentation process removes the fructans. Soy sauce also contains gluten but is low in fructans. Beer comes to mind as well. These foods are off-limits on a gluten-free diet, yet unnecessary to restrict for the vast majority of people out there. So in other words, you may be unnecessarily restricting yourself by trying to adhere to a strict gluten free diet. Avoiding FRUCTANS would likely be best.
The other issue is that most people with digestive issues don’t ever fully recover on a gluten-free diet. This is because FODMAPs (including fructans) are the likely culprit and it's a LOW FODMAP diet- NOT a gluten free diet- that's what's required.
If you’re still unsure about your perceived gluten sensitivity, try this:
Think about if you’ve ever had bloating, excessive gas, or diarrhea several hours after eating any of the following high-fructan foods that don’t contain gluten:
· These fruits: watermelon, grapefruit, nectarine, persimmon, plums, pomegranate, ripe bananas, dates, prunes and raisins
· These vegetables: onions, shallots, leeks, asparagus, artichoke, beets, Brussels sprouts, savoy cabbage, fennel and snow peas
· Kidney beans, black beans, lima beans, mung means, navy beans and split peas
· Cashews and pistachios
· Garlic and inulin (aka chicory root) and some soy products
If so- it's likely FRUCTANS, not the GLUTEN, that is the issue.
If you suspect a fructan intolerance, the best approach is to avoid fructans entirely for two to four weeks. If digestive symptoms improve during that time, then you’ll know there’s a problem digesting fructans. After the initial elimination, gradually add fructan-containing foods back into your diet one at a time in small, controlled amounts to determine your individual intolerance.
Why you shouldn't eliminate fructans forever
Fructans can be a beneficial part of the diet – they can be considered a good source of prebiotics, meaning they feed the good bacteria in the gut. Additionally, fructans have been linked to improvements in blood glucose, triglycerides and the improvement of lipid metabolism and immune function. And truthfully, a diverse diet supports the most diverse gut microbiome, which in turn supports good health overall. Furthermore, stress and anxiety over having to avoid certain foods indefinitely can lead to an increase in the negative digestive symptoms you're trying to improve with a low-FODMAP or low-fructan diet, because stress and anxiety both exacerbate, or worsen digestive health. Even if you DO have a fructan intolerance, it's important to assess your individual tolerance of certain fructans and reintroduce them in amounts as tolerated.
A note on self diagnosing food intolerances or sensitivities
It's not necessarily 'healthy" to continue to avoid foods high in FODMAPs or fructans indefinitely. Elimination should always be followed by a careful, systematic reintroduction. Reintroduction helps you identify which fructan-containing foods are most bothersome and in what quantities.
Whenever I have a client working with me through a digestive health reset I always require that he/she keep a detailed food and symptom diary to help them determine which foods are best avoided long-term, which foods can be reintroduced or consumed, and at what frequency and in what amounts.
If you need help sorting through the details of a digestive health reset or a low FODMAP approach- email me: Allisonmoyer@live.com