Is it gluten, fructan, or fructose sensitivity?
The number of people being diagnosed with gluten sensitivity is on the rise ( Leonard MM et al. 2017) but the food option is also increasing from time to time with almost all supermarkets with gluten free options of any popular food and restaurants with gluten free menus increasing. While gluten sensitivity (intolerance) may be the reason for most of the signs and symptoms commonly diagnosed as gluten sensitivity, fructan sensitivity, fructose sensitivity or fructose malabsorption maybe the actual culprit in some of the cases.
A recent study found that among 231 identified as non-celiac gluten sensitive patients only 16% actually responded to gluten challenge while 40% of those in the placebo group that took substances such as xylose, wey protein, corn starch containing fermentable carbohydrates experienced similar or increased symptoms (Molina-Infante J, and Carroccio A 2017).
What is gluten?
Gluten Exorphine B4
Gluten (C24H27N5O9) is a protein that is found in foods such as wheat, barley, and rye. It gets its name from Latin (gluten, which means glue) and it holds foods together to give foods their shape. In some people, the gastrointestinal system become sensitive to gluten and the body produces autoimmune antibodies against gluten with immediate reaction but the antibodies also attack the intestinal micro-villi causing erosion of the villi and malabsorption resulting in systemic and local symptoms and signs including bloating, gas, abdominal cramp, constipation, and joint pains specially in celiac disease.
What is fructose?
Fructose is a 6-carbon monosaccharide carbohydrate commonly available in fruits and bonded to glucose to form sucrose a disaccharide sugar.
What is fructan?
Fructan is an oligosaccharide or polysaccharide carbohydrate which is a soluble dietary fiber found in onion, garlic, tomatoes, wheat, barley, rye, asparagus, and chicory. Fructan is a polymer of fructose. It is one of the foods with high FODMAP (fermentable oligosaccharide, disaccharide, Monosaccharide and Polyols) according to Monash University that conducted an extensive study on highly fermentable foods that cause gas, bloating, abdominal pain, and diarrhea.
Is it gluten, fructose, or fructan intolerance/sensitivity?
Most foods that contain gluten also contain fructan which makes identifying the real culprit difficult. University of Oslo and Monash University researchers conducted a seven day randomized clinical trial where they administered bars containing gluten, fructan and placebo and measured symptom scores using gastrointestinal symptom rating scale irritable bowel syndrome (GSRS-IBS) version (Skodje GI et al. 2017 ). They found a significantly different symptom scores with fructan showing the highest scores followed by gluten and the placebo showing the lowest symptom scores. Given that most gluten containing foods also contain fructan, it it is highly likely that the sensitivity is to fructan rather than to gluten at least in some of the cases. Both fructose, and fructan are high FODMAP according to Monash University study.
High fructose corn syrup
How to identify whether a food contains gluten, fructose or fructan?
The best thing to do is to read the food ingredients before shopping them. Some foods may be marked gluten free but they may contain either fructose or fructan and it is worth paying attention to all the ingredients. This is specially true in cases of dressings that are often marked gluten-free but contain high fructose corn syrup. In addition, onions, garlic, and tomatoes are part and parcel of most foods and one needs to be aware that they are high FODMAPs. So, if you ate a gluten-free meal but still felt bad it is likely that the meal contained fructan or fructose.
There are gluten-free scanning phone app and the FODMAP app that can be used to help easily identify whether foods contain gluten, fructose or fructan. For the gluten-free scanning app, you just scan the bar-code of the item and it tells you whether the item is free of gluten or it may contain ingredients that contain gluten. It is very easy to use. For the FODMAP app, it has a color-coded lists of foods identified as low, moderate and high FODMAP out of which you can select the low FODMAP foods and add to your shopping lists. In addition, it is wise to check the ingredients of dressings to make sure they do not contain high fructose corn syrup or fructan or substances with high FODMAP.
So, are you gluten sensitive but still get symptoms after gluten-free meal? Next time, avoid onion, garlic, tomatoes, high-fructose corn syrup, and other foods with high FODMAP and check your symptoms in the next 3 to 4 hours.
High fructose corn syrup