Fructan - Not Gluten - Could Be Source of Stomach Woes

Turns out that fructan may be the culprit of gastrointestinal issues and you may not have to cut gluten after all.


Think you’re suffering from gluten insensitivity?
A new study finds that it could actually be fructan that your stomach is not tolerating.

A report published in Gastroenterology from researchers at Monash University in Australia and the University of Oslo in Norway states that fructan can cause similar symptoms to those in people with gluten sensitivity.

Fructan is a carbohydrate that is in wheat and some vegetables.
The problem with confusing fructan and gluten is that people may not be accurately diagnosed or treated.

They randomly assigned them to eat diets that included fructan, gluten, or a placebo for a week.
Next, they used a gastrointestinal rating scale.
Those who ate fructan had higher scores on the scale compared to those on gluten and placebo diets.
Participants only reported stomach pain and bloating on fructan — not the other diets.

Fructan vs. gluten
The research indicates some people may needlessly be on a gluten-free diet.

Dr. Amy Burkhart, RD, a physician from California noted that tests for gluten sensitivity or fructan intolerance do not currently exist.
A diagnosis is made from dietary analysis and manipulation.

Celiac disease must be ruled out before the pathway to determine fructan versus gluten is undertaken, as it will require removal of gluten to determine,” Burkhart said. “If gluten is removed from the diet, celiac testing is invalid. If symptoms have resolved with a gluten-free diet, most people will refuse to reintroduce gluten once it is removed… The treatments, diet, and follow-up care are different so differentiation is important.

Dr. Benjamin Lebwohl, MS, who heads up clinical research at the Celiac Disease Center at Columbia University in New York, noted that people can have antibody tests to diagnose celiac disease. It also can show up in an intestinal biopsy

There’s no readily available way to differentiate gluten from fructan as the culprit ingredient in people without celiac disease, Lebwohl added.

The first step to get to the bottom of a suspected sensitivity is to visit your primary care provider to rule out other conditions, as fructan sensitivity can mimic many other conditions.

If your doctor is still considering gluten/wheat sensitivity as a possibility, Burkhart said to seek out someone who specializes in celiac disease/non-celiac wheat sensitivity.

“While one would assume the GI specialists are familiar with this, many are not,” she said.

“I saw a patient just yesterday who most likely had this exact issue and had seen three gastroenterologists. None of them had mentioned it. Symptoms can mimic IBS or colitis, so proper evaluation is imperative,” Burkhart added.

Lebwohl explained that patients who test negative for celiac disease and have a partial response to a gluten-free diet may have a fructan sensitivity that is found after excluding high-fructan foods and noticing an improvement.

That should only be done under the guidance of a registered dietitian because adding further dietary restrictions has its downsides that can lead to nutritional deficiencies, disordered eating, and diminished quality of life.

The future of food sensitivities
Burkhart said the medical community is looking to change the name of non-celiac gluten sensitivity to non-celiac wheat sensitivity.

This is because fermentable, oligo-, di-, monosaccharides, and polyols (FODMAP) sugar intolerance was recognized as a cause of gluten sensitivity.

Then, it was determined there are other components of wheat that are problematic for many people and most often it is not gluten (if celiac has been ruled out).

“There are other components of wheat that appear to be culprits in gluten sensitivity such as the fructans and amylase-trypsin inhibitors (ATI) proteins [found in wheat]. Others are also being investigated,” she noted.
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