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The Difference Between Gluten and Fructan Sensitivity

With all the publicity about supposed gluten sensitivity in the last few years, the family practice doctors at Cohen Associates in Delray Beach, Florida, often have patients coming into our offices announcing they read online that they are allergic to gluten and they are going to stop consuming all wheat. Not only can this lead to a number of health issues, chances are they don’t really have a problem with gluten in food.

First, celiac disease—which is exacerbated by glutens—can only be diagnosed by a doctor. For these people, the smallest amount of gluten can cause diarrhea, abdominal bloating and pain, fatigue, seizures or migraines, severe weight loss, and many other unpleasant and even dangerous symptoms. These are the people who need to avoid gluten, which can even be present in toothpaste. It’s a difficult way to live, but manageable.

 

The dangers in going gluten-free

Second, avoiding gluten when you don’t need to can be dangerous. One study published in Harvard Heath Publishing found that going gluten-free when it’s not medically necessary can cause nutritional deficiencies, including a lack of iron, thiamine, calcium, folate, phosphorus, zinc, and especially, B vitamins. It also notes that whole wheat is a major source of dietary fiber, which the bowels need to function properly. When abstaining from gluten, this lack of fiber contributes to the higher cardiovascular heart risk found in other studies, according to a report published last year in BMJ (formerly the British Medical Journal).

Finally, another study published recently that followed nearly 200,000 U.S. health professionals over 30 years, found that those following a gluten-reduced or gluten-free diet showed a slightly higher risk of developing type 2 diabetes over the study period.

 

It could be fructan sensitivity

But what about those who insist they feel so much better after reducing or eliminating gluten from their diet? It could be because in the process they’ve also reduced their consumption of fructans, a carbohydrate composed of chains of fructose. But just as most people are not truly gluten-intolerant, neither are most of us fructan-sensitive.

Wheat comprises approximately 70 percent of the fructans we consume. (Fructans should not be confused with fructose, a natural sugar found in whole fruits, and often used in a sweetener for processed foods.) When those who believe they are gluten-intolerant eliminate wheat from their diet, they are also reducing the amount of fructans they consume, so this may be responsible for their reduction in symptoms. But fructans occur in many other foods, as well. They are not only found in wheat, but also rye, oats, barley, chickpeas, bananas, onions, lettuce, garlic, leeks, artichokes, and asparagus.

Humans don’t possess the enzyme required to digest fructans, so they are fermented in the gastrointestinal tract. This is not a problem for most people, but some can experience unpleasant or even painful symptoms with a high intake of fructans.

 

Fructan-related symptoms

Here are some of the symptoms that have been associated with fructan sensitivity:

• gas
• bloating
• abdominal discomfort or pain
• constipation
• diarrhea
• nausea
• cramps

Notice that these are the same symptoms so often associated with supposed gluten intolerance, as well as irritable bowel syndrome (IBS) and many other similar conditions. In addition, as you can see from the list above, eliminating all fructan-containing foods would have many of the same health consequences as adhering to a gluten-free diet.

 

Fructan benefits

Fructans contain prebiotics, necessary to maintain good bacteria in the gut. They also help maintain the immune system and healthy blood sugar levels, as well as conferring antioxidant benefits. The fiber contained in fructans (mainly inulin) has been shown to lower the risk of cardiovascular disease, high blood pressure, diabetes, and obesity. Thus, eliminating all fructans from the diet without medical guidance can have long-term—and possibly serious—health consequences.

That’s why it’s best not to self-diagnose such problems, but to let us help you determine the precise cause of your symptoms and design a treatment plan for addressing them.