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Help or hype?

Fructan, FODMAPs and a new perspective on gluten

Gluten-free. It’s no longer a fringe diet but a lifestyle that has become much more mainstream in recent years, especially in health-conscious Durango.

According to Mintel, a market research company, the gluten-free product industry has increased 44 percent from 2011 to 2013. Locally, the trend has been easy to discern, as grocery stores stock their shelves with gluten-free products and restaurants mold their menus with gluten-free options.

Many people pursue a gluten-free diet to be healthier or to achieve weight-loss goals. But a growing number of people now identify as “gluten-sensitive.” Gluten-sensitivity differs from celiac disease, which is an autoimmune disorder where ingesting gluten damages the small intestine, leading to malabsorption of nutrients, said Mikel Love, a registered dietician and owner of Peak Wellness & Nutrition in Durango.

So, what exactly is gluten sensitivity?

Gluten is a protein found in wheat, and Love said, gluten sensitivity can take many forms, such as “foggy mind,” gastrointestinal symptoms, thyroid issues and skin reactions such as eczema. Gluten sensitivity also can affect energy levels and mood.

But a study published in 2013 in the journal Gastroenterology found that gluten sensitivity actually may be a misnomer. The study concluded that people who say they feel better on a gluten-free diet actually may be sensitive to fructan, a carbohydrate in wheat, not the gluten protein.

Fructan is part of a group of foods referred to as FODMAPs – fermentable oligo-, di- and mono-saccharides and polyols. In addition to wheat, FODMAPs also include food items such as apples, asparagus, most beans, broccoli, garlic, ice cream, onions, pears, yogurt and much more.

“There’s gluten, which is a protein,” Love said. “And most allergies are protein-based. And then, there’s FODMAPs. FODMAPs are short-chain carbohydrates. And a lot of people for whatever reason have problems digesting them. We don’t really know why.”

According to Susie Young, R.D. at the Durango Cancer Center, FODMAPs generally can be characterized as being high in fiber and high in sugar. For people who are sensitive to FODMAPs, the carbohydrates in the food are hard to digest and pull fluid into the gastrointestinal system.

So, should gluten-free individuals switch to a low-FODMAP diet instead?

It depends.

The study only examined individuals whose self-identified gluten-sensitivity resulted in gastrointestinal symptoms. So, if your symptoms relate more to energy, mood and skin, then gluten still may be your culprit. But if you find yourself experiencing abdominal pain, belching, bloating, diarrhea, distention and gas, you may be sensitive to FODMAPs, Young said.

What is a food-sensitive person to do? If you think you have an issue with gluten, Love encourages you to get tested for celiac disease before eliminating gluten from your diet, because once you go gluten-free, the celiac test is no longer accurate. And undiagnosed celiac disease can lead to serious health complications.

If you decide not to test, Young recommends eliminating gluten from your diet for two weeks to see what happens.

“I feel like going gluten-free is fairly easy,” Young said. “And people can notice a difference within about two weeks. And if they don’t see a response to the changes in their symptoms, then that’s not the issue, and we need to look at something else.”

What if you just like eating gluten-free?

“Well, do you feel better when you eat gluten-free? If you do, great,” Love said. “And that’s up to you. If you feel better when you eat gluten-free, then eat gluten-free. Sometimes, the ideology and where it comes from isn’t of most importance but more that you feel better.”

Amita Nathwani, owner of Surya Health and Wellness, said she tries to avoid gluten. “Not because I have a gluten sensitivity, but because when I don’t eat bread, I just feel lighter,” she said.

“When you start looking at it more in terms of quality, then you can start to look to see, does it make me feel heavy? Does it make me feel light? Or am I seriously having some sort of inflammatory reaction? At that point, you can understand whether this is something simple, to incorporate or not incorporate in your life on a day-to-day basis, or if you’re looking at some sort of systemic disorder that needs to be addressed accordingly,” Nathwani said.

“Everything is a medicine, and everything is a poison; it just depends on the person and what their use of it is,” Nathwani said.

OK, but what about those FODMAPs? How do you know if you need to eliminate them?

The only way to officially test for FODMAP sensitivity is a hydrogen test, Young said, which is a lengthy and involved process – not something she generally recommends. Both Love and Young instead recommend an elimination and reintroduction diet to determine if you are sensitive to FODMAPs, which FODMAPs trigger you and what your symptoms are. And FODMAP sensitivity can vary greatly.

“You may be able to tolerate 75 percent of this list but never be able to eat watermelon, because that’s your trigger food,” Young said.

For all you diet-junkies out there, don’t get too excited – the low-FODMAP diet isn’t for everyone. Whereas gluten-free is fairly straightforward and easy to implement, FODMAPs are found in a much larger array of foods.

“It breaks my heart,” Young said. “Because so many of the foods I adore you have to cut out ... all these things that are delicious for us. And to recommend that somebody cut that out, it’s painful.”

However, for people with irritable bowel syndrome and other gastrointestinal symptoms, “if you follow the low-FODMAP diet, 80-85 percent of people experience a decrease in symptoms. And that’s powerful,” Young said.

Instead of jumping on the next diet bandwagon, Love, Nathwani and Young all agree on a pretty straightforward recommendation for those seeking a healthier lifestyle – just eliminate processed foods.

“It’s very boring, it’s not sexy at all, or exciting, but really just whole foods,” Young said. “Get back to making your own meals. Watch your portions. Add some probiotics in. And you can’t get away without exercising. What we recommend is that people cut out processed foods as much as possible and get back to fruits and vegetables, high-quality protein and complex or whole grains.”

But are bandwagons really all that bad?

“The emphasis on gluten-free I don’t think is really understood in its entirety,” Nathwani said. “Everybody wants something that will make them feel better. And in some ways, it has been very helpful. Although it might miss the point, what it has done is it’s built awareness around the amount of carbohydrates that we eat ... and there is a balance. ... Now, a gluten-free diet, does that really solve the problem? It doesn’t, because a lot of times gluten-free products replace the wheat with other types of grains and flours that are often more processed. It doesn’t exactly resolve the issue, but I think it brings some sort of awareness. And at the end of the day, that gives the digestion a little bit of a break.”

Trying to decide?Three Durango residents share their experiences with living gluten-free

Anand McManus

Broker associate, Keller Williams Realty

Gluten-free for 5+ years

For Anand McManus, going gluten-free wasn’t a lifestyle choice, it was a necessity. “I have celiac disease, as does my son, and our whole family is gluten-free,” McManus said.

But gluten-free was just the beginning of her personal food journey. “For me, going gluten-free was just scratching the surface ... If you have celiac disease, the chance of you having a number of other allergies is pretty high,” McManus said. “For me, shifting over to paleo nutrition is where I’ve seen the biggest strides in overall health. And the family really has thrived.

“My husband, being a physician, certainly doesn’t want to endorse that this is the right diet or a better diet. He says the studies aren’t there yet ... And he really hates for me to say that now he feels better on a gluten-free diet. He’ll say, ‘That is not true! I do not feel better on a gluten-free diet!’ OK, so you want me to say you don’t feel better, now you just get sick anytime you have gluten.

“I have observed within myself and with my kids, that they’re just thriving this way.”

McManus is passionate about sharing her experiences and knowledge of going gluten-free and is happy to be a resource for others. For those new to a gluten-free lifestyle, she recommends several local resources: www.glutensolution.blogspot.com, the www.glutenfreedomproject.com, and the free nutrition consultations offered by Natural Grocers.

HHH

Lea Gibbens

Teacher-education student

Gluten-free for 18 months

A year and a half ago, Lea Gibbens was diagnosed with lupus, a chronic, autoimmune disease. “For a long time, I was sick and no one knew what was wrong with me,” Gibbens said. After being diagnosed, Gibbens adopted a gluten-free diet as a way to alleviate her lupus symptoms, which included fever, hives, stomach ache and fatigue. Seven months ago, Gibbens found out that she also is allergic to wheat, soy and peanuts.

“I don’t think it’s super-easy, necessarily, at all, but it’s not the hardest thing ever,” Gibbens said. “And it has also been good for me in that I eat more whole, non-processed foods, because I don’t have to worry about what’s in it. I don’t have to read an ingredient list that’s 1,000 ingredients long. The challenge for me is junk food – that’s fun food. When you go out to dinner at restaurants, most things on the menu have soy and/or gluten in them.

“When I have to ask at a restaurant, I’m like, ‘Oh my god, they’re going to give me that look. Don’t give that look! I have an autoimmune disease, I have a weird allergy, please just let me order how I want to order.’”

So where is Gibbens’ favorite allergy-sensitive place to eat out? She recommends Zia Taqueria and The Intolerant Italian as the establishments where she knows she can always order safely.

HHH

Sandhya Tillotson

Executive Director, The Garden Project of Southwest Colorado

Decided against gluten-free

Sandhya Tillotson has been a lifelong vegetarian, a diet that involves eating a fair amount of gluten. Tillotson had never really considered going gluten-free until an incident a couple winters ago.

“I was having really bad eczema ... on my hands and my legs. And I kept putting lotion on, but it wasn’t getting better, it was just getting worse,” Tillotson said. “I went to a naturopath and she recommended going on a gluten-free, dairy-free diet ... She said that gluten in particular is inflammatory, so it might be inflaming organs within my body, and also inflaming my skin. She said she was prescribing a gluten-free, dairy-free diet to almost everyone that she was meeting with to see if it would help for whatever illness or symptoms they were experiencing.

“But I’m a vegetarian, and I thought it would be an additional challenge ... to go gluten-free and dairy-free. I didn’t know what I would eat. So I decided not to do that. I just didn’t feel that that was quite right for me.”

A couple weeks later when Tillotson went to one of the local food stores to refill her lotion in the bulk aisle, she made a surprising discovery – the “lotion” she had been using for the past few months was actually a creamy hand soap.

“So of course it had been drying out my skin extensively. I realized that I just needed actual lotion. So I got rid of that and just stuck with my high-gluten, vegetarian diet, and I’ve been pretty good ever since.”

Food sources of FODMAPs

This list is not exhaustive. Please consult your health-care practitioner for more information.

Oligosacharides

Artichokes

Asparagus

Broccoli

Cabbage

Onions

Peas

Wheat and rye

Chickpeas

Watermelon

White peaches

Disaccharides (lactose)

Cow, sheep and goat milk

Ricotta and cottage cheese

Yogurt

Ice-cream

Monosaccharides (fructose)

Apples

Pears

Mangos

Peaches

Honey

High-fructose corn syrup

Polyols

Cherries

Plums

Prunes

Avocados

Mushrooms

Cauliflower

Sorbitol



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