Gluten Intolerance & Fructose Malabsorption: Digesting the Differences Food Online Australia

09 Nov ,2024

Gluten Intolerance & Fructose Malabsorption: Digesting the Differences

Gluten intolerance and fructose malabsorption are very common, and while they are two unique conditions, they often coexist.

This blog delves into some key reasons why these two conditions may occur together, the nutritional consequences of both, and how dietary management can be effective in achieving symptom relief.

Shared Gastrointestinal Sensitivities

In Coeliac Disease & suspected gluten intolerance and fructose malabsorption, it can be challenging to pinpoint whether gluten or fructose is in fact causing gut symptoms, as both nutrients can trigger symptoms including abdominal pain, gas, bloating and diarrhoea.

People with sensitive digestive systems, in general, may be more prone to multiple intolerances coexisting, as any irritation or inflammation occurring in the gut can make it more challenging to digest other foods, including those containing fructan and lactose.

How Coeliac Disease affects Gut Function

Consuming gluten triggers an autoimmune response which causes damage to the lining of the small intestine. The damage impairs nutrient absorption into the bloodstream, making it more challenging to absorb fructose and other sugars & nutrients, vitamins & minerals.

This issue promotes temporary symptoms of fructose malabsorption while the gut is inflamed, only resolving when the gut heals with the re-introduction of a gluten-free diet.

Fructose Malabsorption, Gut Inflammation & Triggering IBS

Chronic inflammation in the gut is seen most often in people with undiagnosed or untreated gluten intolerance. This can lead to fructose intolerance (inability to properly absorb fructose in the small intestine).

This inflammation reduces the efficiency of protein nutrient transporters in the gut, including those responsible for absorbing fructose, resulting in symptoms similar to fructose intolerance i.e. gas, bloating, abdominal pain and diarrhoea.

The Role of the Low FODMAP Diet in IBS Symptom Management

Many individuals with IBS say that they have gut sensitivities to both gluten and fructose. Some people with IBS may experience relief following a low-FODMAP diet, which reduces foods high in fermentable carbohydrates like fructose, galacto-oligosaccharides, lactose, and sugar alcohols.

Gluten-containing grains are often limited on a low FODMAP diet due to their high fructan (FODMAP) content, not necessarily because of the gluten protein itself present in the high FODMAP foods. This can be confusing, as it presumes that gluten and fructose intolerance coexist, when in actual fact, the underlying issue may be more complex, like IBS.

This is a very common cause for misdiagnosis, leading people with either condition to incorrectly eliminate gluten and/or fructose from their diet, when it may not be necessary to do so.

Gut Health & Microbiome Consequences

People with gluten and/or fructose intolerance present with a disrupted gut microbiome, often leading to other food intolerances. The balance of gut bacteria in the large intestine impacts how efficiently certain sugars, like fructose, are digested.

An imbalance in beneficial bacteria can cause 'gut dysbiosis'; exacerbating symptoms related to both gluten & fructose intolerance.

How to Co-Manage Gluten Intolerance & Fructose Malabsorption

Follow a strict gluten free diet: For individuals with Coeliac Disease or known Non-Coeliac Gluten Hypersensitivity, a totally gluten free diet reduces gut inflammation and may improve fructose malabsorption over time.

Food intolerance testing: Should symptoms persist, it may be beneficial to undertake formal testing to diagnose gluten intolerance i.e. blood tests or an endoscopy for Coeliac Disease, and fructose malabsorption (like a hydrogen methane breath test).

Trial a low FODMAP diet: A reduction in consumption of foods high in FODMAPs can relieve IBS-type symptoms in up to 75% of sufferers.

Reduce intake of high fructose foods: Fructose malabsorption may be managed by limiting high-fructose fruits like stone fruit, honey, garlic, onion, leeks etc.. sweeteners, and processed foods with added fructose.

Summary

While gluten intolerance and fructose malabsorption may coexist, they are different conditions, and managing both may require personalized dietary modification based on individual tolerance levels and underlying gut health conditions.

Should you require nutrition support, see our useful Directory of specialist Gut Health Dietitians to find a practitioner locally.

References:

Anna Bobrus-Chociej A. et al. (2021). Celiac Disease in Conjunction with Hereditary Fructose Intolerance as a Rare Cause of Liver Steatosis with Mild Hypertransaminasemia—A Case Report. Pediatr. Rep. 2021, 13(4), 589-593; https://doi.org/10.3390/pediatric13040070.

How do FODMAPs Trigger IBS Symptoms? https://www.monashfodmap.com/blog/the-fodmap-grand-tour-down-under-ibs/, The Monash FODMAP Team, Dec 18, 2015.

Jenifer K Lehrer et al. (2019) What is the Rome IV criteria for diagnosis of irritable bowel syndrome (IBS)? Department of Gastroenterology, Jefferson Health System Torresdale Campus, Philadelphia.