It is common that people confuse symptoms in response to fructan malabsorption for coeliac disease, and vice versa! Fructans are a carbohydrate structure made up of chains of fructose, that are poorly digested and absorbed by some people, particularly those with IBS. Fructans are found in rye, barley, oats and wheat, and which are also gluten-containing foods.
Symptoms of fructan malabsorption include increased flatulence, bloating, and diarrhea, similar symptoms to that of coeliac disease. It is common for people to cut out gluten, and begin to feel better as the fructan load of their diet has reduced, and therefore come to the conclusion that is must be coeliac disease..
Part of the low FODMAP diet often includes choosing gluten free breads, biscuits and pasta, but it is important that your GP has tested for coeliac disease before your commence a low FODMAP diet in order to ensure we aren’t confusing coeliac disease of IBS.
When testing for coeliac disease your gastroenterologist will be looking for the damage caused to your body when you are eating a gluten including diet. If you have stopped eating gluten containing foods your body may begin to heal, resulting in unreliable, and falsely negative results. This might mean you continue to include small amounts of gluten, or not consider cross contamination, and therefore have improvements in symptoms but still be exposed to gluten, and still be damaging your gastrointestinal tract.
If you have begun a gluten free diet before testing it isn’t the end of the world! It just means that a normal, gluten containing diet much be resumed for at least 6 weeks before your tests. This usually includes a gluten challenge, in which a minimum equivalent of four slices of wheat-based breads should be consumed each day. Speaking to a dietitian to receive support and guidance on your gluten challenge can be really helpful!
A clear diagnosis is important! If it is IBS then cross contamination with gluten containing products, and inclusion of small amounts of wheat-containing products is typically ok. Fructans are part of the FODMAP family, and management of fructan malabsorption often involved a low FODMAP diet and structured reintroduction in order to understand what other foods may trigger symptoms, and how much of each of the FODMAP groups, and the overall FODMAP load you can tolerate.
On the other hand, a strict gluten free diet must be adhered to if coeliac disease is the reason behind the symptoms and discomfort. Either way, the help and support of an accredited practicing dietitian can be incredibly helpful!