Not Everything that Irritates is Gluten

by Max Hammonds, MD

The latest “fad” is to eliminate gluten from the diet – everything “gluten” is bad.

Note the labels on tomatoes and bottled water: “Gluten Free” as if this is a sign that this food product is healthier than the competition. Truth #1: All tomatoes and all bottled water is gluten free – always has been. Truth #2: Not everything that irritates the bowel is gluten.

For decades, people have known about lactose intolerance. Some people (less than 10% Caucasians, up to 75% other groups) lack the enzyme to digest lactose (a combination of two simple sugars – glucose and galactose) in the upper small bowel.

Transported further down the GI tract, the molecule osmotically pulls water into the bowel and the molecule is fermented by bacteria. The water and the hydrogen gas cause flatulence and bloating of the bowel, causing swelling, pain and discomfort, bowel irritation and dysfunction – resulting in constipation and/or diarrhea. (This is NOT a “milk allergy” – which is due to a reaction to milk protein.)

Much less common, a few people lack the enzyme to digest galactose, one of the simple sugars in lactose. The symptoms: water retention and fermentation by bacteria resulting in hydrogen gas which bloats the bowel and irritates it, causing flatulence, swelling, pain, discomfort, and dysfunction – constipation and/or diarrhea.

Only a few people cannot absorb as much fructose as other people. The result: water retention, gas formation from bacterial fermentation – flatulence, swelling and pain, constipation and/or diarrhea.

Now consider FODMAPs – Fermentable Oligo- (a few), Di- (two), Mono (single)-saccharides (sugar combos) And Polyols (sugar alcohols). The most egregious of this group are lactose, fructose and short-chain fructose molecules (fructans), galactose and short-chain galactose molecules (galactans), and artificial sweetners – poorly digested sugars (xylitol, sorbitol, and others). These are all poorly absorbed by most people but are poorly tolerated by less than 10% of the people. The result: water retention, gas formation from bacterial fermentation – flatulence, swelling and pain, constipation and/or diarrhea.

Some people have gluten sensitivity. Others have gluten allergy. But the symptoms are the same as for the short-chain sugars. Less than 10% of the people have this problem.

Notice: In North America, 10% of people are lactose-intolerant and should avoid milk and some dairy OR use lactose-free products. Very few people have intolerance to galactose or fructose – found mostly in fruits and some vegetables.

Less than 10% of people are intolerant to FODMAPs which are found in a variety of foods: fruits, vegetables, grains, and legumes. Less than 10% of people are intolerant to gluten – found in wheat, rye, and barley.

Lesson #1: There are many types of food intolerances but few people who actually have these problems.

Lesson #2: If you are not having these symptoms, DO NOT AVOID perfectly nutritious foods in balanced amounts from a wide variety of sources. Don’t buy in to the marketing hype. Think carefully; eat healthfully.

If you have questions, ask your health professional and do your research. Don’t assume.