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Fructan, not gluten, induces symptoms in patients with gluten sensitivity (gastrojournal.org)
244 points by kmundnic 64 days ago | hide | past | web | favorite | 138 comments

I had a 3-year span where I could not eat gluten, and for 1 year of that I could not eat corn. My level of sensitivity was such that I could not eat gluten-free meals at any restaurant due to cross contamination nor drink instant coffee because the conveyors are sprayed with a corn-based anti-clumping solution.

I saw 3 different digestive specialists (I believe all gastrointestinologists, it's been a few years). Their approaches did nothing. Then I searched for digestive disease research centers, went to one, and was "cured" after two visits. The doctor said that my situation is becoming more prevalant, and that the issue is typically one or more of the following: A hostile bacteria in the digestive tract, overgrowth of one or more bacteria in the digestive tract, or a parasite.

A round of the following two drugs fixed me within a few days: Alinia and Neomycin. I was drinking beer and eating noodles again without any problems.

Now I have to take an antibiotic that targets the digestive tract every 1 - 1.5 years as symptoms return. This indicates that my problem is bacterial rather than parasitic, although the exact cause of my problem hasn't been identified.

An interesting side note: I traveled to Japan while affected by gluten (but before corn became problematic), and I ate in restaurants the whole trip with only one problem. I am certain that I was consuming small amounts of gluten with each meal. I learned that Japan and other countries have rejected US wheat shipments over certian GMOs, but I couldn't reliably explain why I was largely unaffected in Japan.

Just curious--do you still have your appendix? I read recently that it keeps a store of the microbiome and replenishes stores as needed.[1] Perhaps the nasty bacteria are hiding in there?

[1] http://dujs.dartmouth.edu/2008/04/a-bacterial-safe-house-a-n...

That is fascinating! Thank you for the information. It's certainly possible that bad bacteria are hiding in there.

There's no commercially available GMO wheat. Maybe Japan is rejecting them based on some conventional breeding factor/pesticide use but it's not because of GMOs.

It's not commercially available in the sense that you can't buy it because it's not approved, but it exists and contaminates existing crops regardless, and it will continue to do so.

--2013-- https://www.smithsonianmag.com/smart-news/where-will-japan-g...

--2016-- http://www.reuters.com/article/us-usa-wheat-gmo-japan/japan-...

miek, I'd really appreciate if you could contact me with more precise information (analysis you did, etc...).

I've been struggling with gluten sensitivity for 1.5yrs (been through the gastroenterologist circuit already, with 0 results) so your comment blew my mind.

Thank you! My email: chris [à] chris-hartwig.com

Hi, I had “gluten sensitivity” for maybe the last decade. Brain fog, fatigue etc. removing gluten helped but did not fix. Then I tried the ketogenic diet and all my problems went. Infact I feel better then I have ever in my life when in a state of ketosis. Not sure of the reason - It could be I’m cutting out a certain foods.. or it’s the anti inflammatory effects of ketone bodies? Still searching for answers on why. But for now it feels like I’ve been given a second chance at life.

I’d be happy to provide more details to you if your interested in trialing this path.

Not sure why you're being downvoted.

If there's one thing I've learned, when researching how diet can affect myself, it's that different humans react to different food types and intake, in different ways.

If a ketogenic diet works for you, the same diet may not work for others. Similarly, other types of diet may not work for you.

It's for that reason I decided to vote you up again - there is no reason to downvote what you posted.

One particularly enlightening book which changed my outlook on diet, raised an eyebrow, and just clicked with me, was "Eat Fat and Grow Slim", written in 1958 by Richard Mackarness, M.B.,B.S.

1958.. The more you dig into th history of nutrition the more you realise there was two parallel tracts. The one that won public opinion (low fat/high carb) has pretty much contributed to an epidemic. Recommend the book “the big fat surprise” by Nina Teicholz on the topic.

I've wondered if a keto diet could help, but if there's a chance antibiotics could fix the problem, I'll take that instead. My gluten intolerance appeared 1 week after a serious food poisoning, which could logically point to a bacterial/parasitic origin...

I also happen to have numerous food allergies, so the gastroenterologist thought "add gluten to the list".

If nothing else works, maybe I'll try a keto diet, but I love sugar... I'm already gluten free (I'm french, no bread), fruit free, raw veggies free, lactose free (I'm french, no cheese), olive free (I live in Spain!)... cutting sugar would be hard ;-)

> gluten intolerance appeared 1 week

A key fact! This type of information could really help a dietician assist finding a solution if you run out of avenues yourself. I said the same about loving sugar but funny enough the cravings / desire simply goes away once your body adapts to a new energy source (which is not glucose anymore). Having just recently been to Spain, the hardest part is eating out and missing out on all the great tapas!

Sure, I will send you an email this evening.

This is incredible. Could you explain what your symptoms were?

Thanks for sharing your story.

Of course. Symptoms: gas, bloating, diarrhea, constipation, mental slowness/fuzziness (I was always saying "sorry, I'm really out of it today"). Symptoms could last anywhere from 12-48 hours, and usually the onset of the symptoms was around 4-8 hours.

Did they do an actual test/sample before prescribing th medication or just take a guess?

Congratulations on escaping all those terrible symptoms!

Thank you! They guessed; they have seen this many times. They did other tests as well, and all came back negative. It was an "off-label" usage of the prescriptions, meaning that it is an unapproved treatment, so insurance didn't cover it. On that note, anyone purchasing medication should probably check sites like GoodRX.com before doing so, because it saved me a lot on those meds. Also, good pharmacists know several "discount codes" that they can type in at the register similar to those provided by GoodRx.. I don't know the proper terminology for this, but once you give them a code from GoodRX, you can say "do you know of any other good codes to try?" That worked for me.

Out of curiosity, which research center did you end up going to?

H.H. Chao Comprehensive Digestive Disease Center

Where did you go by any chance?

H.H. Chao Comprehensive Digestive Disease Center

There are a ton of theories out there that the gluten sensitivity is something other than for gluten, but just a big correlation.

I'm pretty convinced by the literature that gluten sensitivity isn't really a "thing" outside of celiac disease, but even with me, I have problems with painful acne breakouts when I eat gluten, that don't happen when I don't have gluten. And from doing some googling and informal surveying of friends, it seems I'm far from alone on that.

Now is that because of gluten itself? Who knows. Maybe it has to do with how wheat is processed these days, or something else. It's really frustrating that something so basic and common doesn't seem to have any scientific answers, though.

My significant other is in a similar situation. A reasonable amount of wheat-based baked goods (a burger bun, a slice of bread, a slice of pizza) will almost invariably set her off (causing both skin and intestinal distress). And if it sets her off once, it'll always set her off. Small amounts of seemingly similar wheat-containing foods (eg, a bite of someone else's sandwich) will generally not. Non-gluten containing foods seem to be fine...but even when she's great about avoiding gluten, she'll have occasional outbreaks, strongly suggesting it's not (just? only?) gluten.

Her doctor has labelled it as gluten sensitivity, but we're well aware that it's not really clear she has any such thing, or if such as thing even exists. The FODMAP/fructan stuff sounds promising, but one common source of FODMAPs is garlic, and she adores garlic and eats it with everything in vast amounts which 1) strongly suggests that at least some FODMAPs are fine for her and 2) makes her extremely reluctant to try a FODMAP free diet.

The whole this is baffling. She clearly doesn't have coeliac disease, small amounts of gluten are (normally) fine, large amounts of things containing gluten are not fine, very similar things without gluten are fine, but something other than gluten that is consumed even when gluten is being avoided is not fine, at least some high-fructan/FODMAP foods are fine...I feel like I'm missing a piece of the puzzle. My current pet theory is that it's a reaction to at least two different substances, but what?

For now she just avoids gluten and (mostly) avoids outbreaks. It's confusing but it's an easy coping strategy.

I have similar problems, but when i make my own bread it does not happen... I think it has to do more with additives and other stuff they put in wheat-based baked goods these days that actually trigger reactions.

Bread used to go dry after a day, now it lasts for a week... That is not normal.

Here in Germany I know nobody who has this gluten sensitivity, but I meet more people abroad with this issue, esp. many digestive problems seems to appear in US - so maybe something is different during food processing? Do you have this problem if you eat say pasta imported directly from Italy?

I'm in the US and have experienced gluten problems.

It's nowhere near as bad as it was, I can eat wheat with no problem, but can't eat a lot for a long time.

But, imported Italian pasta doesn't give me a problem.

I've noticed even now with US wheat I can get constipated, but not with the Italian pasta.

I've heard so many things, like US wheat has 4x the gluten, or is sprayed with RoundUp after harvesting to dry it out, so who knows, but there does seem to be something different.

There is aspirin and alot of other additional stuff in flour. If you grind your own wheat - you miss out on all those. But you gain great taste- most flour does not contain the oil-containing seed part of the wheat, as this tends to go rank very fast in storage.

Ascorbinsäure (E 300) Natrium-L-Ascorbat (E 301) Calcium-L-Ascorbat (E 302) Lecithin (E 322) Guarkernmehl (E 412) Mono- und Diglyceride von Speisefettsäuren (E 471) Milchsäureester von Mono- und Diglyceriden von Speisefettsäuren (E 472 b) Wein- und Essigsäureester von Mono- und Diglyceriden von Speisefettsäuren (E 472 f) Saccharoseester von Speisefettsäuren (E 473) Zuckerglyceride (E 474) Polyglycerinester von Speisefettsäuren (E 475) Natriumstearoyl-2-lactylat (E 481) Calciumstearoyl-2-lactylat (E 482) L-Cystein (E 920)

Yes, same for me. I know which commercial wheat products I can eat, and which I can't. There's no obvious correlation. Stuff that's labeled "gluten-free" is generally OK. But some whole-wheat stuff that's clearly not gluten-free is also OK.

So basically, I eat what I know is safe for me. If there's something that appeals a lot, I may test a little.

Just to maybe give you some additional orientation: my sister has "proper" coeliac's.

It took years for it to be diagnosed, partly because doctors weren't considering for a while, but also because it can be elusive -- might it be possible that any tests doctors made on your SO were false negatives? It's not uncommon unfortunately.

Also, a surprising number of things contain gluten unexpectedly. Some toothpastes for instance. Vinegars. Lemonades. So perhaps your SO's paradoxical outbreaks are compound effects of "hidden" gluten she has consumed over the day.

There are also coeliac's sufferers who have a tolerance to low amounts of gluten in that they don't feel distress. They are threatened by the same health risks as those who feel pain though (such as increased cancer risk).

Again, not armchair-doctoring here, I just want you to have extra information which might help you both understand this better.

I've been living with the exact same situation. I've started avoiding all FODMAPs (including garlic) and it seems to have helped. But, it's very hard to do since so many processed foods and restaurant meals can seem OK but turn out to have included an ingredient on the "avoid" list. And if ingredients say "2% or less of ...", I'm neither sure how much the package contains in absolute % nor relative effects.

So when I do have an outbreak despite trying to be careful, I am never sure whether it invalidates my hypothesis about the cause or indicates I just wasn't careful enough.

Wheat contains FODMAPs. I can't remember what kind exactly, but they're there. So it's actually kind of hard to eat gluten without FODMAPs, unless it's seitan or something. Hence the abstract of the article states:

"Foods with gluten often contain fructans, a type of fermentable oligo-, di-, monosaccharides and polyols"


My pet theory is that people are sensitive to the glyphosate sprayed on most wheat, not the actual gluten.

People spray glyphosate on wheat?

Glyphosate is typically used in conjunction with "Roundup Ready" crops, or before/during planting in "no-till" crops. While Monsanto developed a Roundup Ready line of wheat, it never actually made it to market, AFAIK, so why would you be spraying glyphosate on wheat?

(Serious question; while I have some background in agriculture, I'm not familiar with all of even the common practices.)

ETA: Reading the Snopes link, looks like it's mainly practiced in North Dakota, which explains why I've never heard of it.

It's not practiced in ND out anywhere else. The export market won't accept it and it's not deliverable against spring wheat futures so it's not marketable and never has been.

It makes the wheat ready for harvest all at the same time.

Glyphosate is banned from organic wheat farming and organic wheat flour is cheaply and widely available for experimenting. "Bobs Red Mill" and numerous other brands, etc.

Glyphosate is popular when growing non-wheat non-organic produce; if a glyphosate allergy existed, it would likely not appear like a gluten allergy because most products that once contacted it are not gluten-containing.

You can buy glyphosate products at home depot for experimentation.

It would appear to be a cheap and simple hypothesis to test.

> Glyphosate is popular when growing non-wheat non-organic produce

I only know of glyphosate resistant soy which ends up in cow food. You usually don’t spray glyphosate on stuff you want to eat because it kills it, which only in the case of wheat is what you want.

Actually, farmers desiccate wheat before harvest because dying plants yield more seed. Glyphosate is among various pesticides used for desiccation.

Just want to chime in for other confused people (I grew up on a Midwestern farm and had never heard of the practice of desiccating wheat, so I've been reading a lot about it on the internet today) -- this appears to be a northern latitude practice - every reference I can find to it is from Canada, the UK and North Dakota, so I'm guessing this has to do with growing wheat in a shorter growing season.

So it's not nearly a universal practice, but on the other hand, North Dakota does account for 20% of the US wheat production. (And on the gripping hand, I don't know what wheat distribution in the US looks like; will ND wheat tend to be consumed in a particular region, or will secondary distribution through eg packaged foods tend to distribute it nation-wide?)

But then why only gluten/wheat products, and not other crops treated with glyphosate?

The EU limit for the residual amount of glyphosate allowed in wheat is higher than many other crops, so maybe that's why. But barley and soya beans, for example, are even higher.

I'll see your pet theory and raise you mine: most people are sensitive to the additives added to fortified wheat sold in the States, especially Vitamin B[0] and Iron[1].

[0]: https://freetheanimal.com/2016/05/enrichment-promotes-everyt...

[1]: https://freetheanimal.com/2015/06/enrichment-theory-everythi...

This makes even more sense.

I was constantly trying to figure out why people with gluten sensitivities don't have reactions in most European countries. The enrichment theory seems pretty persuasive.

A piece of evidence to add to the puzzle: new study just came out in JAMA looking at urine levels of glyphosate in older adults in California. It's increased a lot over the last few decades. Humans are definitely getting a lot of it. https://media.jamanetwork.com/news-item/study-finds-increase...


The EU have acceptable "Maximum Residue Levels" of Glyphosate in foods: http://ec.europa.eu/food/plant/pesticides/eu-pesticides-data...

In wheat it is 10 mg/kg. (Page 5 from the above link).

This UK report: https://www.gov.uk/government/uploads/system/uploads/attachm...

found pesiticide residues in 90 of 96 cereal crop samples tested. However, it concluded that "None of the residues detected by the laboratory would be expected to have an effect on health."

A BBC TV programme covered this issue in 2014: http://www.countryfile.com/news/pesticides-found-over-60-uks...

>nobody is spraying wheat right before harvest

Glyphosate is sometimes used as a desiccant to alter the timing of wheat harvests, ensure even ripening, and to make harvesting easier. While it's not a widespread practice, it does happen in the US.

> Glyphosate doesn't last long enough to persist in plants and nobody is spraying wheat right before harvest.

Citation needed!

Snopes says that the underlying practice is real despite a lack of evidence that the glyphosate causes the ailments: https://www.snopes.com/food/tainted/roundupwheat.asp

This paper attempts to draw some kind of causual biochemical link between glyphosate and celiac through metabolic processes: https://www.ncbi.nlm.nih.gov/pubmed/24678255

Actually, it's a relatively popular harvesting practice for non-organic crops -- kill them all at the same time so they're all ready to harvest. Differs by region, but afaik in the US foods labelled as organic can't be harvested in this way.

The typical Glyphosate mix includes many other chemicals that do persist.

I'm also pretty convinced that "gluten sensitivity" generally has little to do with gluten. I react to many wheat products (including certified organic ones) with gastrointestinal upset, acne, etc. But I can eat some regularly, with no problems. It's clearly not crackers vs bread. But what?

So maybe fructan. I wonder what affects fructan levels in wheat products.

Why should organic products not contain gluten?

I'm not arguing that they don't. But one hopes that they don't contain, for example, glyphosate.

I wish people stop with this glyphosate in food. The traces we cand find aare in small quantities and even if you eat the same quantity of lead, you should still be fine.

The issue with glyphosate is the volatility, the fact that it stay in the ground, it can be absorbed through the skin (hence bad for farmers and people living near farms) but at least in europe, the quantities you can ingest are too small to endanger you. The fact that the main arguments of anti-glyphosate is this flawed argument, lobbies can easely convince the legislators that this argument have non-scientific ground (obviously) and should be ignored.

See Oct JAMA article; while food may contain only trace amounts we're ingesting and excreting more than ever.

Sorry. It was a bad example of pesticides. I used it because it's been discussed.

The human brain has immense ability to correlate things, justifiably or no. Ultimately anecdotes like yours are frustrating because so many possible things could be happening but people treat your hypothesis seriously anyway.

Well it's fair to do so. Correlation is not causation, but that's a starting point at least. And to find an answer, you need to start somewhere.

I'm not a statistician, but the results section is worth reading -- the fructan results are not much higher than placebo but both placebo and fructan are more affective than gluten.

"Overall GSRS-IBS scores differed significantly during gluten, fructan, and placebo challenges; mean values were 33.1±13.3, 38.6±12.3, and 34.3±13.9, respectively (P = .04). Mean scores for GSRS bloating were 9.3±3.5, 11.6±3.5, and 10.1±3.7, respectively, during the gluten, fructan, and placebo challenges (P = .004). The overall GSRS-IBS score for participants consuming fructans was significantly higher than for participants consuming gluten (P = .049), as was the GSRS bloating score (P = .003). Thirteen participants had the highest overall GSRS-IBS score after consuming gluten, 24 had the highest score after consuming fructan, and 22 had the highest score after consuming placebo. There was no difference in GSRS-IBS scores between gluten and placebo groups."

This was my thoughts too. The values appear to be fairly similar for all three, especially given the large variations.

Not to mention that they're explicitly trialling this with people "for whom celiac disease had been excluded". So an alternate conclusion could be "people without celiac disease but with self reported gut issues don't respond significantly differently to fructan, gluten, and placebo". Which is... not surprising?

They don't appear that similar to me - if you plot them graphically you'll see a significant difference, particularly at the lower end.

P values of less than .005 generally mean that you accept the null hypothesis. The authors did otherwise for one hypothesis, which I find interesting.

You're wrong on two accounts.

You want a low p-value, the lower the p-value the stronger the evidence.

A p-value is cutoff traditionally at .05 (1 in 20), and if it's p < .05 you can reject the null hypothesis. The "null hypothesis" is the OPPOSITE of your paper's hypothesis (so you want to reject it): the null hypothesis is "All the variation we saw was from chance"

Why not make the null hypothesis the same as your paper's hypothesis? Wouldn't that make more sense?

The mathematics of statistical hypothesis testing is almost always defined in terms of a ‘null’ and an‘alternative’ hypothesis, where the ‘null’ necessarily includes the equivalent of ‘no correlations/differences exist’ and the alternative hypothesis does not.

This usually means that the alternative hypothesis is the ‘interesting’ one, which is probably what the researcher would like to occur. Which maybe isn’t entirely intuitive.

But I f you don’t follow those restrictions, the math is meaningless.

If you swap the terms in the math, you’ll confuse anyone who knows the stats, while not really benefitting anyone.

And if you’re not using the math, why refer to a ‘null’ and ‘alternative’ hypothesis at all?

>"the ‘null’ necessarily includes the equivalent of ‘no correlations/differences exist’"

"Null" stands for hypothesis to be nullified in this case, not zero.

You cannot prove the null hypothesis; you can only disprove it. The p-value is the probability that the null hypothesis is true. So if the null hypothesis is that there is no difference, and there is a low probability of that being true, then you have shown that there is a difference between the groups. If the p-value is high, you do not show that the null hypothesis is true. Instead, you show that you did not find a statistically significant difference. This can happen when the difference between the values is small or there is not enough data to make the difference clear, which is why a high p-value is not enough to reject the alternative hypothesis.

> The p-value is the probability that the null hypothesis is true.

No, the p-value is the probability that the given data generated is as far away or farther by random chance given the null hypothesis is true. That is to say, we assume the null hypothesis to make some predictions and see if the data is a likely occurrence under those assumptions.

This is not the same as the probability that the null hypothesis is true. If that is what you want (and most of us do want this), then Bayesian methods are more appropriate though they are more complicated and more sensitive to initial assumptions.

>"You cannot prove the null hypothesis; you can only disprove it."

Sure, but thats why the null hypothesis should be predicted by your theory. Then you are checking your theory. Most people could care less about whether there is a miniscule difference between groups or not.

>"The p-value is the probability that the null hypothesis is true."

No, as pointed out by jostylr this is wrong.

The null hypothesis signifies a lack of relatedness. Give circumstance A and outcome B, we make no assumptions, i.e. we assume A and B are unrelated by not assuming they are related. This is the null hypothesis. In order to reject that, we must provide compelling evidence.

If you start by assuming A and B are related, your experiment would have to fail reject that notion in order to prove that A and B are indeed related, which is a less direct way of approaching scientific discovery.

You are also confused about the meaning of "null": https://news.ycombinator.com/item?id=15703503

No, they're not. The commonly accepted definition of Null Hypothesis is "the hypothesis of no effect or no relationship" (source: statistics master's degree, but it's also the first sentence in the wikipedia article: https://en.wikipedia.org/wiki/Null_hypothesis)

That is an awful wikipedia page. How can that even make sense? As soon as people start predicting things it is impossible to test the prediction?

Also, the intro of that page contains blatantly incorrect statements:

>"In the significance testing approach of Ronald Fisher, a null hypothesis is rejected if the observed data are significantly unlikely to have occurred if the null hypothesis were true. In this case the null hypothesis is rejected and an alternative hypothesis is accepted in its place."

There is no alternative hypothesis in Fisher's significance testing.

Here is a better wikipedia page:

"We may, however, choose any null hypothesis we please, provided it is exact."-Ronald Fisher https://en.wikipedia.org/wiki/The_Design_of_Experiments

I've heard that a lot of math fields really fail to teach history, perhaps that is what happened in your stats program.

Take as an example the standard null hypothesis of the means of two groups being the same. This is a very concrete condition that is amenable to having predictions made from it.

But now let's say that you assume they are different. Well, how different are they? You need to make that choice in order to get predictions. And then your rejection is not a rejection of "being different" but "being different in this one specific way".

>'But now let's say that you assume they are different. Well, how different are they? You need to make that choice in order to get predictions. And then your rejection is not a rejection of "being different" but "being different in this one specific way".'

Yes, precisely. You should predict a specific thing will happen based on some theory and check it with data. This sounds like the science we learned about in school.

Only predicting "there should be some difference" with your theories is more like astrology or something.

if placebo is a sugar pill, maybe it's a sugar sensitivity...

I assume placebo is the same muesli bar used in the other groups (without the supplemented fructan or gluten).

Ah! Excellent point!

if the placebo is a sugar pill then it's an experimental methods failure.

My thought is they aren’t looking at anything other than gluten and fructan. I’m sure there are other compounds common in foods containing gluten that need to be examined and eliminated as causative before publishing a study with a title that implies a conclusion.

FWIW, I've been sensitive to gluten for years, but when I traveled in Spain -- I was fine. Then I came back to the US, and tried wheat again. Nope.

I would not be surprised if the way we're processing / spraying our wheat here is giving some folks problems.

I have read that shorter baking time can have an effect on the gluten and increase people's sensitivity to it (can't find the study right now). Many bakers use methods to shorten baking time to yield larger output.

In Switzerland some bakers have started to go back to the old methods because of this.


[1] http://www.motherjones.com/environment/2015/02/bread-gluten-...

This is my personal best bet. I think if we were to introduce a measure as simple as mechanical compressibility of bread (crust removed), and people with "gluten sensitivity" started eating very low compressibility bread, they'd be fine.

Also I think the FODMAP people are on to something important.

Naturally fermented breads that stay away from commercial yeasts (ie oldfashioned sourdough bread), work out for many people who otherwise struggle with normal commercial bread.


The longer fermentation lets bacteria break down some of the gluten, so it's all round easier on the gut.

I would similarly be unsurprised if there is just some other factor. I saw an article onetime that showed a link between alergies to apples and the range of an unrelated tree. That is, there was some other type of tree that, if present, increased the occurrence of reported allergies to the apple. Whereas the same apple in a location without this tree had fewer allergies reported.

Sadly... my inability to refind this article makes me suspect that, though I may be unsurprised by this idea, I have no evidence for it. So, if anyone can help refute the idea, that would be great! :)

You may be thinking birch trees. I’m allergic to certain raw fruits (cooked or canned ok), beans, and tree nuts (peanuts and cashews ok). I’m told this weird combination is a thing.

I found “Oral allergy syndrome” http://acaai.org/allergies/types/food-allergies/types-food-a...

Thanks for the link! That at least makes it look like I didn't imagine the article. The one I remember was a more direct link between allergies to thing X, but only in the presence of thing Y. With no reported allergies to thing Y.

Holy shit. I've always been allergic to random things like cherries, apples, tomatoes, melon, peaches, etc., but only some of the time and never when it's cooked. It could definitely be some other tree or something that's doing it.

Edit: Just read the other reply. I'm definitely allergic to birch and grass pollen and I've always had hay fever. That solves that mystery.

Definitely seek out more information on this. I'm still halfway convinced I imagined the article I am referring to. :(

That is a new idea, thanks! I was suspecting pesticides or similar, since my allergy is highly batch-dependant and there have been less and less occurrences over time.

I stress that I may have made up the article I'm referencing!

I ultimately take "allergy" to mean, "we don't fully understand the reason."

Regardless, it's an interesting theory that I hadn't considered before. It's harder to imagine how that would work, but not inconceivable.

For your theorie I live in central Europe and don't know a single person with gluten issues. While the Americans in this thread make it seem like every 10th or so has it.

For what it's worth: I am an American and I don't know anyone with gluten issues.

Even more so, some cultures specifically use gluten as a cooking / baking ingredient. E.g.: mock duck.

Something being widespread in a community doesn't mean that it's tolerated by everyone in that community. Milk is common in central Europe, but some people are intolerant to lactose. Tomatoes and red wine are also common, but some people can't have them due to histamine intolerance.

(I also have a central European colleague who has actual celiac disease. That said, I agree that the general gluten panic is way overblown.)

The thread is about gluten. Obviously a lot of commenters have gluten intolerance.

I'd wager half of them does not have diagnosed gluten intolerance.

There are many chemicals in bread one can be allergic or intolerant to. Gluten proteins are but one. Bad lactose intolerance and lactose sweetened breads may be responsible for some reported symptoms. Soy protein or bean protein used in fast mixes. Fructans are another.

My wife is from Spain and cannot eat the bread here in the US. She struggled for a long time with a lot of digestive issues. When she goes back to Spain she eats all the bread she wants with no issues. She still doesn't really know what causes the problem because she does not have celiac so she just calls it "gluten-sensitive" but we know it's probably not even related to gluten. Most likely it's just some insane thing you can do to wheat or bread when processing it in the USA that isn't allowed in countries that care more about health than profits.

I just wrote my story in a comment. The was same was true for me when I traveled to Japan. I couldn't go near gluten for 3 years. I went to a digestive disease research center and was cured in a couple of visits with special antibiotics that target the digestive tract. If you haven't tried that route, it may be worth looking into.

Do you mind sharing where and how you determined the antibiotic regime/dosage you used? If allowed. Did you just look up the general regime for those drugs or did you tailor it? How did you go about repopulating your gut flora post treatment - ensuring that you didn't reintroduce bad bacteria?

The doctor decided the dosage. Regarding repopulating gut flora: That is such a poorly understood topic. The more you read, the more you scratch your head.

After my first treatment, I made yogurt with special starters that contained specific strains of bacteria based on those suggested by the SCD (Simple Carbohydrate Diet). The next time I took a round of antibiotics, which was after symptoms returned a year later, I didn't do anything special to repopulate flora. My symptoms did not return for 1.5 years.

I tend to believe that eating probiotic-containing foods is generally a good thing. It's best if you ferment your own foods, because the bacteria counts are typically much higher compared with store-bought products. Sauerkraut, pickles, kimchi, water kefir, ginger bug, and others are incredibly simple to make.

That said, the various common strains of bacteria are debated and their effect on existing flora is not yet well understood. It's possible that some fermented foods could be bad for some people. Hopefully one day the medical community will have a good grasp on how to effectively prescribe fecal transplants!

I honestly believe that fecal transplants are the way forward; using the macro (a healthy fecal culture) to solve the micro (which strains are good vs bad). There has been evidence to suggest that both body weight and athleticism are impacted by gut flora. Thanks

In my experience bread and other (non-sweet) flour-based products in the US have surprisingly high levels of sugar/HFCS/etc. - especially compared to mediterranean bread products, which additionally contain little to no salt (pane sciocco, pan de pagés).

I can confirm this was the case for me. After months of testing I was considered “not gluten sensitive”, while experiencing bad IBS when consuming gluten. Once I tried the FODMAP diet I found that the food should high in fructans were my trigger.

Seconded. For our situation, it was fructans and polyols (to a lesser extent). Gluten seems to be a non-issue for us, except that wheat products also tend to be high in fructose and oligosaccharides. If you're reasonably diligent about keeping to the diet restriction and only reintroducing one food group at a time, it's possible to be quite precise about identifying what compounds might be a problem.

I put my story in another comment, so I'll be light on details. While seeing a specialist at a digestive disease research center, I learned that people with sets of food sensitivities, including those successfully addressed by a fodmap diet, may find relief by taking special antibiotics that target the digestive tract. After 3 years of severe problems with gluten and corn, I'm fine thanks to those antibiotics.

Looked that up, sounds perhaps like a harder diet than gluten free. Giving up onions and garlic, plus pasta, bread, etc...ouch. You have my sympathy.

Ideally you should use FODMAP as an elimination diet to determine what food's you react to. I went though it a couple of years ago and discovered that onions (and large amounts of garlic) will give me IBS symptoms. I'm fine with everything else on the FODMAP list. I know others that have discovered they are sensitive to fruits such as apples, pears, etc.

I don't know anyone who has stuck to a strict FODMAP diet long-term.

I know someone who has, but that was because it helped manage her auto-brewery syndrome. Pretty much any time she ate off-diet she immediately regretted it the next day, so that was very effective at keeping her honest.

We went through a FODMAP elimination diet to try resolving some food intolerance issues that our kids were having. After the initial inconvenience, it's really not that big of a deal adhering to a (reasonably) strict FODMAP diet. Garlic-infused oils in cooking instead of chopped garlic, rolled oats instead of toast, bananas instead of apples. You get used to switching ingredients pretty quickly. We now tend to cook most meals from scratch instead of processed/prepared, so I feel like it's been a net positive change for the whole family.

I had to give up all of that stuff initially, but after symptoms recede (a few days) I was able to selectively reintroduce foods until I found the much smaller subset of foods that caused symptoms.

There is a huge difference between the two mechanisms for causing problems. In celiac, proteins cause massive inflammation in the digestive system, any amount of protein is usually enough to trigger the effect.

That's not how the high fodmap issues work. Everyone has some tolerance level for fermentation in their digestive system. These people just have a lower tolerance so the total high FODMAP foods in their diet has to be lowered. You don't have to give up bread, past, etc. You just need to cut things down. And honestly it's usually easier to cut out other things, like certain fruits. The reason it's done by iterative exclusion is because you don't know just how much you need to cut out and it would be really harmful to your life to cut out more than necessary. So you remove one thing at a time until you've cut enough. Generally you start with the foods on the list that are your least favorite and go that way.

It certainly does but you CAN eat things like pickled onions, various grains like corn, oat, quinoa, etc. I'm sure it makes going out a huge hassle.

Had to do it for two months while recovering from severe gut issues. It's no walk in the park. There were very few meals that I was able to enjoy, and I found it difficult to really meet my nutritional needs.

What do you mean?

The OP means that the publication appears in one of the Elsevier journals, and the link goes to an Elsevier-affiliated website.

The OP provided a link that doesn't go to an Elsevier-affiliated website.

Elsevier is an academic publisher that is a relic of a pre-digital world. Essentially, it leeches on universities, charging money for access created by academics,funded by the state, and peer-reviewed by volunteers for free. They justify their need to charge money by reasons such as hosting costs, but whenever someone tries to host their articles for free, they pull out the big guns.

Such actions, in particular, led to death Aaron Schwartz (see https://en.wikipedia.org/wiki/Aaron_Swartz ).

Elsevier is not liked around here.

Speaking of resources that anger Elsevier by hosting articles for free, Sci-Hub is one. In particular, you can read the full text of the article by going to https://sci-hub.cc/ and looking up the paper's DOI (10.1053/j.gastro.2017.10.040).

This full text is not available for free on the original publication link (nor on the NIH website). The study was funded by: the Extra Foundation Health and Rehabilitation, the Norwegian Celiac Association, the Throne Holst Foundation for Nutrition Research and the Wedel Jarlsberg Foundation - neither entity being Elsevier. (You can find this in the paper once you pay Elsevier to access it).

So yes. Oh, Elsevier.

But what does the link help?

"The OP provided a link that doesn't go to an Elsevier-affiliated website."

Yes, what does that achieve?

It helps remind people that Elsevier should be boycotted, everything that they provide should be avoided whenever possible, and provides an alternative that doesn't rely Elsevier nor make a false impression (by using their resources) that they are a relevant and useful part of the scientific process.

Did you apply your moniker to yourself? [For the rest of the world: Bromskloss is Swedish for brakepad]. The link achieves access to the article without driving traffic to the parasites at Elsevier.

Hah, interesting. Brake pad is a mild insult in Russian, used in the same way slowpoke is used in English online these days.

I've always wondered which languages use brake pad (or any part of the braking mechanism) in the same way.

Yes, interesting, thank you. I've never heard bromskloss used that way in Swedish, but then, I'm Danish, and don't really know this neighbouring language from the inside.

So that elsevier doesn't study user interactions, or that new users don't rely upon their services

I could never pinpoint what foods caused trouble for me until I was an adult. Turns out I have (what I call) an intolerance to canola oil. No allergic reaction, but serious digestive trouble / etc. And it can be in anything. Different production runs of the same brand of crackers can use different oils so it is nearly impossible to identify unless you stumble upon it by accidentally fasting due to flight problems and just making hashbrowns (potatoes and canola) at your destination as a snack. I had accepted it as a fact of life until eliminating it from my diet, and lo and behold, food is always awesome.

My theory is that we have hybridized and bred strains of wheat in the West which have caused these problems.

An interesting study would be take some "old world" wheat (that has not been impacted by the industrial-scale farming practices of the West), and see if the gluten-sensitive people still have the same reaction to that.

Thank you for sharing the link to the actual summary.

N=59 which is enough to justify for a larger survey but probably not to garner the attention this piece is receiving.

This will trigger massive swings in how certain food groups are perceived, affect farmers, etc. Caution is required.

Science is science, not politics, and it must stay that way.

A french wheat producers syndicate has published web pages to say even coeliacs should eat gluten, just less of it... That's even the first article my mom found about gluten intolerance and she called me to tell me gluten intolerance isn't really a thing according to the internet. My guts and my gastroenterologist both disagree.

That's what happens when you listen to politics and silence scientists.

There is an app which might be useful for anyone undertaking or starting a FODMAP elimination diet called Monash Uni Low FODMAP Diet. No affiliation; we just found it very helpful to classify ingredients and for recipe ideas while we were new to the process.

Fructan is, if I trust internet definitions, a fructose polymer. Perhaps fructan sensitivity is an immune/whatever reaction to high fructose corn syrup, mis-directed at fructan due to its similar composite materials.

This study was done in Norway. HFCS is pretty rare in Europe compared to the US. It's possible that it was present in the "fructan" treatment here, but if I had to bet, I'd bet it was unlikely.

Although the study isn't about the FODMAPs generally, note that fructose itself is also a FODMAP (when present in larger quantities than glucose), and so could also cause similar symptoms.

I think the paper focuses only in gastrointestinal symptoms. NCGS actually causes more extra-digestive problems than the classic Celiac disease ones. Before I started my very strict gluten free diet I had migraines, fatigue, joint pain brain fog... I continued eating lots of fructans, especially garlic an onion, but I still improved dramatically. My thyroid, inflamation and cholesterol markers went back to normal. My rheumatologist Carlos Isasi has done extensive work about it and even published a study about a big % of fibromyalgia patients improving a lot by avoiding gluten. So, I don't believe it is all about fructans. I think it is related, though. My theory involves archaea overgrowth, pyrrolisine use for methane production (here comes the gas and IBS symptoms) and leaky gut as a result letting gluten into the bloodstream (which causes the toxic immune response)

Just looking at the abstract, does anyone know what the typical values for that questionnaire of GSRS-IBS would be? Is it a mean of near 0? I would want to see a control group, different notion than a placebo, which has no self-reported problems and see what kind of variety there is in the scoring.

59 subject divided into three groups - is that even statistically relevant?

Maybe. U need a Lectin blocker. Have u looked at lectin in foods?

Lectin in foods? Maybe u need a lectinblocker?

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