How Can I Effectively Manage The Risk Of Fructan Intolerance In Patients With Celiac Disease Who Have Already Been Prescribed A Gluten-free Diet, Particularly When It Comes To Recommending Specific Types Of Gluten-free Bread And Baked Goods That Are Also Low In Fructans, Such As Those Made With Ancient Grains Like Quinoa Or Amaranth?

Managing Fructan Intolerance in Celiac Disease Patients on a Gluten-Free Diet

1. Understanding Fructans and Their Impact:

• Fructans are carbohydrates that can cause gastrointestinal symptoms in sensitive individuals, particularly those with celiac disease who may still experience distress despite a gluten-free diet.

2. Gluten-Free and Low-Fructan Grain Options:

• Quinoa and Amaranth: These ancient grains are gluten-free and may have lower fructan content, making them suitable options.
• Rice and Corn: Both are naturally low in FODMAPs, including fructans, and are excellent bases for bread and baked goods.

3. Caution with Gluten-Free Products:

• Some gluten-free products may contain high-FODMAP additives like inulin. Always check ingredient lists to avoid unintended fructan intake.

4. Alternative Flours:

• Consider using almond flour or coconut flour, which are low in fructans and suitable for baking.

5. Professional Guidance:

• Recommend consulting a dietitian knowledgeable in celiac disease and FODMAPs to tailor a diet that is both gluten-free and low in fructans.

6. Symptom Monitoring and Elimination Diet:

• Advise patients to gradually reintroduce foods and monitor symptoms to identify triggers, possibly through an elimination diet.

7. Education on High-Fructan Foods:

• Educate patients about high-fructan foods to avoid, such as onions, garlic, artichokes, and asparagus, while noting they are already avoiding wheat, barley, and rye.

8. Conclusion:

• Emphasize the use of rice, corn, quinoa, and amaranth in gluten-free products, while highlighting the importance of professional guidance and patient education for effective management.