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Gluten is a protein found in wheat, barley, and rye grains that can create intolerance and gut problems for individuals sensitive to the protein. The food industry has capitalized on gluten-free options for meals and many restaurants even offer a gluten-free menu.

Celiac disease affects about 1% of the population and is an autoimmune disease. Many weight loss patients have used the “gluten- free” way in their attempt to lose weight and many of them report feeling better with less gastrointestinal (GI) bloating and gas.

Going gluten-free is not harmful but bariatric patients need to be reminded that many of these products contain high levels of simple carbohydrates making them off limits in a ketogenic diet.

Lactose Intolerance

Milk and milk products—including caseinate supplements—can cause gas, abdominal bloating, or diarrhea. As the undigested lactose milk sugar moves through the GI tract, these symptoms can lead to vomiting and severe pain. Most mammals cease producing lactase, the enzyme needed to digest lactose, soon after weaning but persistence of drinking milk or eating ice cream into adulthood can produce a tolerance until physiological responses change. Avoidance of dairy products or selection of fermented ones like cheese, yogurt, or kefir can reduce symptoms [19].

Lactulose is not lactose but many people do not know there is a difference. Lactose is a sugar that can raise blood glucose. Lactulose is a synthetic sugar that is broken down in the colon and removed from the body in the feces. Because lactulose pulls water out of the body and into the colon, GI issues like diarrhea and bloating may be experienced from eating foods containing it.

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