Wheat. It’s been around for thousands of years, almost 10,000 BCE. Wheat is a staple in the diets of so many Americans, with our love of bread, pasta and pizza. But for some individuals, wheat spells disaster and pain, and figuring out which condition is causing the issue with wheat can be challenging.
Different types of wheat-related conditions
There are three primary types of wheat-related conditions: a true food allergy to wheat, an autoimmune condition called Celiac Disease, and a newly recognized condition called Non-Celiac Gluten Sensitivity (NCGS) or Non-Celiac Wheat Sensitivity (NCWS). They share only one thing: a sensitivity to wheat.
Wheat allergy is most common in children. The onset is from minutes to hours, and the symptoms may be severe (analphalaxis or an inability to breathe). The individual will test positive to a skin prick (IgE) or a food challenge, which are an exposure, and needs to be conducted under the care of a qualified healthcare professional as an emergency situation could result.
Celiac Disease (also called Coeliac Disease) is an autoimmune response to the intestines, triggered by a grain protein, most commonly, gluten. Other proteins may also cause the response but this is less well studied. Gluten is found in wheat, rye, barley and triticale (a wheat-rye hybrid).
Celiac Disease causes damage to the villi that line the gut wall. The villi are responsible for absorption of our nutrients, and long-standing damage may cause malnutrition. Damage to the gut can be seen in a biopsy.
Symptoms may present in weeks to years. However, 1 in 8 people with Celiac Disease do not have any symptoms but yet have damage occurring. And 40-60% of people with Celiac Disease will not have the expected gastrointestinal symptoms but rather experience symptoms like joint pain, brain fog, skin rashes, osteoporosis and anemia.
Diagnosis is usually made by checking for antibodies, and with an intestinal biopsy:
- tTg IgA
- tTg IgG (especially is IgA deficient)
- Anti-deamidated gliadin
- Anti-DGP IgG
If you are going to be tested for Celiac Disease, it is important to be eating gluten, as unpleasant as that sounds, for at least 2 – 3 months. Otherwise, the antibody count can diminish and the gut damage healed, which can lead to a false sense that you do not have Celiac Disease.
There are genes which indicate a predisposition to Celiac Disease: HLA DQ2 and HLA DQ8. About 40% of the population carries this gene, and carrying the gene does not mean you will develop Celiac Disease. In fact, only about 1% of the population has Celiac Disease.
Ridding the diet of gluten is only the first step: gluten can also be inhaled and cause problems.
Non-Celiac Gluten Sensitivity / Non-Celiac Wheat Sensitivity:
There is a third category which has received increased attention in the past five years. It goes by either Non-Celiac Gluten Sensitivity or Non-Celiac Wheat Sensitivity. NCWS is the preferred term as researchers are unsure if the culprit is gluten, or only gluten and not other proteins as well.
For several years, many people were led to believe if they tested negative for Celiac Disease then there was nothing wrong. This is because we don’t have a test to confirm NCWS, but the absence of our ability to test for an issue does not mean there is not an issue! The prevalence is believed to be higher than Celiac Disease, ranging from 0.5% – 6%.
Individuals with NCWS may experience similar symptoms, both intestinal and other symptoms, as those with Celiac Disease. However, symptoms typically occur more quickly – in hours to days. However, there are key differences:
- Absence of genetic predisposition
- Absence of specific antigen tests
- Absence of intestinal damage upon biopsy
- Absence of elevations in IL-8, IL-10 and IL-12 after ingestion of gluten (elevations are seen in Celiac Disease)
- Absence of intestinal permeability (also known as gut dysbiosis or leaky gut)
We do not have a test for NCWS, and the diagnosis is made after excluding other possible causes. One area of research is whether it is gluten itself which is causing the symptoms, other proteins or potentially FODMOPS. FODMOPS are fermentable, oligosaccharides, di-sacchardies, monosaccharides and polyols Research has been specifically promising on fructans, which are included in FODMOPS. A low FODMOPs diet may be beneficial.
What can I do to change my diet?
Most healthcare professionals will recommend a modification in gluten or wheat intake following the proper diagnosis.
For wheat allergy, the reaction can be severe. Avoid wheat entirely, although other grains even those containing gluten may be acceptable. For those with Celiac Disease or Non-Celiac Wheat Sensitivity, a gluten-free diet or better, a gluten-undetectable diet may be needed. Gluten-undetectable means the product was prepared in a facility that has no other gluten-containing processes, so the risk of cross-contamination is lessened.
A good resource is: www.foodallergy.org, and search for wheat. This will also alert you to possible other sources of wheat and wheat products including soy sauce (use tamari!), vinegars, beers, meatballs and breaded meats, breaded vegetables, and mixes (even rice bowl mixes). When in doubt, call the manufacturer.
Two other resources are:
- https://dfwceliac.org/ This is for the Dallas-Fort Worth area
- https://gluten.org/ for national product searches or to find your local branch
- American Academy of Allergy, Asthma & Immunology for information on wheat allergy