Gluten is a protein found in wheat, as well as a few other grains such as barley and rye. When mixed with water, gluten forms a gluey network of proteins that creates the elastic nature of bread dough, enables it to rise, and produces the springy, chewy quality of bread.
Although gluten-free diets have become increasingly popular in recent years, gluten is not a problem for everyone. However, some people do have an adverse reaction to wheat or to gluten. These adverse reactions can stem from several different conditions: wheat allergy, celiac disease or non-celiac gluten sensitivity (NCGS).
Wheat allergies are most common in children, many of whom outgrow the allergy before they reach their teens, but it is also possible to develop a wheat allergy later in life. People can develop celiac disease or gluten sensitivity at any age, and, indeed, the prevalence of celiac and NCGS in adults and elderly people is rising. There is no cure for celiac disease, but adhering to a gluten-free diet will relieve symptoms and prevent long-term health issues.
Studies have shown that gluten is not always the cause of so-called gluten sensitivity. Several other elements present in wheat have been identified as possibly problematic for some people. Carbohydrates known as fructans and proteins called amylase trypsin inhibitors may also cause the symptoms commonly attributed to NCGS. To determine exactly what elements of wheat cause problems for certain people, more research is needed.
Wheat Allergy vs. Celiac Disease vs. Gluten Sensitivity
A wheat allergy usually manifests in symptoms comparable to those of other allergies: nasal congestion, eye irritation, hives, vomiting, diarrhea, and difficulty breathing. An allergy may be diagnosed with a skin prick test or blood test. Those with a wheat allergy should follow a strict wheat-free diet but should not have a problem with other gluten-containing grains such as rye and barley.
Celiac disease is an autoimmune disease. This disease is unique because the consumption of gluten damages the small intestine and prevents absorption of nutrients. In children, symptoms of celiac disease often center on the digestive system: bloating, gas, diarrhea, constipation, nausea and vomiting. Adults may also experience these symptoms, or they may experience any of a wide variety of non-digestive symptoms.
Non-digestive symptoms of celiac disease common in adults include:
- Tingling in the hands and feet
- Canker sores in the mouth
- Joint pain, arthritis, or osteoporosis
For those with celiac disease, a completely gluten-free diet is essential, both for the body’s general wellbeing and also to prevent increased risk of other autoimmune diseases, as well as osteoporosis, cancer and even death.
If you are experiencing any of the above symptoms, it’s important to get tested for celiac disease to find out if going gluten-free is crucial for your health. Celiac disease is identified with either a blood test and possibly a biopsy to check for damage to the small intestine.
It’s estimated that only 1% of the population has celiac disease. A much larger number may have some form of non-celiac gluten sensitivity (NCGS). People with NCGS may experience similar symptoms.
If your doctor rules out celiac disease, but you are experiencing symptoms such as bloating, discomfort or fatigue that you think might be connected to eating wheat, you can try a gluten-elimination diet to find out if that alleviates the symptoms.
Non-Celiac Gluten Sensitivity: Is Gluten Actually the Issue?
NCGS is controversial and not well-understood. There is no official diagnosis process available. Some experts think the main culprit is not gluten at all―rather, that some other element present in wheat causes the symptoms. Some studies have shown that some people who were following a gluten-free diet because of perceived gluten sensitivity did not develop any symptoms when they unknowingly consumed pure wheat gluten.
Studies point to two other possible causes of sensitivity related to wheat: fructans and amylase trypsin inhibitors. Fructans are complex carbohydrates in wheat that ferment in the large intestine and can cause bloating, cramping, gas and diarrhea. Fructans are part of the hard-to-digest group of carbohydrates known as FODMAPs. Eliminating FODMAPs may relieve the symptoms of irritable bowel syndrome.
Amylase trypsin inhibitors are proteins in wheat that act as natural pesticides, protecting the plant by making it difficult for insects to digest the starches in the wheat. Modern wheat has been bred to have increased amylase trypsin inhibitors, and some studies have indicated that these proteins can cause inflammation in the gut and exacerbate pre-existing chronic disease.
Some experts think that some element of wheat, whether gluten, fructans, amylase trypsin inhibitors or an as-yet-unidentified element, cause the membrane of the intestine to become more permeable (a condition known as “leaky gut”), allowing partially-digested wheat into the bloodstream, where it triggers an immune response.
A related condition, whose symptoms are sometimes confused with celiac or NCGS, is fructose malabsorption, where the body is not able to absorb the fructose sugars present in fruits and fruit juices, as well as sweeteners such as honey and high fructose corn syrup.
Whether or not gluten is the cause of NCGS, a wheat- or gluten-free diet can alleviate the symptoms. If symptoms continue, eliminating fructose or lactose may be the next step.
If you and your doctor decide that a gluten-free diet is right for you, what can you eat? The good news is, most unprocessed foods have no gluten. Vegetables, fruits, unprocessed meats, dairy, eggs, legumes, nuts, seeds, and many grains (including rice, corn and quinoa) are naturally gluten-free.
Wheat (and therefore gluten) is a key ingredient in most baked goods, as well as pastas and many breakfast cereals. Gluten is also less-obviously involved in several other common products: beer, malt, soy sauce, and many processed foods such as hot dogs, condiments, and sauces. Check ingredient labels for wheat, barley, rye, spelt, or maltodextrin. Triticale, a hybrid of wheat and rye, is less common but also has gluten.
Oats do not naturally contain gluten, but they often have gluten contamination due to being processed in facilities where wheat or other gluten grains is also processed. People with celiac disease or wheat allergy should only eat certified gluten-free oats.
Gluten may also be present in non-food products. It can be used as a binder in drugs and vitamins, and is often an ingredient in beauty products. These products may not indicate on the label that they contain gluten.
Wheat, which contains protein as well as nutrients, has traditionally been a central part of the American diet. Products marketed as gluten-free, especially processed foods, are not necessarily healthy. Gluten-free processed foods often contain high levels of soy, sugars and vegetable oils. If you try out a gluten-free diet, it’s important to be sure you replace the wheat products in your diet with other foods or supplements that provide sufficient protein and nutrients, and support your body as you transition to the new diet.
If you have been suffering from symptoms that are reducing your quality of life and are concerned that you could be dealing with wheat-related problems, contact a BodyLogicMD-affiliated physician today. Physicians within the BodyLogicMD network specialize in integrative medicine, including focusing attention on food and nutrition, and they can get you back on a path to vitality. Take the first step today to reclaim your health and wellbeing.