There are many aspects to the topic of reactions to wheat and gluten:
- True wheat allergy happens, but is uncommon. This is a true allergy, meaning the IgE part of the immune system is involved. The symptoms are the range of what we usually mean by saying “allergy symptoms” and can range from mild to severe, life-threatening or fatal anaphylaxis. Wheat allergy can also cause reaction when wheat is inhaled – such as when baking with wheat-derived ingredients such as flour.
- Celiac Disease is often thought of as being an allergy to wheat.The actual cause of illness and tissue damage in Celiac disease is an auto-immune attack on one’s own body, like other auto-immune diseases. This auto-immune reaction is set in motion by cross-sensitization with gliadin – part of gluten in wheat and other gluten-containing grains.
- The syndrome called “Non-Celiac Gluten Sensitivity” (NCGS) has been recently recognized and still poorly understood. We are not even sure that gluten is the part of wheat that is being reacted to. There has been confusion caused by the fact that some researchers seem to not have considered the difference between digestive symptoms caused by certain poorly-digested carbohydrate molecules in wheat and wheat-family foods (part of the FODMAPS topic) and NCGS. The current thinking, though not proven, is that NCGS is an immune reaction that is mediated by non-IgE parts of the immune system. Many people with NCGS symptoms report reactions to trace amounts (similar trace or very small amounts as can cause harm in other immune-mediated conditions, such as celiac disease and food allergy). Also, symptoms are not just in the digestive tract, but can occur elswhere in the body – most particularly the nervous system – such as migraine headaches. In fact, some people with NCGS have no digestive tract symptoms at all.
- Wheat and other gluten-containing grains contain a poorly-digested type of molecule called “fructans”. This has nothing to do with the gluten and it is present in white flour, not just whole-wheat products. This is one of the molecule types referred to by the “FODMAPS” designation. Responses, when they occur, are related to the quantity of the fructans, not by an immune response to small exposures.
- It is known that gluten is poorly digested by humans. This is established as a fact and not just some hype. It is associated with an increase in the “leakiness” of the lining of the gut. However, gluten is only one of many things that cause a more leaky gut. Because this brings up a number of things to be concerned about regarding eating wheat, researchers are trying to understand the impacts of this. This research, though, is still in it’s early phases. There are no clear answers yet as to what any specific medical recommendations should be. While we wait for better knowledge, some people, particularly people with significant chronic health problems, have chosen to eliminate wheat/gluten as a “prudent” move – that is, knowing they may be erring on the side of caution. There is no particular health need for wheat-family grains or gluten, however one would want to be cautious that the effort to eliminate wheat does not interfere with other health interventions that may be more specifically beneficial.
There are also things about eating wheat that can relate to symptoms or wellbeing in a non-specific way.
Doing a gluten elimination trial to see how you feel is NOT a great first step. Tests to screen for or diagnose celiac disease are not accurate unless you are currently eating gluten-containing foods on a regular basis. The first best step is to see your doctor and discuss your concerns, so testing can be ordered first if indicated. If you feel much better with eliminating wheat, and ask your doctor for testing then, you might be very disappointed when you find out that the tests will not be reliable unless you went back on daily substantial wheat exposure over an extended period – such as two months or so.
For people who do a trial of eliminating wheat/gluten to see how they feel, there is a lot to keep in mind when evaluating your experiences:
- for many people, wheat is a major source of starch in the diet. Eating a large amount of wheat – e.g. as a large pasta serving – could cause symptoms related to the large intake of starch – not having anything specific to do with the fact that it is wheat or not.
- cutting out wheat often means many other changes to the diet at the same time –
- the starch intake may be cut (or not, depending on how much other starchy food is substituted for the wheat) – which may relieve some symptoms having to do with starch or carbohydrate ingestion.
- when cutting wheat out, for some people this is such a major change in their habits that they intentionally or unintentionally cut their calorie intake quite a bit – over the day or just at certain times of the day. This enforced change in habitual eating can work out well if leads to breaking some old habit patterns and a re-evaluation of eating patterns. In can work out badly if your body responds to the lower calorie intake with cravings, mood changes, fatigue and a shift to a more erratic eating pattern. When this happens, it is often delayed, so that things look great initially, but then the cravings or erratic appetite develop more slowly over time.
- because eating either snacks or meals out of the home becomes more difficult when you are avoiding wheat, this can lead to less snacking and more often eating home-prepared food and a shift towards less use of packaged and highly-processed foods. For a number of reasons, this change itself may improve health substantially.
- being off wheat or gluten takes some considerable effort and planning, so people may make this a time when they pay more attention in general to various aspects of healthy living – part of an over-all change of habits and lifestyle to improve their health. Improvements in heath or sense-of-wellbeing in this situation can be for many reasons, so it’s hard to know if the wheat or gluten elimination was itself an active factor.
Resources:
Wheat Allergy resource page on the Food Allergy Canada site LINK
FODMAPS info on this site LINK
Core Health MD 