First, a sidebar about celiac disease: Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley. Gluten is found mainly in foods but may also be found in everyday products such as medicines, vitamins, and lip balms. (National Digestive Diseases Information Clearinghouse).
Anne is a 46-year-old teacher with a problem. She suffers from diarrhea, abdominal pain and bloating that are difficult to manage at work; she can’t leave the children alone in the classroom while she makes that mad dash to the ladies room. She’s had a number of tests and procedures, and her doctor says she doesn’t have anything serious wrong with her. No celiac disease. Yet, as she experiments with her diet, Ann is becoming more convinced that gluten might be causing her distress. When she tried a gluten-free, she felt better. When she went back to her normal diet (bagel for breakfast, sandwich for lunch and pasta for dinner) she started feeling sick again. What’s going on?
Have you discovered that you feel better when you don’t eat wheat? Less gas, bloating, abdominal pain and irregularity? Skin conditions, energy level and mental acuity improved? What is it about wheat, anyway?
That deceptively simple question has more than one answer. For one solitary grain, wheat can cause quite an assortment of problems! Wheat is more than just gluten. Wheat contains a complex assortment of proteins, carbohydrates and fats.
Sometimes people have health problems realated to one of the proteins in wheat, for example:
- Classic food allergy to the protein in wheat. Hives, mouth and throat swelling, or anaphylaxis can result from wheat allergy. Diet prescription: 100% wheat-free diet.
- Celiac disease, an autoimmune disease related to consuming gluten, a wheat protein (see sidebar). Diet prescription: 100% gluten-free diet.
- Non-celiac gluten sensitivity. According to the National Foundation for Celiac Awareness, “Non-celiac gluten sensitivity is diagnosed by process of exclusion. Experts recommend that you first get tested for a wheat allergy and for celiac disease. If both of those are negative, then your doctor may recommend a gluten elimination diet. If symptoms improve on a gluten-free diet, then you likely have non-celiac gluten sensitivity.” Diet prescription: unknown, but some experts recommend 100% gluten-free diet.
But wait! Some people coincidentally feel better on a “gluten-free” diet because they are eating less of wheat carbohydrates called fructans. If your symptoms are mostly GI in nature, you’ve been evaluated by a doctor and diagnosed with irritable bowel syndrome (IBS), or have noticed you sometimes get similar symptoms when you eat or drink too much milk, ice cream, certain fruits or juices, garlic, onions, soy or other beans, this possibility deserves serious consideration. These foods all contain carbohydrates that are rapidly fermented by bacteria in the gut. They are referred to as a group by the acronym “FODMAPS.” This type of intolerance can usually be managed by eating smaller portions of wheat-based foods like bread, crackers and pasta less often or eating them less often. A 100% gluten- or wheat-free diet is not necessary.
If you are having health problems you think might be related to wheat, please consult your health care provider for an evaluation. A registered dietitian can assist you with making changes to your diet for celiac disease, non-celiac gluten sensitivity or irritable bowel syndrome.
Patsy Catsos, MS, RD, LD is a registered dietitian at Nutrition Works, LLC in Portland, ME. Her private practice focuses on gastrointestinal health. She is the author of IBS–Free at Last! Second Edition and editor of www.IBSFree.net.