On gluten and wheat

Celiac disease, gluten, gluten sensitivity, and wheat allergy

Last week at bookclub, the conversation turned to adopting a gluten free diet. My one girlfriend tried it out last year to see if it would help her then GI problem. (She actually ended up having a parasite from traveling to India). She told us she wanted to give it a try again to help with her fogginess and current GI issues. Of the group there were so many questions on gluten vs. wheat vs. Celiac disease vs. allergies. I broke this down in three segments:

Celiac disease

One out of every 133 people in the US has celiac disease. People with Celiac disease (CD) are food sensitive, not allergic, and these patients can’t consume the protein gluten because it causes their body to generate an autoimmune response that causes damage to the villi in the intestine. Over time the reaction wears down the villi that line the walls of your intestine called villous atrophy. Damage to the villi impairs absorption of nutrients from food. Digestive problems are more common in infants and young children, which may include chronic diarrhea, vomiting, constipation, weight loss, and addition symptoms of growth retardation, ADHD, headaches, and skin rashes. Adults may experience the same digestive symptoms and are more likely to experience different extra-intestinal manifestations of the disease including: unexplained iron-deficiency anemia, fatigue, bone or joint pain, arthritis, numbness or tingling sensations in the extremities, depression, bone loss, infertility, canker sores in the mouth. The diagnosis involves blood tests for gluten antibodies and a small bowel biopsy to access gut damage. The only treatment is a gluten free diet, so patients must avoid wheat, rye, barley, triticale (a cross between wheat and rye), and sometimes oats if cross-contaminated.

Fortunately, grocery stores and restaurants are becoming more accommodating to these patients. I've been to so many groceries that have half of an aisle dedicated to gluten-free products including gluten free beers, and on many restaurant menus, I now see several gluten free options including gluten free pasta and pizza.

 Celiac disease: condition that damages the lining of the SI and prevents it from absorbing nutrients from food that is a reaction from wheat, barley, rye.

Foods to avoid: wheat, barley, rye, triticale, sometimes oats.  

Foods to enjoy, all plain: meat, fish, rice, fruits, vegetables, beans, corn, white/brown/wild rice, nuts and seeds

Sub for wheat: potato, rice, soy, amaranth, quinoa, buckwheat, bean flour

Hidden: sharing the toaster, medications, chapstick, makeup, lotion, shampoo 

Gluten free drinks to order at the bar: Wine, Brandy, Champagne, Gin, Cognanc, Tequila. I read these drinks are safe according to their website, Bourbon Makers Mark, gluten free vodkas including Ciroc, Titos, and Chopin.  

Non-celiac gluten sensitivity

This is less of a diagnosis but more of a description of the patient who does not have the immune response and intestinal changes characteristic of CD but still experiences certain nonspecific symptoms oftentimes seen with CD. There is still research developing, but it hasn’t been established what causes gluten sensitivity. It has been confirmed that certain genetic mutations present in CD are not seen in these patients. Gluten sensitivity symptoms include: nausea, abdominal cramping, bloating, gas, or diarrhea after ingesting gluten, rashes, brain fog, headaches, depression, joint pain, and numbness in extremities. Patients visiting their GI doctors will be administered a celiac disease testing to first rule out CD.  They may choose to still follow a gluten-free diet to see if this helps with their complaints. Patients should be generally advised against following a gluten free diet without having a workup to exclude or confirm CD, because there may be an underlying medical condition where gluten free is not the treatment. 

Gluten sensitivity or gluten intolerance: a reaction to gluten but is not associated with the intestinal damage that characterizes celiac disease.

Patient may choose to follow a gluten-free diet after ruling out CD from GI doctor. 

Wheat allergy

Celiac disease or gluten sensitivity is not a wheat allergy. A wheat allergy generates an allergy-causing antibody to proteins found in wheat. Celiac disease is a reaction to one particular protein, the gluten, which causes an abnormal immune system response in the small intestine. A wheat allergy is common in children and tends to resolve by adulthood. Symptoms include swelling, itching, irritation of the mouth or throat, hives or rash on skin, cramps, nausea, vomiting, and difficult breathing. Blood testing can also be performed to screen for this particular allergy, however, a skin test is a more sensitive diagnostic tool used to confirm wheat allergies.

Wheat allergy: allergy-causing antibody to proteins found in wheat

Mostly found in children and grown out of by adult age.

Wheat free alternatives: Amaranth, barley, buckwheat, chickpea, corn, lentil, millet, oats, quinoa, rice, tapioca.

About 20% of children are also allergic to other grains. It is important to ask your doctor if foods containing barley, oats, and rye are safe to enjoy

Sources: Dr. Patrick Saitta, Gastroenterologist with Concorde Medical Group, NYC

http://www.celiac.com/categories/Allergy-vs.-Intolerance-%252d-What-is-the-Difference%3F/