Demystifying Wheat & Gluten Sensitivities
[updated - original article posted January 8th, 2014]
Wheat and gluten continue to make headlines, as many people are still adopting or experimenting with a "gluten-free" diet for a variety of reasons. Although there has been a lot of coverage in the media, you may still find yourself confused and curious the subject, especially since this issue remains quite controversial. With all of this hype, it is important to shed some light and perspective on this very inflammatory topic.
First and foremost, it is necessary to be clear on the difference between wheat and gluten. Quite simply, “wheat” is a type of whole grain, such as rice and oat; while, “gluten” is the protein complex found in high amounts in wheat, but also found in other grains (i.e. barley, rye, kamut, spelt, etc.). The most well-known gluten-free grains are rice, quinoa, millet, and amaranth. In the baking world, gluten is considered highly valuable because it adds the fluffy, doughy consistency to baked goods that we all know and love.
While wheat has long been considered one of the top eight most common food allergies (an IgE mediated immune reaction), along with dairy, soy, corn, eggs, peanuts, shellfish, and citrus fruit; it is now suspected that wheat, particularly gluten, has a spectrum of other non-allergic reactions. The most well accepted and understood is the genetic, autoimmune type known as Celiac Disease (characterized by the immune system's destruction of the small intestine whenever gluten is consumed). Much more common, however, is what is now being referred to as a wheat/gluten "sensitivity" (more technically known as: "Non-Celiac Gluten Sensitivity" abbrv NCGS) . This term is now being used to label reactions to wheat/gluten that are neither an allergy nor Celiac Disease, and describes a clinical picture of digestive and non-digestive symptoms that resolve with elimination of wheat/gluten from the diet. It is not yet clear what the mechanism behind this type of reaction is, but leading theories suggest it may be due to a delayed immune system response, mediated by IgG antibodies ; or it may be due to the damaging effect of the gluten protein complex on the mucosa of the intestinal lining [1, 3]; or it may be due to the inability to digest certain components of wheat such as the FODMAPs (i.e. fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) . It is conceivable that all of the above could be playing a role for certain individuals.
As you can see, there are a number of different types of reactions that can be caused by wheat and gluten, with a sensitivity being the most common. But the question remains: "how do I know if I'm sensitive?" The difficulty with diagnosing a sensitivity to wheat/gluten is that there isn’t any test available that is 100% accurate, and there are various possibilities of symptom presentation that can confuse the matter. Any of the following symptoms are possible in varying degrees of severity: fatigue, muscle aches, ‘brain fog’, headaches, joint pain, sinus issues, digestive disturbance (gas/bloating, diarrhea, constipation, abdominal cramps, acid reflux, nausea, etc.), and weight gain. If you experience any of the above symptoms long term, and other causes have been ruled out by your doctor, you could possibly be sensitive to wheat/gluten. The gold standard in identifying any food sensitivity is that of the ‘elimination & challenge diet’, which involves strictly eliminating the suspected food(s) for an adequate amount of time, followed by a step-wise reintroduction/challenge. However, there are also blood tests available that may be helpful in identifying a possible delayed-type immune reaction mediated by IgG antibodies. This type of testing may be helpful when you suspect multiple food sensitivities and a complete ‘elimination & challenge’ diet of the most common food sensitivities seems overwhelming or not manageable.
The bottom line is this: although not everyone is sensitive to wheat or gluten, it appears that for a variety of complex reasons, many people are. If you are, it is worthwhile knowing as it can alleviate chronic health complaints and prevent the development of more serious problems. Even if completely eliminating gluten is not feasible for you, significantly reducing your daily intake and incorporating healthy, gluten-free whole grains might be a step in the right direction to optimizing your health!
1) Elli L, Roncoroni L, Bardella MT. Non-celiac gluten sensitivity: Time for sifting the grain. World J Gastroenterol [Internet]. 2015 Jul [cited 2017 Jul 24];21:8221 - 8226. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507091/
2) Caio G, Volta U, Tovoli F, De Giorgio R. Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity. BMC Gastroenterology [Internet]. 2014 Feb [cited 2017 Jul 24];14:26. Available from: https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-14-26
3) Catassi C, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A, et al. Non-celiac gluten sensitivity: The new frontier of gluten related disorders. Nutrients [Internet]. 2013 Sept [cited 2017 Jul 24];5:3839-3853. Available from: http://www.mdpi.com/2072-6643/5/10/3839/htm