The hype around gluten intolerance in recent years has at times been misleading. Gluten is a protein found in wheat and while some people may have an allergy to it and others can be sensitive to gluten, overall it is not a common condition as is often portrayed. In fact compared to other food intolerances like lactose intolerance, gluten intolerance is relatively rare.
Differences between Intolerance, Allergy and Sensitivity
A food intolerance is a condition where the body cannot digest a certain nutrient due to a lack of specific enzymes or malfunctioning of these enzymes. Lactose intolerance is a typical case where the body lacks the enzyme lactase which is needed for digesting the milk sugar known as lactose. Undigested nutrients can then draw out water into the gut and serves as a food source for bacteria in the large intestine thereby giving rise to various digestive symptoms.
Read more on food intolerance.
In the case of gluten intolerance, it is believed that gluten in wheat is the cause of this digestive disturbance. However, apart from a gluten allergy like celiac disease, there is no significant evidence to suggest that gluten intolerance is similar to lactose intolerance exists. Instead some individuals are sensitive to gluten and may experience digestive symptoms when consuming foods high in gluten.
In gluten sensitivity there is usually no damage to the bowel wall as is seen with celiac disease (gluten allergy). The reaction to wheat is nevertheless present, often for unidentified reasons. It is also unclear whether the sensitivity is to gluten specifically or to some other substance in wheat. A malabsorption syndrome is a different food-related condition that is sometimes confused with an intolerance. In a malabsorption syndrome the body cannot absorb certain nutrients .
Celiac disease is a condition where the immune system reacts to the presence of gluten in the gut. As a result of this abnormal immune response, the bowel wall becomes inflamed and can even be damaged. The bowel cannot absorb nutrients in food and this leads to deficiencies and even malnutrition. A host of other complications can arise with digestive and non-digestive symptoms.
Read more on celiac disease.
Celiac disease may be linked to a family history of the condition as well as other conditions such as type 1 diabetes, Addison’s disease, autoimmune thyroiditis and rheumatoid arthritis among other conditions. These risk factors increase the likelihood of celiac disease but the condition can affect any person.
Digestive and Non-Digestive Symptoms
In celiac disease, digestive symptoms are more likely to occur in children. Few adults exprience these symptoms in celiac disease. With wheat sensitivity, some adults do experience digestive symptoms while others do not. Non-digestive symptoms of a gluten allergy or wheat sensitivity can sometimes be misleading. There are several other conditions that can cause similar symptoms. While there are tests for celiac disease, such conclusive diagnostic investigations are lacking for wheat sensitivity.
Nausea and Vomiting
The presence of wheat, or gluten specifically, irritates the gut lining. As a result this sends signals back to the brain and the sensation of nausea is elicited. It may or may not be followed by vomiting depending on the severity of the gut irritation. Vomiting is also the way the body expels irritants from the gut in order to prevent any damage or danger to the body.
Most of us are accustomed to the odd episode of diarrhea that lasts for a few days. However, with a gluten intolerance, be it a sensitivity or allergy, diarrhea persists for long periods. This chronic diarrhea occurs when the bowel wall becomes inflamed and damaged. Nutrients cannot be absorbed from the gut and these residual nutrients draw water into the bowel. Movement through the bowel may also be sped up due to the irritation.
NOTE: Some people with celiac disease and wheat sensitivity may experience constipation instead of diarrhea.
Acid Reflux and Heartburn
Even without vomiting there still may be some backward flow of the acidic stomach contents, known as acid reflux. This causes the typical burning pain the chest known as heartburn. Children may not always be able to clearly describe this symptom and simply report chest pain a short while after eating gluten-rich foods. It is often accompanied by stomach pain.
While most adults may not notice these digestive symptoms, unintentional weight loss is often more noticeable. In children this is seen as failure to thrive. Despite eating, the child does not gain weight as expected or experience growth in terms of height and head circumference. There may also be weight loss in children as well as muscle wasting due to malnutrition. Weakening (osteoporosis) and softening (osteomalacia) of the bones may also occur.
Other Signs and Symptoms
- Abdominal distension
- Delayed puberty
- Joint pain
- Mouth ulcers
- Neurological conditions like ADHD, learning disabilities and seizures.
- Poor appetite
- Skin rash with itching and blisters (dermatitis herpetiformis)
Diet for Gluten Intolerance
Whether it is celiac disease or wheat sensitivity, there is no specific medical treatment that will permanently allay the allergy or sensitivity and its symptoms. Instead the dietary approach to managing this condition is crucial. It involves avoiding foods that are rich in gluten. Wheat is not the only such food although it is often abundant compared to other gluten-rich foods in the modern diet.
Foods made from the following grains should be avoided:
- Graham flour
Although these grains need to be avoided entirely by people with celiac disease, the same may not apply to wheat sensitivity. In terms of the latter, wheat specifically appears to be the problem and it may not even be the gluten that is the trigger. Other grains may not elicit the sam reaction. It is important to note that gluten may be present in a number of different processed foods and non-food items, such as toothpaste.
It takes days or weeks for the symptoms to subside once gluten intake is stopped. In addition, vitamin and mineral supplements may be necessary for severe cases of celiac disease to replenish the micronutrients that are not absorbed from food. Always consult with a doctor and dietitian for proper treatment and management of a gluten allergy or wheat sensitivity.