This article forms part of my series on food sensitivities and allergies; you can catch up on any of the previous articles below:
- Part 1: Food Allergy or Sensitivity – What’s The Difference?
- Part 2: How Do I Know If My Child Has A Food Allergy?
- Part 3: Back to School – 4 Steps to Keeping Your Allergic Child Safe
In this article, I want to talk about a very important topic that many people find very confusing – wheat allergies, sensitivities and Celiac disease – three different, but increasingly common, reactions to wheat. The symptoms of these three conditions can overlap so, until people have the correct diagnosis, they may be confused about what is causing their problem. Later I will explain the difference between these conditions and how we can test for them but first, let’s look at why wheat is such a problem for so many people and how it fell from grace as the pillar of a healthy diet it was when I was a child,
The Problem with Wheat
When I was growing up we were lucky enough to have a wonderful bakery in our town (we still do) that baked the most delicious wholegrain breads that we would buy as part of our healthy and wholesome diet. However, over the last few years, bread and wheat have fallen out of favor. We hear more and more about how wheat is bad for us, how we should cut down on it or even cut it out of our diets altogether. Sometimes it seems as if everyone we meet is sensitive to (or allergic to) wheat, ‘gluten-free’ or has Celiac disease. Why is that? What happened to turn this once optimal healthy food into the cause of so much ill-health in this country and worldwide?
There are a couple of reasons for this switch in the health benefits of wheat:
- We have mucked it up
Our scientists have changed the original genetic makeup of the grain our ancestors used to consume. It has been genetically modified to grow faster, produce a higher gluten content and taste better. By altering wheat from its original form scientists have taken what was once a healthy food and created a new version that has the potential to cause severe illness.
- We eat too much of it
Most people will eat wheat in some form or another at every meal. It is so ubiquitous that you may find that is in most meals and snacks that you eat throughout the day Take a moment now to think about your diet – chances are it looks something like this:
- Breakfast – cereal or toast
- Lunch – a sandwich
- Dinner – pizza or pasta
All of these things have wheat flour as a major ingredient and, because food reactions tend to be time and dose-related, the more wheat we eat over a long period of time, the greater the likelihood that we will develop a reaction to it whether that is a sensitivity reaction, an allergic reaction or a Celiac reaction.
Let’s look at each of these conditions in turn, along with the tests we can do to help us figure out which of them is causing the problem.
Wheat sensitivity is very common and the symptoms can vary in timing and intensity. As I explained in part 1 of this series, a food sensitivity can occur within minutes of eating the problem food (in this case wheat) or the reaction can be delayed by anything up to 72 hours later. We are all different and therefore all react differently to problem foods so it’s impossible to give a definitive list of wheat sensitivity symptoms but here are the most common – you may experience any or all of these, or none of them:
- Abdominal pain
- Irritable Bowel
- Skin symptoms such as eczema
- Joint Pain
- Muscle aches and pain
- Sinus congestion
Wheat sensitivity testing is done through an IgG antibody test. This involves taking a blood sample and then separating out the blood serum and adding wheat to it to see if there is a reaction. If there is, then we know that you have a sensitivity to wheat.
A true wheat allergy is when we have an anaphylactic reaction within minutes of eating wheat. Here are some of the symptoms of an anaphylactic reaction for you to look out for:
- Shortness of breath
- Tingling or itching in the mouth
- Swelling in the mouth and/or tongue
- Wheezing/nasal congestion
- Abdominal pain, nausea, diarrhea, vomiting
- Throat closing
- Losing consciousness
Wheat allergies occur within minutes of eating, or even inhaling, wheat products (for example when you are baking). As for wheat sensitivity, a blood serum sample is tested to see if you have circulating levels of the IgE antibodies that are responsible for an allergic reaction in your blood. Labs can test for gluten IgE antibody levels at the same time as testing for wheat antibodies.
Celiac disease is an autoimmune disease in which the immune system reacts to gluten, a protein that is found in certain foods such as wheat, rye, oats and barley. When someone with Celiac disease eats a diet high in gluten, the immune systems attacks the gluten in the small intestines causing inflammation and damage to the intestinal cell lining. The vital role of the small intestines is to absorb the nutrients that are taken in through our diet. If the intestinal lining is attacked then they are not able to fulfil this primary function.
Often periods of extreme stress on the body can accelerate the progression of Celiac disease, this could be pregnancy, extreme weight loss or gain, or illness. In addition, emotional stress such as divorce, family illness, death of a loved one or work stress can also accelerate the onset. Illnesses like type 1 diabetes, autoimmune thyroid, lupus, Sjogrens and Rheumatoid arthritis may also predispose people to develop Celiac Disease. The following are the most common symptoms associated with Celiac disease.
- Gas & Bloating
- Abdominal Pain
- Weight loss
- Skin rashes
Children may also exhibit these symptoms:
- Slow growth and weakened bones
- Weight loss
- Vomiting after eating gluten
In addition to the usual symptoms, long-term conditions can occur if Celiac disease is not treated properly; these include but are not limited to:
- Low Vitamin D
- Type 1Diabetes
- Infertility and Miscarriage
- Intestinal Cancer
Note: There is a genetic component to Celiac disease so it does run in families. If you have a family member who has it you will want to periodically get yourself tested as the disease can occur at any time.
There are two tests for Celiac disease. The first is what is known as Transglutaminase IgA & IgG- Celiac Testing. All this means is that we take a blood sample and then test the serum for the transglutaminase IgA & IgG antibodies that are produced when your immune system is attacking your intestinal lining. If any transglutaminase IgA antibodies are found it would suggest that you have Celiac disease. These antibodies will disappear within 6 months of eliminating wheat completely from your diet so it is important to test these antibodies again within a few months of eliminating wheat and gluten from your diet to check that the numbers are reducing. IgG antibodies can take up to a year to completely go away. We would also test for anti-gliadin antibodies IgA & IgG when testing for celiac using the same blood sample. These antibodies are produced by the immune system when there is an exposure to wheat and gluten.
The second test is an Endoscopic Biopsy which your Gastroenterologist will do following a positive blood test to confirm the diagnosis of Celiac disease. The biopsy involves taking tissue samples from your small intestinal cells to see whether there is any damage to the intestinal lining as a result of eating gluten. Before the biopsy you will have to eat a gluten-rich diet for at least 3 month.
People often ask me if it is possible to have all three conditions. Well, the answer is ‘Yes’. I have had patients show positive labs for wheat allergies, wheat sensitivity and Celiac disease. However, I have also had patients who test negative for food sensitivities but positive for Celiac disease.
Wheat, as a food group, can be very irritating to some people and there are multiple reasons why it can cause such severe symptoms so, even if you don’t have a wheat sensitivity, allergy, or Celiac disease it is still a good idea to keep consumption of wheat to a minimum and try not to eat it every day. if you have a sensitivity to wheat (though not if you are allergic or have celiac disease), you may try other varieties of wheat, such as spelt and kamut as they may not produce the same reactions as the more genetically modified varieties.
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