What is a Wheat Allergy?
When someone has a wheat allergy it means the immune system has an abnormal reaction to one of four proteins from wheat (albumi, globulin, algliadin and gluten), with symptoms similar to that of other allergic food reactions.
What is Gluten Intolerance?
Gluten sensitivity affects roughly 15% of the population, and is a non-allergic and non-autoimmune condition in which the consumption of gluten can lead to symptoms that are similar to those who suffer from celiac disease or a wheat allergy. Gluten sensitivity might be diagnosed by determining elevated levels of IgE in the blood, or more effectively, when symptoms go away after going on a gluten free diet. It is also important to rule out allergens found in many wheat based processed products such as yeast or amylase, as these allergies or intolerance can have similar effects.
What is Celiac Disease?
Celiac disease is a lifelong autoimmune intestinal disorder that cannot be cured. To develop celiac disease, a person must have one or both of two genes known as HLA-DQ2 and HLA-DQ8.
The major environmental factor is gluten ingestion, and the sensitivity to gluten is very high. Gluten proteins interact with the celiac disease genes to trigger an abnormal immune response that damages the lining of the small intestine. More than 97% of patients with celiac disease have at least one of the two genes. Most patients (more than 90%) carry the DQ2 gene. Fewer than 10% carry the DQ8 genes. It can be genetic and may affect several family members.
Common Wheat Allergy, Gluten Intolerance and Celiac Symptoms:
- Many can live symptom free.
- It can be triggered initially by pregnancy or childbirth, severe emotional stress, or even surgery.
- Symptoms are extremely varied and a number of bodily systems may be affected.
- Mimics other intestinal disorders, such as irritable bowel syndrome, gastric ulcers, and anemia.
- Look for: weight loss/gain. chronic diarrhea and/or constipation, abdominal pain, gas, bloating, weakness, inadequate growth in children, anemia, pale skin, lack of fat under the skin, fatigue, arthritis, depression, brain fog, and fibromyalgia, attention-deficit disorder and hyperactivity, schizophrenia, muscular or bone or joint pain.
- Recent studies show that this disease affects about one in every 100 people, with 97 percent of those remaining undiagnosed.
- In the U.S., it takes an average of nine years for diagnosis (Ahemmmm: why 8 years too late?).
- It is often dismissed by physicians as psycho-somatic, depression, or attributed to a number of other “unknown” conditions (like IBS or fibromyalgia).
- Higher risk people are those with a family history of celiac disease, anyone with Type 1 Diabetes, people with multiple endocrine disorders (thyroid, and Addison’s diseases), both women and men with fertility problems, and people with other auto-immune disorders (lupus, rheumatoid arthritis, and Sjogren’s syndrome).
- To diagnose, blood tests are usually the first step and measure levels of certain autoantibodies which attack the body’s own tissues. The autoantibodies that doctors usually measure to test for celiac disease are called immunoglobulin A (IgA), anti-tissue transglutaminase (tTGA), and IgA anti-endomysium antibodies (AEA). Unfortunately there can be false negative results so repeat tests become important.
- A small-bowel biopsy can also be used to determine intestinal damage and, later, monitor the healing progress. Ordinarily, the lining of the small intestine (the mucosa) is covered with hair like projections called villi that are responsible for absorbing nutrients. In patients with untreated celiac disease, the inflammation that develops in response to gluten causes these villi to shrink and flatten making it hard for the body to absorb nutrients. This can often lead to malnourishment or stunted growth in children.
- Since the body may be trying to cope with long-term malnourishment, it’s also important to measure blood levels of iron, folic acid, vitamin B12, and calcium.
- DNA test: A positive test would increase the likelihood that the symptoms were caused by celiac disease, but would not prove it (the only way to prove the diagnosis would be to resume eating gluten and then undergo a biopsy.) Unlike a blood test, a negative genetic test, however, would not irrevocably confirm that there is no celiac disease.
What the #@$!& does “Gluten Free” Mean?
Let’s just be REALLLLLLLY clear on this one: Gluten Free, from a labeling and manufacturing perspective, does not mean “has no gluten in it”.
In the US in 2007, the FDA determined that a “Gluten Free” claim means that the food has no wheat, rye, barley, or any crossbreeds of these grains (unless gluten removed), and does not contain 20 or more parts per million (ppm) of gluten.
The FDA is currently reviewing this 2007 “proposal” and has had input from many gluten organizations to take the 20ppm down to 10ppm. This level of 20 ppm is also recognized internationally in the Codex Alimentarius Standard for Foods for Special Dietary Use for Persons Intolerant to Gluten (Codex Stan 118-1979).
Likewise, in Canada the government has accepted the 20 parts per million on the basis that: (a) those affected by Celiac disease have been shown to be capable of tolerating a small amount of gluten in their diet (or threshold level); and, (b) studies found signs of damage to the intestinal villi were found in Celiacs given 50 mg/day of gluten while those who consumed 10mg/day appeared safe and would be “unlikely to cause significant histological abnormalities.”
The Canadian government also stipulated that the food cannot contain gluten proteins from barley, rye, triticale, wheat, kamut, or spelt. To clarify, barley, rye, triticale, wheat, kamut, and spelt all contain gluten naturally.
In Europe and the UK, only foods that contain 20 ppm or less can be labelled as ‘gluten-free’. The term can be used on specialist substitute gluten-free products like breads, flours and crackers, which may contain gluten-free (Codex) wheat starch, as well as processed foods that are naturally gluten-free like soups, ready meals and snacks. Additionally, wheat based Codex starch has to be identified on the label so any wheat allergies can be avoided. The ‘gluten-free’ label may also be used for uncontaminated oat products which must also contain no more than 20 ppm.
One issue to be aware of is that other grains and seeds that ARE naturally gluten free can become cross contaminated due to the lack of consideration and good practices by growers and processers.
Cross contamination means that a food naturally gluten or wheat free, has become contaminated as a result of either:
- Crop contamination, where a gluten free crop is close to a gluten crop resulting in airborne gluten residue;
- Storage of naturally gluten free grains, seeds, or flours in facilities or silos that have stored gluten food and have not been properly decontaminated;
- Processing (dehulling, cleaning, grinding, sorting) of many different crops in one facility so that residue results due to airborne or equipment contamination; or
- Packaging in a facility that is not a gluten free facility resulting in airborne or equipment contamination.
So, the potential of any food, even if naturally gluten free like oats, to be contaminated is quite high if the manufactures, on ALL levels of the food manufacturing process, are not consistent with clear quality control issues.
If you are a Celiac, the next time you reach for the bulk bin of amaranth, think again. Just because it is naturally gluten free does not mean that it is. A lot of companies have jumped on the gluten free band wagon so choose carefully. Buy your food from conscious companies that actually care. They are out there.
Watch Out For Sources Of Wheat:
- Enriched flour, white flour, whole-wheat flour;
- Graham flour, high gluten flour, high protein flour;
- Spelt (dinkel, farro);
- Triticale (a cross between wheat and rye);
- Titicum aestivom; and
- Wheat bran, wheat flour, wheat germ, wheat starch.
Watch out For Possible Sources of Wheat:
- Baking powder;
- Most baked goods e.g., breads, bread crumbs, cakes, cereals, cookies, crackers, donuts, muffins, pasta, baking mixes;
- Batter fried foods;
- Binders and fillers in processed meat, poultry and fish products;
- Coffee substitutes made from cereal;
- Chicken and beef broth;
- Gelatinized starch, modified starch, modified food starch;
- Gravy mixes, bouillon cubes;
- Communion/altar bread and wafers;
- Hydrolyzed plant protein (HPP), hydrolyzed soy protein (HSP), or hydrolyzed vegetable protein (HVP), which may contain soy, wheat, corn, or peanut as the source of protein;
- Ice cream;
- Imitation bacon;
- Pie fillings, puddings, and snack foods;
- Prepared ketchup and mustard;
- Salad dressings;
- Sauces i.e., chutney, soy sauce and tamari;
- Seasonings, natural flavoring (from malt, wheat);
- Candy, candy bars; and
- Pie fillings and puddings.
Watch Out For Non-Food Sources Of Wheat:
- Cosmetics, hair care products;
- Medications, vitamins;
- Modeling compounds such as Play-Doh; and
- Pet food.
What to Eat Instead of Wheat:
- Other vegetarian foods to look for are: all Superfoods (especially quinoa), buckwheat, amaranth, teff, montina, sorghum, millet, beans, rice, potatoes, and seeds; and
- For flours choose: quinoa flour, coconut flour, arrowroot flour, cassava flour, buckwheat flour, masa flour, potato flour, rice flour, tapioca flour, pea flour, yam flour, sorghum flour and mesquite flour.
Also, many people with Celiac disease are also lactose intolerant at the time of diagnosis. BUT After sticking to a gluten-free diet and allowing the intestinal lining to heal, you may be able to tolerate dairy products over time. A good chance though to lay off the dairy in the meantime!
i Catassi, C. Response to P.Collin et al, AmJ Clin Nutr, 2007 ; 86:260-9; and Catassi, C., Fabiani, E., Iacono, G., D’Agate, C., Francavilla, R., Biagi, F., Volta, U., Accomando, S., Picarelli, A., Vitis, I. de, Pianelli, G., Gesuita, R., Carle, F., Mandolesi, A., Bearzi, I.,Fasano, A. A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr. 2007;85(1):160-166