Dear Dietician: Wheat & gluten

Dear Dietitian,

I've been experiencing a lot of digestive problems like stomach cramping and bloating. My friend who has celiac disease thinks I may have it, too. I have an appointment with my doctor and have been reading up on celiac disease. What is the difference in gluten sensitivity, celiac disease, and wheat allergy?

Susan

Dear Susan,

It can be very disruptive to have a digestive problem, and I'm glad you are taking the right steps to get this resolved. First off, gluten is a protein found in wheat, barley, rye, and triticale (a hybrid of wheat and rye). It is also used as a binder in some products such as soy sauce, ice cream, and hot dogs. Binders are used in food processing to thicken and improve the product's texture.

Celiac disease is an autoimmune, genetic disorder that affects as many as three million Americans. It is caused by a reaction to gliadin, a component of gluten. The body's reaction to gliadin causes a flattening of the villi, the fingerlike projections in the small intestines that facilitate the passage of fluids and nutrients. This damage, in turn, results in malabsorption of nutrients.

Symptoms of celiac disease include diarrhea, abdominal cramping and bloating, and possible weight loss from malabsorption. One may also experience headaches and joint pain. A physician will perform a blood test to look for certain antibodies. If these are found, the next step is an intestinal biopsy to look for damage to the villi, which will provide a definitive diagnosis of celiac disease.

Gluten sensitivity, sometimes called non-celiac gluten sensitivity, is not well-defined in the medical community, and there are no blood tests to diagnose this condition. Symptoms produced after consuming gluten are similar to those with celiac disease, but damage to the small intestine is not found. It is usually diagnosed after ruling out celiac disease and wheat allergy.

Wheat allergy is sometimes confused with celiac disease, but these conditions differ. With a wheat allergy, the body produces antibodies to the proteins in wheat. In celiac disease, the body has a response to a specific protein, gluten, and the body's reaction is different than a typical allergic reaction.

A wheat allergy occurs when the body mistakes this substance as harmful. Symptoms occur after eating wheat and sometimes when inhaling wheat flour, and may include itching, hives, diarrhea, and even anaphylaxis. Anaphylaxis is a severe, life-threatening allergic reaction that requires immediate medical attention.

If you are sensitive to gluten, you are also sensitive to wheat. However, if you are allergic to wheat, you will react to other components of wheat, not just gluten. Therefore, you need to be sure all the products you buy are labeled "wheat-free" as well as "gluten-free."

It is important to note that certain nutrients may be lacking in a gluten-free and/or wheat-free diet. While wheat flour is enriched with nutrients that are stripped during processing, gluten-free manufacturers are not required to enrich or fortify their products. Missing nutrients may include vitamin B 12, thiamin, folate, niacin, riboflavin, and fiber. You may consider taking a supplement to obtain these vitamins, and eat plenty of fruits and vegetables to get your fiber. Consult a Registered Dietitian to design a healthy meal plan that works for you.

As always, be healthy!

Dear Dietitian

Leanne McCrate, RD, LD, CNSC, aka Dear Dietitian, is an award-winning dietitian based in Missouri. Her mission is to educate consumers on sound, scientifically-based nutrition. Do you have a nutrition question? Email her today at [email protected]. Dear Dietitian does not endorse any products or diet plans.