Dr. Tariq Jagnarine
Family Medicine /Endocrinology/ Diabetes
Gluten is a protein found in cereals such as wheat, barley, and rye. A person with gluten intolerance or sensitivity may experience pain and bloating after eating foods that contain gluten. While data is lacking on the prevalence of gluten sensitivity, studies suggest that 0.5–6% of the global population may have this condition, 1% have a wheat allergy, and 6% or more have a gluten intolerance also known as non-celiac gluten sensitivity.
A person with gluten intolerance may experience bloating, abdominal pain, and nausea. Gluten intolerance can cause symptoms that are similar to celiac disease, but it is a different issue with different long-term effects.
The symptoms of gluten intolerance may also resemble those of a wheat allergy, or intestinal condition such as irritable bowel syndrome (IBS). Experts estimate that 10–15% of adults have IBS symptoms.
People with celiac disease must avoid gluten, as it can cause intestinal damage and prevent the body from absorbing essential nutrients. Those with a wheat allergy must avoid all wheat products, as consuming any could be immediately life-threatening.
Gluten intolerance can lead to discomfort, but it is unlikely to cause severe symptoms that require emergency care. Scientists have found evidence that environmental factors can play a role in celiac disease. However, experts are unsure of exactly what causes gluten intolerance, and how it compares to similar illnesses. Some researchers have suggested that other ingredients in wheat, not gluten, may be causing some of these reactions.
SYMPTOMS
An individual with gluten intolerance will develop symptoms after consuming foods containing wheat, barley, or rye. The symptoms may include:
• Tiredness
• Bloating
• Abdominal pain
• Diarrhoea
• Nausea
• Constipation
• A general feeling of being unwell
• Anxiety
• Headaches
• Brain fog
• Confusion
• Numbness
• Joint or muscle pain
• A skin rash
See a doctor about any of the above symptoms. A correct diagnosis is important, as many conditions affecting the gut have similar symptoms.
Severe abdominal pain can be a symptom of a serious medical issue, and anyone who experiences it should receive immediate medical attention.
GLUTEN INTOLERANCE VS WHEAT ALLERGY
When a person has a wheat allergy, their body reacts to a protein in wheat, and that protein is not necessarily gluten. A wheat allergy can cause life-threatening symptoms.
Anyone with this allergy who ingests wheat requires immediate medical attention. A person with a wheat allergy may develop:
• Hives
• Swelling
• Breathing difficulties, including wheezing
• In severe cases, anaphylaxis may develop. This serious reaction causes the body’s blood pressure to fall, and the person may lose consciousness and stop breathing.
While an allergic reaction requires urgent care, an intolerance is not immediately dangerous. However, it can cause discomfort, and may affect a person’s overall health.
FOODS TO AVOID
Glutens are proteins that enable wheat and other cereals to absorb water, stick together, and remain viscous and elastic. They help give bread dough its texture, and make it possible for the dough to rise, for example. Wheat, barley and rye contain gluten, which may be present in:
• Bread
• Cookies and biscuits
• Pastas
• Semolina-based products
• Couscous
• Some beers
Gluten may also be in products that are not obviously cereal-based, such as:
• Seasonings
• Sauces
• Soups
• Canned foods
• Spices
FOOD TO EAT
Foods that do not contain gluten include:
• Fruits and vegetables
• Plain meat, poultry and fish products
• Pulses such as beans and lentils
• Rice
• Quinoa
• Potatoes
• Some oat products
A person looking to avoid gluten should be sure to check food labels carefully. It may also be a good idea to make soups, sauces, and salad dressings at home.
Products with “gluten-free” on their labels do not contain enough gluten to trigger symptoms of celiac disease or gluten intolerance. Manufacturers may remove the gluten from wheat flour, or use a substitute such as oat or chickpea flour. Many fast foods contain gluten, but some major chains are now offering gluten-free options. Learn more about gluten-free fast food here.
DIAGNOSIS
If a person believes that consuming gluten is causing any health issues, they should see a doctor. After asking about symptoms and carrying out a physical exam, the doctor would likely perform laboratory tests to rule out celiac disease and other gastrointestinal conditions. The doctor may then recommend a plan that allows them to monitor the person’s diet for any ill-effects. Researchers have yet to find any specific biomarker of gluten intolerance. At present, before diagnosing gluten intolerance, the doctor would need to rule out other options.
It can be challenging to differentiate between celiac disease and gluten intolerance, but testing for antibodies can help. To rule out or diagnose celiac disease, a doctor may ask for:
• Blood tests: If results show that certain antibodies are present, the person may have celiac disease.
• A biopsy: This involves taking a tissue sample from the lining of the intestine. If results show damage to the lining, the person may have celiac disease.
If the doctor rules out celiac disease, the doctor may look for signs of IBS or wheat or gluten intolerance next.
• Monitoring the diet
One group of researchers has suggested the following plan, which a person follows at home but under medical supervision:
• The individual specifies 1–3 symptoms to monitor.
• They consume a diet containing gluten for 1 week.
• They avoid gluten completely for the next week.
• They reintroduce some gluten in cooked foods for another week.
• They monitor for any symptoms and report back to their doctor.
Experts emphasise the need for tests that can identify gluten intolerance, and distinguish it from celiac disease, IBS, and other intestinal conditions. Such tests would enable doctors to provide more effective treatment for each issue.
A person with gluten intolerance should eliminate gluten from their diet. However, consuming gluten occasionally is unlikely to cause severe health problems, unless a person has celiac disease.
Keeping a record of meals and symptoms can help a person identify potentially problematic foods, and it may also help them manage an intolerance.
Some experts have expressed concern that people who avoid gluten are missing out on essential nutrients in whole grains. Grains can also be a crucial source of energy. Anyone who is considering going gluten-free should consult a doctor or dietitian about the necessity and strategies for doing so a healthful way.
