Humans have been cultivating wheat for around ten thousand years. This is a relatively short period of time considering humans in their present form have been around for two hundred thousand odd years, and that earlier forms of man existed long before that. It is therefore perhaps not surprising that we have not necessarily all evolved to be able to digest wheat and gluten as easily as others.
It is important to distinguish between general wheat intolerance and a condition known as celiac disease (coeliac disease in the UK). Less than 1% of the population have been diagnosed with celiac disease. If you think that you or your child may have celiac disease or wheat intolerance, you should visit your doctor who will be able to refer you for tests. If you have already stopped eating products containing gluten this may affect the accuracy of the tests. Speak to a doctor before eliminating any major food group from your diet.
When somebody has celiac disease, gluten, which is found not just in wheat but also in barley and rye, causes permanent damage to the lining of the small intestine. This makes it difficulties to absorb all necessary nutrients. The patient with celiac disease may have one or more of a wide range of symptoms including general fatigue, weight loss, vomiting, diarrhea and gas. Sometimes there are no obvious symptoms at all. The sufferer will sometimes be found to have anaemia.
If you have celiac disease then you have it for life. You need to completely eliminate all foods containing gluten from your diet.
Wheat / Gluten Intolerance
An increasing number of people (possibly as many as 20% of the population) who do not have celiac disease are believed to be intolerant either to gluten, or to other elements found in wheat grains. The difference between these persons and those with celiac disease is that the intestinal lining of those who are merely intolerant/sensitive to gluten or wheat is not damaged by consumption of these products. Instead the digestive system is irritated when these foods are eaten, possibly because they lack the necessary enzymes to digest these foods properly. However, the symptoms can be similar to those of celiac disease.
Symptoms of Wheat / Gluten Intolerance
It is often hard to directly connect the consumption of gluten or wheat with the onset of symptoms as most of us eat foods containing wheat and gluten so often that the symptoms might just feel like normal indigestion. Many people do not realise that their symptoms are the result of food intolerance. Symptoms might include:
- Stomach pain/cramps
Some studies have even listed headaches, joint pain and depression among the symptoms.
After taking a full history of your food habits and symptoms, your doctor might decide to refer you for tests. A blood test might help with the diagnosis of celiac disease. Your blood will be checked for levels of antibodies produced after eating wheat. These are higher in persons with celiac disease. It is important that you do not stop eating foods containing gluten before the test.
A more accurate, but also more invasive test for celiac disease is to conduct an endoscopy. During this procedure, a small tube with a light and camera is inserted into the digestive system and samples are taken from the lining of the intestine.
If tests for celiac disease are negative then wheat/gluten intolerance/sensitivity will be considered. Unfortunately there is no simple test available for these. Your doctor will probably recommend completely eliminating gluten/wheat from your diet to see whether symptoms disappear. Although the symptoms of gluten sensitivity do not cause the damage to your small intestine found with celiac disease, the symptoms can be just as unpleasant.
Management of Celiac Disease
If you have been diagnosed as having celiac disease then eating any gluten, found not just in wheat, but also in barley and rye will damage your guts. These foods need to be completely avoided. Your doctor might also advise you to avoid oats as these sometimes contain traces of wheat. Persons with celiac disease are often also intolerant to lactose, found in milk so, if your symptoms do not resolve within a suitable time frame after you have stopped consuming gluten, your doctor might want to send you for further tests. You might be referred to a registered dietician for advice about how to change to a gluten free diet without missing out on important nutrients. It may be necessary to take food supplements. Gluten can be found in a surprising number of products. Always read labels carefully. A “wheat-free” label does not necessarily mean the food is gluten-free. It may contain gluten from rye or barley. Look out for “gluten-free” labels.
Management of Wheat / Gluten Sensitivity
If you do not have celiac disease, but you still experience unpleasant symptoms which could be connected to eating wheat or gluten, your doctor will most likely recommend that you undertake an elimination diet. This usually starts by completely cutting out wheat/gluten from your diet for a certain time period, usually several weeks. You may be asked to keep a food diary and a list of any symptoms. After this time, an evaluation will be done of whether or not your symptoms have improved. After a suitable time lapse it may be possible to gradually reintroduce gluten products into your diet without experiencing further symptoms. Any elimination diet needs to be done under medical supervision, particularly where children are involved, to ensure that you do not lose out on vital nutrients.
Foods Containing Wheat / Gluten
Wheat and gluten are difficult to avoid. Breads, cakes, pastries, pizzas, pasta, pancakes couscous, many breakfast cereals, cookies and biscuits almost always contain wheat and gluten. Fish and meat which are coated in breadcrumbs also need to be avoided. Wheat and gluten are also found in most beers, ales and lagers. Check labels carefully. Even foods such as soups, sauces, tortillas and tacos usually contain wheat and gluten.
Fortunately there is now a wide range of gluten free food, including pasta, breads, cakes and cookies available in most supermarkets (try the free from aisle) and health food shops. These products have improved in quality and texture in recent years and are often indistinguishable from those containing wheat and gluten.
If you need to eliminate gluten for life, over time you will develop ways of substituting gluten-free food more easily. Use cornflour or arrowroot to thicken sauces, use buckwheat, quinoa, corn and rice instead of bread and pasta. Meat, fish and vegetables are all safe. Some ready-meal providers now guarantee some of their meals as gluten-free. Even gluten-free beers and lagers can be found once you know where to look.