There is a lot of confusion around the terms Celiac disease, gluten intolerance/sensitivity and wheat allergy. These are all distinct conditions. Celiac disease is an autoimmune reaction to the protein in gluten. People are genetically pre-disposed to this condition that attacks the small intestine and leads to damage in the villi.
Non-celiac Gluten Sensitivity is used to describe the reaction that people without Celiac disease have when ingesting gluten. These symptoms mimic those of Celiac disease, but without evidence of an autoimmune reaction. A wheat allergy is a reaction caused by an allergy-producing antibody to the proteins found in wheat whereas Celiac disease is an autoimmune response to a specific protein found in wheat: Gluten. So, do you have Gluten Intolerance? Are you sensitive or allergic to Gluten?
Gluten is a general term for the proteins found in wheat, barley and rye. It is a mixture of two proteins and acts as a glue in products like bread, pasta and cereal. This “glue” helps these foods to hold their shapes.
Here are some common symptoms of Gluten Intolerance:
Gluten intolerance is not an allergy. An allergy usually involves an immediate reaction to the offending substance. With Gluten Intolerance/Sensitivity, as well as Celiac Disease, the symptoms are typically delayed. However, Gluten Intolerance or Gluten Sensitivity is an adverse reaction to gluten- a protein found in wheat, barley and rye. In some cases, cross-contamination can be a problem in oats. Oats are often grown in or near the same fields as wheat, barley and rye.
Wheat sensitivity is not the same as gluten sensitivity or gluten intolerance. Wheat sensitivity is a reaction specifically to wheat products, whereas gluten sensitivity or intolerance is a reaction to the specific protein- gluten which is found in wheat, rye, barley and sometimes oats (through cross-contamination in the fields). It can be hard to determine whether you have a wheat sensitivity or another condition that causes a reaction to wheat because the symptoms are similar. The symptoms of wheat sensitivity are:
There is no clearly identified genetic marker for Non-Celiac Gluten Sensitivity (NCGS). It is important to first rule out other possible conditions and to get tested for wheat allergy and Celiac disease. If none of these conditions seem apparent but you feel you are experiencing reactions to gluten, you and your doctor should create a plan to test for NCGS. There are a couple of options. One is to keep a diary of everything you eat and record your reactions. Another is to follow a gluten exclusion diet to see if your symptoms improve. If you want to rule out other sensitivities, it is best to do an elimination diet and slowly reintroduce foods like dairy, soy, and, of course, gluten that are common triggers for food intolerance and sensitivity.
People generally like clear, concise explanations of why someone can’t eat gluten (or any other food that is a problem for them). It is very common for others to ask a gluten intolerant/gluten sensitive person what happens to them when they eat gluten. So, if you get stomach-aches, bloating, rash, headaches, etc. Tell them so.
Use an example of a specific time that gluten was a clear culprit of a bad reaction. For example, if a small bite of a gluten-containing food like pasta made you sick for days. Tell them so. There are also cards available for you to carry that explain what you can and can’t eat. You can also refer them to this site or any other research sites you find relevant and helpful. It is best to ensure that your diagnosis is verified by a doctor. If it is, be sure to tell doubters that your doctor was involved in your diagnosis. You may also want to explain to your friends and families what the long-term problems of consuming gluten when you are gluten sensitive can be. If you have autoimmune disorders, such as Hashimoto’s Thyroiditis or it’s opposite: Grave’s Disease, that are often associated with gluten sensitivity or intolerance, you may wish to explain the commonalities and why the two may be related.
There is recent research that indicates the bad reactions to gluten may be actually be caused by FODMAPS: short chain carbohydrates, disaccharides, monosaccharides, fructose and sugar alcohols. Interestingly, this study was done by the same person who first identified non-Celiac gluten sensitivity as a separate condition from Celiac disease. While many tout this as being a better study than the first one, there is a critical flaw to the approach: the diet use.
While the 3 separate diets, high, low and no gluten all showed similar responses, the study removed lactose, but not other milk byproducts. In fact, all of the diets included whey. Whey is a highly allergenic product and, in whey intolerant/sensitive people also produces bloating, gas and diarrhea, as well as other digestive symptoms similar to those found in reactions to gluten.
Connection between Gluten Sensitivity/Intolerance and Other Autoimmune Disorders
While more research is needed, there is a suspected connection between both Celiac disease and Non-Celiac Gluten Sensitivity and autoimmune disorders, such as Hashimoto’s thyroiditis and rheumatoid arthritis.
Leaky Gut: Do you have Gluten Intolerance?
Leaky gut is the name given for the condition in which the intestinal wall lining becomes inflamed. This inflammation leads to the breaking down of that intestinal wall. As a result, there is no filter for items that should be kept out of the gut. Once leaky gut occurs, those foreign items in the intestine lead to a variety of immunological responses. One possible immunological response to leaky gut is non-Celiac gluten sensitivity.
The top 4 leaky gut contributors are wheat, dairy, corn and soy. Dairy and wheat are the top 2 human allergens. In both substances, the primary culprits of intestinal damage and problems are glue-like substances. In dairy, casein and in wheat, gluten.
While at one point in time, Celiac disease and non-Celiac gluten sensitivity where only considered childhood diagnoses, this has changed. It is clear that symptoms from both these conditions can show up later in life, including in late adulthood. Also, in both conditions, years of wheat consumption can lead to symptoms of intestinal wall damage, such as digestive symptoms like bloat and diarrhea, but can also affect brain functioning, contribute to skin problems, such as eczema or other rash and cause inflammation in your joints.
At one point, gluten intolerance and Celiac disease were thought to exhibit primarily in digestive symptoms. Over the years, however, research has shown that it has a profound effect on neurological function as well. As the gluten and the anti-gliadin antibody prevalent in gluten intolerance combine, can turn on a particular immune cell in the body. When those cells are turned on it creates inflammatory chemicals called cytokines. Elevated cytokines may explain the connection many people have seen between gluten sensitivity and ADHD and other developmental delays. Elevated cytokines have also been seen in other neurological disorders, such as frequent headaches and hypotonia (low muscle tone).
Anxiety and depression are two very common mood disorders. While therapy is the best first step to treating these disorders, diet may also be connected to symptoms of mood disorders. Undiagnosed Celiac or non-Celiac Gluten Sensitivity can lead to mood-related symptoms. Additionally, symptoms of gluten intolerance or Celiac disease can cause depressive or anxious symptoms. When a person doesn’t feel well physically (gastrointestinal distress, migraines, and fatigue), it can cause them emotional suffering. Also, nutritional deficiencies, particularly B-12 deficiencies that can result from gluten intolerance can also lead to chemical imbalances in the brain.
As with learning disabilities and other neurological disorders, anti-gliadin antibodies appear in elevated numbers in patients with schizophrenia. It may appear that the connection between gluten and schizophrenia would show in recent years, but there actually has been researched and identified since 1951.
Begin with fresh, naturally gluten-free products like meat and vegetables. You can use naturally starchy fresh-products if you wish to ensure that you still have some carbohydrates in the meal. For example, assuming that you are not allergic or sensitive to eggs, you could make a frittata with eggs, potato and spinach.
In addition, there are many prepared gluten-free foods. Be aware, however, that these are highly processed and tend to have higher levels of sugar and salt. That being said, as a supplement to a healthy, whole foods-based gluten-free diet it can open up a world of possibilities. Make sure that the gluten-free labels are from companies with gluten-free certification. Also, be careful that items that are naturally gluten-free aren’t simply being marked that way to drive up the prices. In other words, be a smart consumer while remaining healthy.
Tips for Gluten Free Cooking and Baking
The first thing to keep in mind when cooking gluten-free is that gluten-free products, by definition, will not naturally have the elasticity that gluten-containing products, such as bread, pancakes, etc. do. So, do not expect perfection. Also, experimenting is a big part of any kind of cooking or baking, but especially true of gluten-free cooking.
You will need to play around with flour mixes to get the right texture and also figure out what to use as a binder in place of gluten. For thicker textures, you may want to consider almond or teff flours. If you want that density to help a product keep its shape, but want a lighter taste, consider a blend of almond and tapioca flour or coconut flour. Some common choices to use as binders are chia and flax meal. Guar gum and xanthan gum are also options, but come with their own list of health risks.
When you bake or cook gluten-free use a scale and keep track of measurements so that you can repeat the results in the future. You also may have many people in your life that are on a gluten-free diet and have experiences and recipes to share with you. A way to keep it fun beyond the fun of experimenting with new foods is to cook in a group, either with friends or at a cooking class. This allows you to not only learn from your own mistakes, but learn from the mistakes your classmates or friends have made.
When you go to a restaurant, ensure that you let your server know that you are gluten-sensitive/gluten-intolerant. Learn what items most commonly contain hidden sources of gluten. Some common ingredients to check are sauces, soups, and seasonings. Soy sauce typically contains wheat.
Most restaurants with knowledgeable staff will not ensure there is no chance of cross-contamination. However, those with well-trained staff will take as many steps as possible to remove the risk of cross-contamination. They will ensure that gloves are changed before making your meal, that each area is well-cleaned and, ideally, will put the items in a separate cooking area from allergen-containing foods.
Be particularly careful of deep fryers where items like fried fish, fried chicken and french fries are made. The breading from the fish and chicken are quite problematic. Fries are often sometimes dusted with flour. Another surprising place you could risk cross-contamination is in some white wines. In some aging processes, flour is used to seal the barrel of a white wine.
Hydrolyzed wheat protein and other hydrolyzed gluten products are often used in beauty products, such as hair care products, body wash, lip balms and other makeup. These hydrolyzed gluten products are used to create emulsifiers and stabilizers. The gluten in cosmetic products can cause contact reactions in some people. Sunblock may also include wheat or other gluten-containing products.
Gluten is often used as a binder or filler in medications. This seems to be particularly common in generics, but it is in many name-brand medications as well. Also, be sure to check your vitamin supplements for gluten as well.
Many dog and cat food products contain wheat and other gluten. It is unlikely that you will try to eat Fido or Fluffy’s food, but contact can be a problem. So, check their food. Ideally, replace it with something that doesn’t contain those product. However, if you still want to keep them on the same diet, but worry about contact, make sure to where gloves while handling the food, use a utensil like a scoop to dish it out and wash your hands before and after serving your pet.
The glue used on stamps, envelopes or other gummed products. So, rather than licking these items, use a damp sponge or cloth to steal them. Another option is to use the self-adhesive kind. Other sources of gluten include cleaning products, latex gloves, play-dough and art supplies.
If you are experiencing any of the symptoms listed here, you may want to consider getting evaluated for Celiac disease or non-Celiac gluten sensitivity. The first step in diagnosis is to talk to your physician. Ensure that you get tested for Celiac first. This is done with a blood test and an endoscopy. You should also get an allergy test done to rule out wheat allergy. If you still suspect gluten sensitivity after eliminating the other possibilities, you can keep a food diary of what you’ve eaten and what your resulting symptoms are. If you find your symptoms are worse after eating gluten, you likely have non-Celiac Gluten Sensitivity (NCGS). Another way to diagnose NCGS is through an elimination diet.
If you do discover that you have gluten intolerance, there is a simple solution: following a gluten-free diet. There are some challenges to doing so, but in time you will adjust. Luckily, there are considerably more gluten-free options available than there have been in previous years. Also, fresh foods are the safest way to ensure a gluten-free diet.
Other considerations in remaining gluten-free are ensuring that your non-food items are also gluten-free. These items include cosmetics, medicines, stamps and envelopes. Also ensure that you are aware what products are used in your pet’s food, especially if you have reactions to gluten on contact.
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