- Gluten Intolerance, Celiac Disease, or a Wheat Allergy: What’s the Difference?
- What Is a Wheat Allergy? Understanding Its Causes, Symptoms, and Treatment
- What Is Celiac Disease? Exploring Possible Causes, Spotting the Signs, Getting a Diagnosis, and Finding Relief
- Gluten or wheat intolerance
- An introduction to gluten or wheat intolerance
- Wheat intolerance
- Gluten intolerance
- Foods to consider eliminating
- Symptoms of gluten or wheat intolerance
- Coeliac disease
- Celiac Disease
- Gluten Intolerance
- Visiting Your Family Doctor
- Gluten sensitivity
- What is the difference between the conditions?
- Research into non coeliac gluten sensitivity
- What should you do if you think you may be non coeliac gluten sensitive?
- Gluten-Free & Wheat-Free: What’s the Difference?
Gluten Intolerance, Celiac Disease, or a Wheat Allergy: What’s the Difference?
Having celiac disease, a wheat allergy, or a gluten intolerance may lead to similar symptoms, but the diagnoses are markedly different. Stefka Pavlova/Getty Images
There’s no doubt that celiac disease has been thrust into the public spotlight, especially with the popularity of gluten-free foods on store shelves and g-free options at restaurants. Because of gluten-free diets, which have become trendy, there’s often confusion about what it means to have celiac disease, be gluten intolerant or gluten sensitive, or have a wheat allergy.
“There is a lot of literature that defines gluten-related disorders. The term basically encompasses conditions related to problems with ingesting gluten-containing foods,” says Rupa Mukherjee, MD, an attending gastroenterologist of the celiac center at Beth Israel Deaconess Medical Center and an assistant professor of medicine at Harvard Medical School in Boston.
Foods that contain gluten — which is a binding protein — include many types of bread, cereals, and baked goods, but the conditions associated with it are markedly different. (1)
What Is a Wheat Allergy? Understanding Its Causes, Symptoms, and Treatment
Wheat allergy is commonly conflated with having celiac disease or a gluten intolerance — and sometimes a “gluten allergy” (there’s no such thing!), but it’s completely different. (2) A wheat allergy is an adverse immunologic reaction to wheat protein, says Dr. Mukherjee. Meaning: Your immune system overreacts to wheat the way it might to seasonal allergy or another food allergy. Risk factors include a family history of allergies, asthma, or eczema. (2)
A wheat allergy will cause telltale symptoms of an allergic reaction like hives, sneezing, headaches, and in the worst case, life-threatening anaphylaxis. That said, nausea, diarrhea, and stomach discomfort are also common, and that can make distinguishing between wheat allergy and a gluten intolerance difficult. (2) An allergist can help uncover the right diagnosis. To treat it, you’ll avoid foods that contain wheat as well as foods that may be contaminated by wheat. (3)
What Is Celiac Disease? Exploring Possible Causes, Spotting the Signs, Getting a Diagnosis, and Finding Relief
One in 133 Americans (about 1 percent of the population) has celiac disease, an autoimmune condition. (4) That’s about 3 million people. When someone has celiac, they react to a group of proteins found in wheat, rye, and barley called gluten, explains Gerald Bertiger, MD, a gastroenterologist with Hillmont G.I. in Flourtown, Pennsylvania, who is also on the board of directors for the advocacy organization Beyond Celiac. “The problem is that for reasons that are not completely understood, ingesting gluten makes the body see the intestine as foreign and attacks it with an inflammatory reaction,” he explains. (The body will produce certain antibodies in response.)
Dr. Bertiger adds that for most people with the condition, being entirely gluten free would clear celiac disease symptoms completely, but there is still a small group of patients who are gluten-free but still have that inflammatory reaction and side effects. “Gluten isn’t 100 percent part of the story, but it’s a big part of the story,’ he says.
Unfortunately, 83 percent of people with celiac disease are undiagnosed or misdiagnosed. (5) That’s largely because signs and symptoms can vary widely. “These fall into two categories, called GI and extra-GI,” says Mukherjee.
GI symptoms include chronic diarrhea or constipation, abdominal pain, bloating, and weight gain or loss. “Extra-GI” symptoms refer to those that are seemingly unrelated to your GI tract, like joint pain, difficulty concentrating, brain fog, fatigue, muscle cramps, unexplained anemia, and fertility issues in women, she notes. (6)
It can be tough getting a diagnosis. “If a physician doesn’t suspect celiac, it can be years before a patient is diagnosed,” she says. (7)
These symptoms, along with a personal history of autoimmune disorders or a family history of celiac or autoimmune disorders, should tip off your physician that celiac may be a possibility, and you should be tested, she says. Testing is done through a tissue transglutaminase IgA antibody and IgA antibody test. (8) Stay on a regular diet while having the test done, because cutting gluten before testing can give you a false result.
If you’re diagnosed with celiac, the only treatment available right now is a strict gluten-free diet, which will allow your small intestine to heal, relieving symptoms and preventing nutritional deficiencies that can arise from problems absorbing food when you have the disease.
You’ll avoid the obvious things — like traditional bread, pasta, cookies, and crackers and other processed foods — as well as products that may also contain sneaky sources of gluten, such as nutritional supplements, communion wafers, and even certain cosmetics. (9)
Treatment means more than just feeling less bloated or clearer headed. It’s a matter of long-term health. Because of these common nutritional deficiencies associated with celiac (like iron, calcium, and vitamin D), people with the disease are more at risk for anemia, osteoporosis, infertility, and liver, gallbladder or pancreatic problems. (10)
The bright side is that drugs are being developed to help relieve the gluten burden for people living with celiac disease. “There are at least five or six drugs with various pharmaceutical companies coming down the pipeline aimed at treating celiac disease. They’re all in different phases of trial,” says Bertiger.
While none offer a cure for celiac, he says, some may allow patients to eat some gluten, while others may be taken post-meal if you think you’ve eaten something contaminated. Approval of the drugs is further down the line, but it’s a step in the right direction. “Finally, the pharmaceutical industry is starting to look at celiac,” he says.
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What Is a Wheat Allergy?
When someone is allergic to wheat, the body’s immune system, which normally fights infections, overreacts to proteins in the wheat. If the person eats something made with wheat, the body thinks these proteins are harmful invaders and responds by working very hard to fight off the invader. This causes an allergic reaction.
Wheat allergy is more common in kids than adults, and many children seem to “outgrow” their wheat allergy over time.
What Are the Signs & Symptoms of a Wheat Allergy?
When someone with a wheat allergy has something with wheat in it, the body releases chemicals like
. This can cause symptoms such as:
- trouble breathing
- throat tightness
- belly pain
- itchy, watery, or swollen eyes
- red spots
- a drop in blood pressure, causing lightheadedness or loss of consciousness (passing out)
Allergic reactions to wheat can differ. Sometimes the same person can react differently at different times. Some reactions can be very mild and involve only one system of the body, like hives on the skin. Other reactions can be more severe and involve more than one part of the body.
Wheat allergy can cause a severe allergic reaction called anaphylaxis. Anaphylaxis might start with some of the same symptoms as a less severe reaction, but can quickly get worse. The person may have trouble breathing or pass out. More than one part of the body might be involved. If it isn’t treated, anaphylaxis can be life-threatening.
What’s the Difference Between Wheat Allergy and Celiac Disease?
An allergy to wheat involves an allergic response to a protein in wheat. Gluten is not one of the wheat proteins that typically causes an allergic reaction. Gluten is involved in a condition called celiac disease.
It’s easy to confuse celiac disease with wheat allergy, but they are very different. Celiac disease does not cause an allergic reaction. With celiac disease, there is a different type of immune system response in the intestines, causing a problem with the absorption of food.
While people with wheat allergy can usually eat other grains, people with celiac disease cannot eat any food containing gluten, which is also found in other grains such as barley, rye, and sometimes oats.
How Is an Allergic Reaction to Wheat Treated?
If your child has a wheat allergy (or any kind of serious food allergy), the doctor will want him or her to carry an epinephrine auto-injector in case of an emergency.
An epinephrine auto-injector is a prescription medicine that comes in a small, easy-to-carry container. It’s easy to use. Your doctor will show you how. Kids who are old enough can be taught how to give themselves the injection. If they carry the epinephrine, it should be nearby, not left in a locker or in the nurse’s office.
Wherever your child is, adult caregivers should always know where the epinephrine is, have easy access to it, and know how to give the shot. Staff at your child’s school should know about the allergy and have an action plan in place. Your child’s rescue medications (such as epinephrine) should be accessible at all times.
Every second counts in an allergic reaction. If your child starts having serious allergic symptoms, like swelling of the mouth or throat or difficulty breathing, give the epinephrine auto-injector right away. Also give it right away if the symptoms involve two different parts of the body, like hives with vomiting. Then call 911 and take your child to the emergency room. Your child needs to be under medical supervision because even if the worst seems to have passed, a second wave of serious symptoms can happen.
It’s also a good idea to carry an over-the-counter (OTC) antihistamine for your child as this can help treat mild allergy symptoms. Use
after — not as a replacement for — the epinephrine shot during life-threatening reactions.
What Else Should I Know?
If allergy testing shows that your child has a wheat allergy, the doctor will give you guidelines on keeping your child safe. Your child must completely avoid products made with wheat. Although most allergic reactions to wheat happen after eating a wheat product, sometimes people can react to raw wheat that they breathe in (such as a baker who inhales flour in the workplace).
Natural food stores and the health food section in grocery stores usually have safe alternatives, including wheat-free breads, crackers, and breakfast cereals. Also, look for substitute flours made from potato, rice, wheat, barley, oats, and corn. For information on foods to avoid, check sites such as the Food Allergy Research and Education network (FARE).
Always read food labels to see if a food contains wheat. Manufacturers of foods sold in the United States must state whether foods contain any of the top eight most common allergens, including wheat. The label should list “wheat” in the ingredient list or say “Contains wheat” after the list.
Some foods look OK from the ingredient list, but while being made they can come in contact with wheat. This is called cross-contamination. Look for advisory statements such as “May contain wheat,” “Processed in a facility that also processes wheat,” or “Manufactured on equipment also used for wheat.” Not all companies label for cross-contamination, so if in doubt, call or email the company to be sure.
Cross-contamination can happen if wheat gets into a food product because it is made or served in a place that uses wheat in other foods. This can happen on kitchen surfaces and utensils — everything from knives and cutting boards to a toaster or grill. Fried foods often have the potential to be cross-contaminated, because they can be fried in the same oil as foods that contain wheat.
When eating away from home, make sure you have an epinephrine auto-injector with you and that it hasn’t expired. Also, tell the people preparing or serving your child’s food about the wheat allergy. Sometimes, you may want to bring food with you that you know is safe. Don’t eat at the restaurant if the chef, manager, or owner seems uncomfortable with your request for a safe meal.
Also talk to the staff at school about cross-contamination risks for foods in the cafeteria. It may be best to pack lunches at home so you can control what’s in them.
Other things to keep in mind:
- Make sure the epinephrine auto-injector is always on hand and that it is not expired.
- Don’t feed your child cooked foods you didn’t make yourself or anything with unknown ingredients.
- Tell everyone who handles the food — from relatives to restaurant staff — that your child has a wheat allergy.
Reviewed by: Stephen F. Dinetz, MD Date reviewed: August 2018
Gluten or wheat intolerance
An introduction to gluten or wheat intolerance
References to wheat and gluten intolerances are frequently used interchangeably but they are in fact often two separate issues.
Wheat intolerance without being sensitive to gluten is relatively rare but can occur. Around 15% of the population is thought to be intolerant to gluten, which also means they will have to avoid wheat. It is important to understand what this means for you and how it can be managed through diet.
The structure of a grain of wheat is comprised of simple sugars, starch, fibre, cellulose and different proteins, gluten being one of them.
The processes involved in wheat intolerance are not well understood. Wheat intolerance may arise when you lack the necessary enzymes to break down wheat, preparing it for absorption. A deficiency of enzymes required to break down the protein gluten found in wheat is possible, however, the issues associated with wheat intolerance aren’t always thought to be attributable to gluten.
It is possible that it is some other part of the wheat grain that you are reacting to. In this case you would be wheat intolerant but other grains containing gluten may still be tolerated (e.g. rye or barley).
Different parts of the wheat grain, or by-products from its digestion, may be responsible and are even thought to contribute to a low-grade inflammatory response. This is separate from a wheat allergy which is an acute immune response and can be life-threatening.
Wheat intolerance (without sensitivity to gluten) is less common than gluten intolerance and doesn’t involve the elimination of so many foods from one’s diet. Refer to our section below to understand the differences in the foods that should be considered in an elimination diet.
Gluten is a specific protein found in grains including wheat, barley and rye.
Again, mechanisms for gluten intolerance aren’t yet well understood. The issues arising may be due to a lack of the appropriate enzymes required to break down gluten in your small intestine. This would result in gluten travelling partially undigested into the large intestine where it causes irritation and gives rise to nasty symptoms. In light of this, scientists have produced some gluten specific digestive enzymes designed to help the breakdown of gluten, which in theory should help. However, the results have not been resoundingly successful and these supplements should not be taken in coeliac disease.
This suggests other processes may be involved. An adverse reaction to the components involved in gluten breakdown (constituents of the protein and then the enzymes themselves) have also been considered, activation of the immune system may also be involved as in many cases low-grade inflammation is present and there appears to be a link with the intake of gluten.
Gluten intolerance is often referred to as non-coeliac gluten sensitivity (NCGS). Coeliac disease is unique and marked by a specific immune response which can be diagnosed with a blood test. NCGS is not as distinctive.
Gluten may be tolerated in small amounts if you have intolerance, although this is not the case for everyone – highlighting how complicated and individual the issue can be. This isn’t the case at all in coeliac disease; gluten should be avoided completely.
If the immune system is involved in a low-grade response, it begins to explain why gluten intolerance is often related to problems such as eczema.
Gluten is a common sensitivity in its own right but if you have already tried eliminating gluten from your diet with some improvements but find you are still experiencing some symptoms, it is possible that a broader group of food called FODMAPs may need to be considered. FODMAPs include gluten-rich grains as well as many fruit, vegetables, legumes and artificial sweeteners.
Foods to consider eliminating
- Bulgur wheat
- Durum wheat
- Hydrolyzed wheat protein
- Wheat products: berries, bran, durum, germ, germ oil, gluten, grass, malt, protein isolate, sprouts, starch
Wheat is commonly found in many processed foods too, including baked goods, cakes, biscuits, soy sauce, crisps, processed meats such as sausages, beer, sauces, soups, salad dressings and breakfast cereals. Always check the food label where the allergens will be listed in bold.
- Sources of wheat as above
- Oats (may be contaminated)
- Brewer’s yeast
Even with wheat or gluten intolerance you may find you are able to tolerate small amounts of certain varieties of foods containing the problem component. For example, ancient sources of wheat such as spelt or kamut may not affect you in the same way or to the same degree as do more modern and processed sources of wheat.
A degree of trial and error may be necessary for you to determine the threshold over which you produce symptoms.
Symptoms of gluten or wheat intolerance
Symptoms of wheat or gluten intolerance can vary greatly and can appear quickly or take up to several days to materialise. Symptoms can range from mild to severe and can include:
- Digestive problems such as bloating, flatulence, constipation, diarrhoea, nausea.
- Mouth ulcers
- Skin conditions
Refer to our example of a food and symptoms diary to begin recording and evaluating your symptoms.
Coeliac disease is an autoimmune disease caused by an adverse reaction to a specific component of gluten called alpha gliadin. The immune system mistakes alpha gliadin for a pathogen and, in doing so, attacks the lining of your small intestine causing significant damage.
The structure of the inside of the small intestine wall is unique. Finger-like projections called villi project into the inside space creating an increased surface area and allowing better absorption of the products of digestion. Unfortunately, these delicate villi are attacked in coeliac disease and become shorter, flatter and less efficient at their job.
People with coeliac disease are susceptible to flatulence, constipation diarrhoea, extreme stomach pain and cramping after sources of gluten, nausea, vomiting, headaches, fatigue, malabsorption and deficiencies in certain vitamins and minerals. Common deficiencies in coeliac disease include iron, calcium, vitamin D, zinc, B vitamins, magnesium, folate and phosphate. Sufficient calorie intake and weight loss may also be a problem.
Unlike food intolerance, people with coeliac disease should not consume any gluten. Obtaining essential vitamins and minerals from fresh sources of gluten-free foods is essential. Many processed gluten-free products are lacking in nutrients so should be consumed sparingly.
It is not fully understood what causes coeliac disease but in many cases it is likely to be linked to genetics.
Words Dr Eva Detko, PhD, www.dr-eva.com
Even though the terms “wheat” and “gluten” are often used interchangeably, they are not the same thing. Dr Eva Detko, PhD explains the difference…
Why it’s important to know the difference between wheat and gluten
Understanding the difference between wheat and gluten can help avoid any unnecessary symptoms that may be brought on by ingesting the wrong foods. Confusing wheat and gluten may have less of an impact on people with non-coeliac gluten sensitivity, or wheat sensitivity, but it can have more serious consequences for those with wheat allergy and coeliac disease. Just to clarify, the same way as coeliac disease and non-coeliac gluten sensitivity are two very different conditions (despite sharing many of the same symptoms), wheat sensitivity and wheat allergy are not the same. Wheat sensitivity, or wheat intolerance, is a delayed reaction caused by gluten (similarly to non-coeliac gluten sensitivity), and is not life-threatening. Whereas, wheat allergy is a true allergy, although it is far less common.
People with a wheat allergy tend to display symptoms almost immediately, or within a couple of hours, following ingestion of foods containing wheat ingredients. Symptoms can include stuffy nose, watery eyes and skin irritations, but they can be much more serious ie. difficulty breathing or an anaphylactic shock. Wheat allergy is more common in children than adults. It usually develops during infancy and many children outgrow it by the age of five, but it can also persist into adulthood. To confuse matters further, some people refer to wheat allergy as gluten allergy, but the actual allergic reaction to wheat involves more components of wheat than just the gluten proteins. So far researchers have identified almost thirty different potential wheat allergens. Therefore, people who have been diagnosed with wheat allergy need to avoid any foods that contain wheat ingredients.
Gluten vs. wheat
Gluten is a composite protein made up of gliadin and glutenin proteins. Gluten is found in wheat, rye and barley. This means that while all foods that contain wheat also contain gluten, not all gluten comes from wheat. Wheat has a much higher content of gluten than rye and barley.
However, those who have problems with gluten should eliminate all of the above out of their diet. It is worth noting that wheat and gluten-containing ingredients are often listed under different names so it is important to scan labels for the presence of: bran, semolina, couscous (dried granules of semolina), triticale (a hybrid of wheat and rye), farro, emmer, farina, udon, einkorn, kamut (Khorasan wheat, or Pharaoh grain), bulgur, durum wheat, spelt (dinkel, or hulled wheat), and orzo.
Other wheat and gluten-containing ingredients and products to be aware of when shopping include brewer’s yeast, bread crumbs, bread stuffing, hydrolysed wheat protein, modified wheat starch, malt, malt extract, malt syrup, malt flavouring, malt vinegar, malted milk, soya sauce, oyster sauce, panko, matzah (traditional Jewish bread), atta (chappati flour), and fu or seitan (Asian food made from wheat gluten).
Because all wheat-containing foods contain gluten, it is often assumed that if foods are gluten-free they are automatically wheat-free. That is certainly not the case. Some gluten-free products contain ingredients that are originally derived from wheat from which gluten has been removed. One example of that is gluten-free wheat starch (Codex wheat starch) used by some manufacturers. The Codex wheat starch was first introduced to improve the quality and texture of the gluten-free products, particularly baked goods.
The Codex wheat starch is produced by extracting gluten out of wheat flour. This is achieved by first kneading the flour and then washing the starch out of the dough. The amount of gluten in the Codex wheat starch is at the level that is safely tolerated by people with coeliac disease. However, it is not safe for people who react to wheat.
Ingredients that are both wheat and gluten-free.
There are many substitutes for gluten-containing grains. Quinoa, amaranth, buckwheat, millet and teff are not only suitable for wheat and gluten-free diets, but are also more nutritious than wheat. Moreover, they are incredibly versatile and can be sourced in a flour, grain, or flake form. This means that they can be used in baking, as breakfast cereals, as well as in savoury dishes. There are of course many other types of gluten-free flour, including rice, corn, tapioca, potato, almond, hazelnut, coconut, carob, chickpea, and sorghum (also known as jowar flour). When purchasing gluten-free flours on their own, it is worth noting that their texture dictates how they behave in recipes. As a general rule, flour mixes produce better results than single flours, provided that factors such as relative flour weight and absorption rate have been considered.
Contrary to popular belief, pure oats do not contain gluten. However, the issue with most oat-based products on the market is that they are cross-contaminated with small amounts of wheat, rye or barley. For this reason, people with gluten sensitivities are advised to source oat-based products that are labelled “gluten-free”. Research has shown that even people with coeliac disease are able to tolerate moderate amounts of oats. However, a very small number of coeliac sufferers have been found to react to a different protein found in oats called avenin. In those people even the purest oats could trigger an immune response.
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 should make sure that products you buy are labelled “wheat-free”, as well as “gluten-free”. Unless it is clearly stated that the product is wheat-free, it is advised to read the ingredients list on gluten-free baked goods (such as breads, cakes, biscuits, crackers, etc), in order to ensure that they are actually wheat-free as well as gluten-free.
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Do you ever experience unpleasant symptoms after eating gluten-rich foods like bread or pasta, and wonder if you have celiac disease, gluten intolerance, or possibly a wheat allergy? Although the three conditions share similar symptoms, there are distinct differences in the way a person’s body reacts to gluten. The types of tests a doctor uses to diagnose each condition are also very different. Let’s take a closer look at the symptoms of celiac disease, gluten intolerance, and wheat allergy and see if one of these three conditions is causing your unwanted symptoms.
Celiac disease is an autoimmune disorder that causes genetically susceptible individuals to negatively respond to gluten, a protein found in wheat, barley, and rye. Over time, as gluten triggers immune responses, the small intestine’s lining becomes damaged. Without a diagnosis and appropriate treatment, it is likely that individuals with celiac disease will suffer from malabsorption, the inability for the small intestine to absorb nutrients into the bloodstream.
Symptoms of Celiac Disease
There are many common signs of celiac disease that are directly related to the body’s inability to properly digest food. These include:
- Weight loss
- Bloating and gas
- Abdominal pains
There are also signs that you may not originally associate with celiac disease since they are not directly related to the digestive system. These other symptoms of celiac disease can include:
- Itchy skin
- Headaches and fatigue
- Bone and joint pain
- Acid reflux and heartburn
- Mouth ulcers
Celiac disease is a serious disorder. If you are diagnosed with celiac disease, the most effective way to manage the symptoms is to completely cut gluten from your diet.
Gluten intolerance, also known as non-celiac gluten sensitivity, has similar symptoms to celiac disease. Although both conditions cause the body to have a negative response to gluten, the two types of responses do not have the same longevity or consequence. When a celiac person ingests gluten, his or her immune system will attack against its own body’s tissue. Whereas, if a person is gluten intolerant, the consumption of gluten will cause short-term bloating and belly pain. Unlike celiac disease, gluten intolerance doesn’t usually cause long-term harm to the body.
Symptoms of Gluten Intolerance
There are many symptoms of gluten intolerance, most of which are gastrointestinal symptoms. If you see some of these signs after eating foods with gluten, it’s possible that you may be gluten intolerant. Some common signs of gluten intolerance include:
- Stomach ache
Like celiac disease, there are other signs that may not commonly be associated with gluten intolerance. These symptoms include:
- More sever stomach pain (not just an upset belly). This type of pain is not normal and may require medical attention.
- Joint and muscle pain
Notice that there are slight differences between the less common symptoms of celiac disease and gluten intolerance; mouth ulcers, seizures, and itchy skin can be associated with celiac disease, but aren’t likely to result from gluten intolerance.
Individuals with gluten intolerance may find relief by supplementing with digestive enzymes to help alleviate the symptoms, reducing the volume of gluten in their diet, or eliminating gluten from their diet entirely.
Those with a wheat allergy experience a response (by the immune system) to a number of food proteins found in wheat, including gluten. However, unlike celiac disease, this immune response is most often temporary. Also, a wheat allergy does not cause ongoing harm to the small intestine unless the reaction causes anaphylaxis, the most serious type of allergic reaction. Unlike celiac disease and gluten intolerance, a wheat allergy can actually be outgrown.
Symptoms of Wheat Allergy
You will notice that many of the symptoms of wheat allergies are very similar to gluten intolerance. The symptoms are also comparable to any other kind of food allergy. Symptoms of wheat allergy include:
- Stomach cramp
- Nausea and/or vomiting
- Nasal congestion
- Skin rash
- Difficulty breathing
Although a wheat allergy won’t cause permanent damage to your intestines, the risk of anaphylaxis should be taken very seriously. If you are diagnosed with a wheat allergy, your doctor may suggest antihistamines, epinephrine, and/or a wheat-free diet.
Visiting Your Family Doctor
If you believe that you may have celiac disease, gluten intolerance, or a wheat allergy, a visit to your family doctor is recommended. Since your doctor will need the full history of your symptoms, it is important that you stick to your current diet until your doctor gives you specific instructions to reduce, or eliminate gluten from your diet. This way, the physician can tell if gluten is the culprit behind your symptoms.
Since the symptoms of all three conditions are so similar, your doctor might conduct a number of tests. Each condition has its own test that can appropriately determine a diagnosis:
1. Celiac Disease: This is the most invasive of the three tests. To test for celiac disease, the doctor will take a small biopsy of your small intestine. Using this sample, the doctor can identify if there are specific antibodies in your blood that correspond to celiac disease.
2. Gluten Intolerance: Gluten intolerance is less understood by doctors than celiac disease and wheat allergies. Therefore, your doctor will only be able to diagnose you as gluten intolerant by ruling out celiac disease and wheat allergy by using the applicable tests.
3. Wheat Allergy: Much like other allergy tests, the doctor may use a skin prick test or blood test to identify if you have a wheat allergy. The doctor may also try eliminating gluten from your diet so that he or she can determine if there are any significant changes in your symptoms. An oral food challenge, a test in which an allergist will feed you suspect foods in measured doses, may also be conducted. This type of test should be done at a medical facility so that you are surrounded by the appropriate medications and equipment in case anaphylaxis occurs.
The most important thing to recognize is that while the symptoms of celiac disease, gluten intolerance, and wheat allergy can be very similar, they also have their unique differences. Therefore, it is extremely difficult to diagnose yourself and visiting your family doctor is highly recommended if you experience any of the symptoms listed above.
If you have been diagnosed with celiac disease, gluten intolerance, or wheat allergy, and you’re required to reduce or eliminate gluten from your diet, our Registered Dietitians can help recommend proper dietary choices for your specific needs.
It’s becoming more and more common to have problematic reactions after consuming foods that contain gluten. Gluten intolerance and coeliac disease are the most common diagnoses among those who have problems consuming gluten, which is a protein found in wheat, rye, barley and sometimes oats. It is important to note that gluten isn’t just exclusive to foods – it can also be found in vitamins, medicines, lip balms and (oddly enough) even lickable envelopes and stamps!
Difference between Gluten Intolerance and Coeliac Disease
Although coeliac disease and gluten intolerance are treated similarly, they’re not the same thing. Coeliac disease can cause permanent damage, while a Non-Coaliac Gluten Sensitivity (NCGS), or gluten intolerance, causes symptoms but only until it gets out of your system. Coeliac disease is an autoimmune condition triggered by consuming gluten. A gluten “intolerance” is just that: an intolerance of the body’s inability to handle gluten. You can read more about NCGS here
Symptomatic vs. Non-Symptomatic Patients
Although coeliac disease is a permanent disorder and the symptoms will vary from person to person, some people are asymptomatic. Being asymptomatic means the small intestine is still able to absorb enough nutrients to prevent symptoms from occurring however this does not always mean you are free from the complications that coeliac disease can cause.
Gluten intolerance and coeliac disease can contain a wide variety of symptoms. Common symptoms to watch out for typically include gastro-intestinal issues (gassiness, diarrhea, stomach pain, bloating, constipation and nausea), weight loss/gain, headaches and fatigue. Depression, irritability and behavioural changes may also occur. Children may actually appear as if they have malnutrition (which, technically, they do) and may have an extended belly.
It used to be more difficult (and it still can be) to diagnose coeliac disease and gluten intolerance since symptoms are very similar to other illnesses, like Irritable Bowel Syndrome, Crohn’s Disease and Chronic Fatigue Syndrome. Fortunately, tests can be done to rule out or determine if you’re suffering from coeliac disease. Common tests include blood tests that screen certain raised auto-antibodies, as well as a small intestinal biopsy. It is extremely important to continue eating gluten until you are tested since it is the presence of gluten that raises these auto-antibodies in the blood. Coeliac disease is hereditary and if one person is diagnosed, the whole family should be checked.
ImuPro does not test for coeliac disease, rather Non-Coaliac Gluten Sensitivity which is an IgG-mediated gluten intolerance. If coeliac disease has been ruled out, but you still feel that gluten affects you, it is likely you just have NCGS.
The only way to treat coeliac disease and gluten intolerance is by making a lifestyle change of eliminating gluten from your diet. Although a gluten-free lifestyle can be challenging and a little more difficult financially, it is essential to avoiding further damage caused by coeliac disease and those uncomfortable symptoms of gluten intolerance.
If coeliac disease is left untreated, it can cause severe damage to the lining of your intestinal wall leading to more severe problems like malnutrition, nutritional deficiencies and dehydration. If you do not cut gluten from your diet, or catch it in time, it can further progress causing damage to your major organs, which can lead to problems like iron deficient anemia and even cancer.
While the symptoms of gluten sensitivity or non coeliac gluten sensitivity can often be similar to that of undiagnosed coeliac disease, the two conditions are different.
The symptoms of non coeliac gluten sensitivity may be similar to those experienced by people with coeliac disease, but it is not clear how the immune system might be involved and there does not appear to be damage to the lining of the gut.
What is the difference between the conditions?
Coeliac disease is a well defined, serious illness where the body’s immune system attacks itself when gluten is eaten. This causes damage to the lining of the gut and means that the body cannot properly absorb nutrients from food.
Coeliac disease is not a food allergy or intolerance, it is an autoimmune disease.
Wheat allergy is a reaction to proteins found in wheat, triggered by the immune system and usually occurs within seconds or minutes of eating.
Non coeliac gluten sensitivity is when symptoms similar to coeliac disease are experienced, but it is not clear how the immune system might be involved because no antibodies are produced, and there does not appear to be damage to the gut lining.
Research into non coeliac gluten sensitivity
Non coeliac gluten sensitivity is a condition that is being recognised as a problem in many countries across the world. This is a new area and we need more research to understand the condition and who is at risk. There are no specific diagnostic tests for non coeliac gluten sensitivity.
Some researchers define non coeliac gluten sensitivity as an improvement in symptoms when following a gluten free diet. However, it is difficult to rule out the possibility of a placebo effect.
There is also some debate around whether gluten is the cause of the sensitivity or if other components are to blame. These components are also removed from the diet when gluten containing ingredients are removed, for example Fermentable Oligo- Di- Mono-saccharides and Polyols (FODMAPs) and other non gluten proteins found in wheat.
What should you do if you think you may be non coeliac gluten sensitive?
If you are experiencing symptoms when eating foods that contain wheat, barley, rye or oats and think you may have a sensitivity to gluten, it’s important to first rule out coeliac disease.
We do not recommend trying a gluten free diet as a first option if you are experiencing symptoms because this could prevent a coeliac disease test from giving you an accurate result.
Check if your symptoms are related to coeliac disease by taking our online assessment. If the results are positive, you can take them to your GP to ask for further testing for coeliac disease. It’s essential to keep eating gluten for the tests to work.
If you get a negative test result for coeliac disease and other causes of your symptoms have been ruled out, you might wish to discuss the possibility of non coeliac gluten sensitivity with your healthcare team.
If you need to follow a gluten free diet, we can help you get the hang of it. We help everyone who needs to live gluten free live happier, healthier lives. Find out more.
Gluten-Free & Wheat-Free: What’s the Difference?
Today we are increasingly hearing terms such as gluten intolerance, wheat allergy and coeliac disease. On top of this, the words wheat and gluten are often used interchangeably too, even though there is a very clear difference between the two substances. So what do they actually mean and how are they different?
Gluten is a component of wheat and is also a protein that is found in some other grains too, including spelt, barley and rye. It’s also what gives yeast-based dough its elasticity. Because gluten is found in a variety of grains, people who react to gluten (including those with coeliac disease, which is actually an autoimmune response triggered by gluten, as we’ll see below) need to avoid not only wheat, but also other gluten-containing grains and any foods that contain them.
A reaction to wheat can be completely different from a reaction to gluten. In fact, those with a true allergy to wheat are often not reacting to the gluten, but to some other part of the plant. Researchers have actually identified 27 different potential wheat allergens (1), of which gluten is one type. Albumin and globulin proteins may be particularly common triggers (2).
Let’s look more closely at the difference between wheat allergy, coeliac disease and gluten intolerance.
A true wheat allergy should not be confused with gluten intolerance or coeliac disease. A food allergy is caused by the immune system producing IgE antibodies to a specific food protein or proteins. Symptoms tend to occur fairly soon after eating the food, from seconds up to two hours. When the food protein is ingested, it can trigger a range of allergy symptoms from mild (such as a rash, itching, or sneezing) to severe (trouble breathing, wheezing, anaphylaxis). Wheat allergy symptoms may also include abdominal pain, diarrhoea and other digestive disturbances. A true food allergy such as this can be potentially fatal.
Allergy to wheat is thought to be more common in children, who may ‘grow out of’ it before reaching adulthood. But it can also develop in adults.
Those with a wheat allergy may still be able to consume other gluten-containing grains; although in some cases these will need to be avoided too.
According to the Coeliac Society (www.coeliac.org.uk), coeliac disease is a well-defined, serious illness where the immune system attacks the body’s own tissue, when gluten is eaten. This causes damage to the lining of the small intestine and means that the body cannot properly absorb nutrients from ingested food. Usually diagnosed by a gastroenterologist, it is a digestive disease that can cause serious complications, including malnutrition and intestinal damage, if left untreated. Coeliac disease is not a food allergy or intolerance; it is an autoimmune disease where the sufferer must completely avoid gluten from all grains – not just wheat.
The Coeliac Society states that one in 100 people in the UK is thought to have coeliac disease, but only 24 per cent of these people are diagnosed. This leaves nearly half a million people in the UK who could have coeliac disease but aren’t yet diagnosed (www.coeliac.org.uk/coeliac-disease/myths-about-coeliac-disease).
Many people who do not have coeliac disease can still experience uncomfortable symptoms when they consume gluten. This is known as non-coeliac gluten sensitivity or gluten intolerance. Researchers continue to debate just how many people are truly sensitive to gluten, but the number has been estimated to be approximately 6% of the population.
As some of the symptoms of coeliac disease, gluten intolerance and even wheat allergy can overlap, it is important to be tested by your doctor to determine which of these may be causing your symptoms.
A gluten-free diet may also be beneficial for other conditions. These include inflammatory bowel diseases such as Crohn’s disease and other digestive conditions or symptoms such as irritable bowel syndrome or excessive bloating and gas. There’s increasing evidence that following a gluten-free diet may be beneficial for some people with other types of autoimmune disease too.
“Gluten-Free” and “Wheat-Free” Foods
Now let’s look at why understanding the difference between these two terms is important, depending on which of the above conditions/symptoms you may have.
‘Wheat-free’ foods are free from any components of wheat, including other proteins that people with a wheat allergy can react to. But foods that are just labelled ‘wheat-free’ may still contain other gluten-containing grains or substances derived from them, and are not necessarily gluten-free.
‘Gluten-free’ foods have to be free of gluten from any of the gluten-containing grains (more accurately, they have to contain less than 20 parts per million of gluten – a very tiny amount). Once again, these grains include rye, barley and spelt as well as wheat. Oats can also contain small amounts of gluten via contamination from other grains. Therefore oats also need to be avoided on a gluten-free diet, unless they are specifically labelled ‘gluten-free’, indicating that the oats have been processed in facilities that eliminate risk of contamination with gluten.
However, ‘gluten-free’ doesn’t necessarily mean the food is free from other wheat components. So if you have a wheat allergy and you’re buying packaged or processed foods, it can be wise to look specifically for ‘wheat-free’ and not just gluten-free – or thoroughly check the ingredients list to make sure the food you’re buying doesn’t contain other wheat components.
Reading The Ingredients
If a label on a packaged food doesn’t explicitly state ‘gluten-free’ or ‘wheat-free’ then you may need to look through the ingredients to check. But it’s not enough to avoid anything that lists the word ‘wheat’ (or when looking for gluten-free products, the words ‘wheat’, ‘barley’, ‘rye’ or ‘spelt’). Products such as gravies, soya sauce, salad dressings and casseroles can contain derivatives of wheat or other gluten grains that are harder to identify and can also be listed under different names. The following should all be avoided: durum wheat, spelt, kamut, couscous, bran, wheat bran, wheat germ, farina, rusk, semolina, wheat starch, vegetable starch, vegetable gum, malt extracts, vegetable protein, cereal filler, cereal binder and cereal protein.
Alternatives To Wheat and Gluten Grains and Flours
Chickpeas, beans and lentils are good fillers and can be added to soups and gravies, while wheat-free pasta and rice noodles are a great alternative to standard wheat pasta.
Understanding the difference between wheat and gluten can help avoid any unnecessary symptoms that may be brought on by ingesting the wrong foods. Confusing wheat and gluten may have less of an impact on people with non-coeliac gluten sensitivity/intolerance, or wheat sensitivity/intolerance, but it can have more serious consequences for those with a true wheat allergy and coeliac disease.
Clearspring’s Range of Gluten-Free Products
The Clearspring promise is to provide great-tasting, delicious foods that support good health and provide optimum nutrition. We want to give our customers who need to avoid gluten or wheat the opportunity to have great-tasting food and to be able to cook with confidence. This has inspired us to launch a range of gluten-free ingredients, from meal staples such as soya protein, rice and vegetable pastas to seasonings, sauces and garnishes. These are tasty, nutritious alternatives perfect for those on a gluten-free diet but equally delicious for the whole family.
1. Sotkovský P et al. A new approach to the isolation and characterization of wheat flour allergens. Clin Exp Allergy. 2011 Jul;41(7):1031-43.
2. Mittag D et al. Immunoglobulin E-reactivity of wheat-allergic subjects (baker’s asthma, food allergy, wheat-dependent, exercise-induced anaphylaxis) to wheat protein fractions with different solubility and digestibility. Mol Nutr Food Res. 2004 Oct;48(5):380-9.