The gluten-free dilemma: Should I be gluten-free? How?

Eating gluten free is on the minds of many health conscious people today, but why is it important for some people to eat gluten free and not others? Let’s take some time and explore three health conditions related to the need to reduce or eliminate gluten and how it can be managed.

First, it’s important to understand what gluten is. Gluten is the protein found in wheat, barley, and rye (as well as some less common grains) that helps food maintain their shape and act as a “glue” to hold foods together.

Wheat Allergy

Wheat allergy is an allergic reaction to components of wheat, but not necessarily gluten. Wheat has many components that can cause allergic reactions and not everyone reacts to the same part of the wheat plant. This overreaction by the immune system to a normally harmless substance happens with many common allergies like grass and weeds, known as hay fever.

Wheat allergy symptoms can vary, including:

• hives (or skin rash)
• various digestive issues (including nausea, cramps, indigestion, vomiting, or diarrhea)
• stuffy or runny nose
• sneezing
• headaches
• asthma
• anaphylaxis

The severity of the body’s reaction varies by person. A reaction is caused by exposure to wheat which can include eating foods containing wheat, being in a room with wheat in the air, or using products that contain wheat, such as some Play-Dohs and makeup products.

Wheat allergy, like other allergies, is more likely to present itself in children if there is a family history of allergies. Approximately 65% of children with a wheat allergy will outgrow it by age 12. Wheat allergy is diagnosed similarly to other allergies with a skin-prick or blood test. If these two tests are inconclusive, the allergist may order a food challenge, where small amounts of wheat are ingested under close medical supervision.

The primary treatment for wheat allergy historically has been avoiding wheat (the severity of the allergy will determine how much wheat needs to be avoided), however allergy specific treatment such as sublingual drops can help those with wheat allergies build tolerance in case of accidental exposures, and for some, enabling them to tolerate wheat in their diets.

Gluten Sensitivity

Those with gluten sensitivity typically experience digestive issues or discomfort linked to the consumption of gluten. There are no medical tests for gluten sensitivity and the symptoms may vary. Symptoms and severity may also be affected by the amount of gluten consumed.

The only treatment for gluten sensitivity is to avoid gluten in the amounts causing reactions. A small portion of individuals with gluten sensitivity actually have celiac disease, so it is important to talk to you doctor.

Celiac Disease

Celiac disease is an autoimmune disease that when gluten is consumed, the immune system attacks the lining of the intestine, destroying the microvilli affecting absorption and digestion. Symptoms of celiac disease can include:

• digestive discomforts similar to those seen with gluten sensitivity, especially diarrhea following gluten consumption, but can also include:
  • weight loss (or inability to gain weight in children)
  • malabsorption
  • rash
  • infertility
  • no symptoms at all

Due to the issues with absorption and digestion in celiac disease, diagnosis and treatment is crucial. Diagnosis must be done by a gastroenterologist who can perform various tests that help point to or against celiac disease. The only definitive test is a colonoscopy to take samples of the intestinal lining. In order to receive an accurate diagnosis, gluten must be in the diet at the time of testing.

The only treatment for celiac disease is complete removal of all gluten from the diet, even down to the tiniest crumb.

Living Gluten-Free

Now that we understand the differences between a wheat allergy, gluten sensitivity, and celiac disease, we can address how individuals can live with them. The most important aspect is knowing what to eat.

Choosing naturally gluten-free foods is the best start; these include:

• fruits
• vegetables
• meat
• dairy
• gluten-free grains like rice and quinoa

It is important to remember to replace the grains you take out with new gluten-free grains to maintain a balanced diet, focusing on whole grain options whenever possible.

Being able to eat processed foods can make life easier, so label reading is critical. With wheat being one of the top eight allergens, it is required to be labeled on every nutrition facts label. Gluten, on the other hand, currently is not required to be labeled. When looking for gluten free items, first learn what types of grains must be avoided (wheat, rye, barley, etc.) and look for the gluten-free emblem on processed foods.

Once gluten-free foods are purchased, it’s important not to contaminate them in the process of storing and preparing them. First, be sure to thoroughly clean the kitchen to remove any previous gluten residue. If the kitchen must be shared between gluten-containing and gluten-free food, try to follow the following tips:

1. Keep gluten-free foods on the upper shelves of cupboards, freezers, and fridges to avoid gluten falling into them.
2. Clean all preparation areas and cooking spaces thoroughly before preparing gluten-free foods.
3. With appliances that are hard to clean, such as a toaster, have two toasters, one for gluten and one without.

Beyond the personal kitchen, how is gluten free achievable?

When dining out, plan ahead. Do research online or call the restaurant to see if they have gluten-free items. Upon arrival, make your dietary needs known to the waiter and ask questions about croutons, sauces, spice combinations, and other unknown ingredient combinations that may have gluten added. If something is brought out incorrectly, don’t be afraid to say something and have it remade. When attending potlucks or parties, talk to the host ahead of time and see what might be available to eat; many hosts are more than happy to accommodate. Another option for gatherings is to bring a dish or dessert that you know is gluten free to ensure you have at least one “safe” option.

There are three main reasons an individual might need to eliminate some or all gluten from the diet: Wheat allergy, gluten sensitivity, or celiac disease. It is important to remember to substitute items if you are eating gluten-free to ensure nutritional needs are met, as whole grains are a needed element of the human diet. When someone is carefully following a gluten-free diet, being educated on how to replace the missing grains, how to store the food, and how to prepare the food is essential to the gluten free lifestyle’s success.

For more information on how Allergychoices can help you and your provider address the underlying cause of wheat allergy through sublingual immunotherapy, read more about food allergies.

by Sarah Aubin, Nutrition and Dietetic Student, Allergy Associates of La Crosse

References

1. American College of Allergy, Asthma, and Immunology. Wheat allergy. 2014. Available at: http://acaai.org/allergies/types/food-allergies/types-food-allergy/wheat-gluten-allergy. Accessed July 21, 2017.