In the past few months, two of our friends have told us that they need to avoid eating wheat products, even though they said tests for celiac disease came back negative. Are there other reasons people would need to avoid wheat?
It could be that your friends actually do have celiac disease, but the medical tests they took had indefinite results. If that's the case, they would need to avoid all foods with gluten -- not only wheat products, but also those made with rye and barley. With celiac disease, it's the gluten in those products that damages the intestine, causing nutrient malabsorption, abdominal pain, chronic diarrhea, vomiting and constipation. Fortunately, symptoms go away and the intestine heals just by avoiding those foods; unfortunately, gluten is found in many, many foods, including some types of tomato sauce, ice cream, cheese spreads and salad dressings, as well as in some kinds of medicines and vitamins, and even, sometimes, the glue on stamps and envelopes. Working with a registered dietitian on establishing a gluten-free diet is very helpful -- even essential.
It's estimated that 1 in 133 people have celiac disease, although many go undiagnosed and may have relatively minor symptoms.
However, some people, particularly children, actually have a similar but distinct condition -- a wheat allergy -- that spurs an autoimmune reaction to gluten or one of the other proteins found in wheat: albumin, globulin or gliadin. According to the Food Allergy and Anaphylaxis Network (http://www.foodallergy.org/), children usually outgrow an allergy to wheat; obviously, it's less common in adults. People with a wheat allergy need to avoid only wheat; they can feast on rye and barley to their heart's content.
Another possibility is that your friends have gluten sensitivity or gluten intolerance. According to a fact sheet by the Gluten Intolerance Group of North America, available under "Resources" on its web site, http://www.gluten.net/, people with gluten intolerance may suffer a variety of gastrointestinal reactions when they consume foods containing gluten, but do not suffer damage to the villi in their small intestine -- the hallmark of celiac disease. Unfortunately, medical tests can't confirm a diagnosis of gluten intolerance. And, there's not a solid base of scientific study to recommend a course of action beyond eliminating gluten from the diet, although sometimes a low-gluten diet (instead of a gluten-free diet) works well. Following a doctor's or dietitian's guidelines is always recommended.
Chow Line is a service of Ohio State University Extension and the Ohio Agricultural Research and Development Center. Send questions to Chow Line, c/o Martha Filipic, 2021 Coffey Road, Columbus, OH, 43210-1044, or firstname.lastname@example.org.
Editor: This column was reviewed by Julie Shertzer, registered dietitian and program specialist for Ohio State University Extension in the Department of Human Nutrition, in the College of Education and Human Ecology.