Dear Dietician: Digestive issues need proper diagnosis
I’ve been experiencing a lot of digestive problems like stomach cramping and bloating. My friend has celiac disease and thinks I may have it, too. I have an appointment with my doctor and have been reading up on celiac disease. I don’t understand the differences between gluten sensitivity, celiac disease, and wheat allergy. Can you help?
It can be very disruptive to have a digestive problem, and I’m glad you are taking the proper steps to resolve this. First, gluten is a protein found in wheat, barley, rye, and triticale (a hybrid of wheat and rye). It is also used as a binder in some products, such as soy sauce, ice cream, and hot dogs. Binders are used in food processing to thicken and improve the product’s texture.
Celiac disease is an autoimmune, genetic disorder that affects as many as 3 million Americans. It is caused by a reaction to gliadin, a component of gluten. The body’s response to gliadin causes a flattening of the villi, the fingerlike projections in the small intestines that facilitate the passage of fluids and nutrients. This damage, in turn, results in the malabsorption of nutrients.
Symptoms of celiac disease include diarrhea, abdominal cramping and bloating, and possible weight loss from malabsorption. One may also experience headaches and joint pain. A physician will perform a blood test for specific antibodies. If these are found, the next step is an intestinal biopsy to look for damage to the villi, providing a definitive diagnosis of celiac disease.
Gluten sensitivity, sometimes called non-celiac gluten sensitivity, is not well-defined in the medical community, and there are no blood tests to diagnose this condition. Symptoms produced after consuming gluten are similar to those with celiac disease, but damage to the small intestine is not found. It is usually diagnosed after ruling out celiac disease and wheat allergy.
Wheat allergy is sometimes confused with celiac disease, but these conditions differ. With a wheat allergy, the body produces antibodies against the proteins in wheat. In celiac disease, the body responds to a specific protein, gluten, and the body’s reaction is different than a typical allergic reaction.
A wheat allergy occurs when the body mistakes wheat as harmful. Symptoms occur after eating wheat and sometimes when inhaling wheat flour and may include itching, hives, diarrhea, and even anaphylaxis. Anaphylaxis is a severe, life-threatening allergic reaction that requires immediate medical attention.
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 need to be sure all the products you buy are labeled “wheat-free” and “gluten-free.”
It is important to note that certain nutrients may lack in gluten-free and wheat-free diets. While wheat flour is enriched with nutrients that have been stripped during processing, gluten-free manufacturers are not required to enrich or fortify their products. Consult a Registered Dietitian Nutritionist to design a healthy meal plan that works for you.
Until next time, be healthy!
Dear Dietitian Leanne McCrate, RD, LD, aka Dear Dietitian, is an award-winning dietitian based in Missouri. Her mission is to educate consumers on sound, scientifically-based nutrition. Do you have a nutrition question? Email her today at firstname.lastname@example.org. Dear Dietitian does not endorse any products, health programs, or diet plans.