Joseph R. Anticaglia, MD
Medical Advisory Board
Over the past three decades, the gluten-free diet (GFD), and products have gained increasing popularity, particularly in the U. S. and Europe. The interest in GFD has been associated with a remarkable growth in the sales of gluten-free products. The sales of such products were estimated to be 3.88 billion dollars in 2016, and more than 6 billion dollars in 2023. What is gluten?
Gluten is a mixture of proteins found in wheat, barley, and rye. These proteins, primarily gliadin and glutenin work to shape and hold food together. They give dough its elasticity and texture and allows dough to rise and maintains its shape. Gluten is an ingredient in many foods such as creamy sauces, fried foods, salad dressings, soups, pancakes, and waffles.
Five Common Foods Containing Gluten
- Bread — Including whole wheat, white, and sourdough bread.
- Pasta — Most traditional pastas, and noodles are made from wheat.
- Baked Goods — Such as cookies, crackers, cakes, and muffins.
- Cereals — Many breakfast cereals contain wheat or barley.
- Beer — Often brewed from barley, which contains gluten.
Gluten Intolerance
Gluten intolerance, also known as non-celiac gluten sensitivity (NCGS), happens when you feel sick after eating foods, or drinking liquids containing gluten. Individuals may have symptoms that last a few hours, or several days after eating, or drinking gluten products. The symptoms most often include intestinal complaints such as bloating, abdominal pain, and/or change in bowel habits. But some people complain of brain fog, feeling tired and/or sluggish.
Causes
Apart from gluten, potential dietary triggers that cause gluten-like symptom include fructans, sugars found in wheat, barley and rye; also, lectin, a naturally occurring protein that protects wheat, barley, and rye from bacteria, insects, and yeast.
Basic Differences Between Gluten Intolerance, Wheat Allergy, and Celiac Disease
Gluten Intolerance (NCGS) is a gastrointestinal sensitivity disorder with symptoms similar to celiac disease. but without damage to the small intestine. It”s not an allergy, or an autoimmune disorder. It affects about six percent of the U. S. population. Gluten-free diet help diagnose gluten intolerance.
Wheat Allergy is an allergic reaction to proteins found in wheat, (barley or rye) including, but not limited to gluten. Symptoms can include hives, difficulty breathing, and anaphylaxis, which is a life-threatening emergency that can develop within seconds or minutes. Skin tests help diagnose allergies.
Celiac Disease is an autoimmune, inherited disorder where ingestion of gluten leads to inflammation, and damage in the small intestine. Although symptoms may be similar to gluten intolerance, wheat triggers a person”s antibodies to attack its own small intestine causing more severe symptoms. It affects about one percent of the U. S. population. Blood tests help diagnose celiac disease.
Treatment
Gluten Intolerance: Initially try cutting back on foods that contain gluten instead of a strict, gluten-free diet.
There”s no cure for gluten intolerance. Most people get intestinal symptom relief by reducing gluten dietary intake, or following a gluten free diet.
In some patients, gluten may not be the trigger that causes the sensitivity reaction. It”s essential to work with your physician, and dietitian to manage your particular need.
Wheat Allergy: Avoidance of wheat and carrying emergency medication like epinephrine.
Celiac Disease: Complete, and lifelong, gluten-free diet is recommended for people with celiac disease. Blood tests help diagnose celiac disease.
Glossary
Gluten Intolerance — non-celiac gluten sensitivity (NCGS)
ATIs (amylase trypsin-inhibitors) are a group of non-gluten proteins found in wheat.
WGA (wheat germ agglutinin) is a lectin, a naturally occurring protein that protects wheat from bacteria, insects, and yeast.
References
- American Academy of Allergy, Asthma and Immunology; Celiac Disease, Non-Celiac Gluten Sensitivity and Food Allergy: How are they different?
- Maria Gloria Mumolo, et al; Is Gluten the Only Culprit for Non-Celiac Gluten/Wheat Sensitivity? Nutrients, Dec 12, 2020
- Sabrina Geisslitz, et al; Wheat Amylase/trypsin inhibitors(ATIs); Eur. J. Nutr., March 2, 2022
- Daniel F. McCarter. MD; Non-Celiac Gluten Sensitivity: Important Diagnosis or Dietary Fad? Am Fam Physician
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.