A Wheat-Free Diet

A wheat-free diet is prescribed to persons with gluten-intolerance, a type of protein in wheat and many other grains that causes a severe allergic reaction and discomfort in affected individuals. True wheat allergy is diagnosed as Celiac Disease and necessitates lifelong avoidance of all foods containing gluten to avoid life-threatening complications and premature death.

Frequency of Occurrence in the U.S. Population.

With the overwhelming attention being given by the lay public to “food allergies” today, it is important to realize that, while many individuals may have mild intolerance to certain foods, frank wheat-allergy is not as common as the public is led to believe. At the same time, because Celiac disease is a serious condition, diagnosis in those affected is essential as soon as possible.

Celiac disease is a genetic disorder affecting approximately 1 in 200 Americans. Also known as gluten-intolerance or gluten sensitive enteropathy is more common among people of European descent and is more rare among African-American and Asian populations.

What are the Symptoms of Gluten-Intolerance?

Symptoms of gluten-intolerance can vary from individuals, but because the disease is specific to the intake of foods containing gluten, most symptoms are related to discomfort in the intestines. Symptoms vary across individuals but may include diarrhea, weight loss, malnutrition, isolated nutrient deficiencies, bloating, abdominal pain and other digestive symptoms. Symptoms range from mild-to-severe.

In persons who suffer from Celiac disease, the villi (short hair-like projections in the small intestine that aid absorption of nutrients) are damaged and become flattened, which makes them unable to absorb nutrients properly. Additionally, gluten-intolerant individuals have adverse reactions to the gluten proteins – attacking it as a toxin which leads to further damage. The damage caused by gluten makes the gut “leaky.” This means that other and more foreign allergens may be exposed to the body’s immune system through the gut than normal. For this reason, individuals with Celiac disease generally have more allergies than the general population.

How is Gluten-Intolerance Diagnosed?

Diagnosis of gluten-intolerance is fairly straightforward and usually confirmed by a gastroenterologist. By removing all food items containing gluten (or even processed in a way that gluten comes in contact with the food) for a period of time, an individual with the disease will notice that all symptoms will disappear. With an intestinal biopsy performed by a health care specialist before and after removal of gluten from the diet, he or she will notice the return of the intestinal villi to normal size and function over time. There are also blood tests that are being used today to screen for the disease.

If Celiac disease is diagnosed, one must immediately begin a strict gluten-free diet for the rest of his or her life. Cheating is much more serious than a mere return of the symptoms of gastrointestinal discomfort. Continued intake of gluten will promote further intestinal damage and increase the chances of many life-threatening autoimmune diseases and early death. Research has shown that a person with Celiac disease who continues to each gluten will increase their chance of gastrointestinal cancer by 40 to 100 times that of the normal population!

The Cans and Can’ts of a Wheat-free Diet.

The gluten-free diet is commonly called a wheat-free diet because gluten is a main protein in wheat and wheat is so abundant in the American diet. However, many other foods contain gluten or are processed with gluten-containing ingredients.

In order to follow a true wheat-free diet, an individual with gluten intolerance must avoid all products that contain wheat, rye and barley or any of its derivatives. The task of determining if a product has a gluten derivative or been refined using a method that put the item in contact with gluten can seem daunting so it is important to become familiar with reading labels and the many hidden sources of gluten.

While dietitians generally stay away from telling clients there are “bad” or “forbidden” foods, it is essential that individuals with true gluten intolerance avoid any food that contains gluten. A typical American diet contains 10-40 grams of gluten per day and studies have shown that even the smallest amount of gluten – equivalent of 1/48^th slice of bread (or 0.1 grams) - can cause damage to the intestinal villi!

There are numerous foods and additives that contain gluten. Consult a Registered Dietitian and the Celiac Disease and Gluten-Free Diet Resource Center on the Internet (www.celiac.com) for detailed lists of “safe” and “forbidden” items.

What can I expect by following a wheat-free diet?

If truly diagnosed with Celiac disease, the only acceptable treatment is to strictly follow a gluten-free diet. While this can be a challenge, nearly all complications of the disease can be avoided with some creativity and planning. There are several web sites, support groups and cookbooks available today that can help an affected individual enjoy their special diet and lifestyle maximally.

Special considerations.

While individuals with Celiac disease do face challenges in maintaining a wheat-free diet in the United States, they can look forward to a normal and healthy life with adherence to this specialized diet. A wheat-free diet can be an opportunity to experiment with a variety of nutritious food alternatives and there are several specialized food manufacturers and recipes available that do not use ingredients containing gluten.

Gluten-intolerant individuals must become familiar with how to recognize hidden sources of gluten – in some medications, certain lotions, creams and cosmetics, from cross-contamination in the manufacturing process, in some toothpastes, and even some stamps and envelope gums. Caution must be taken to avoid incorrect advice from some health food store professionals who may not be well-educated on the many sources of gluten and the importance of strict avoidance when following a completely gluten-free diet. Individuals should always consult a Registered Dietitian and appropriate health care professional when considering a major change to their diet.

References:

Internet site: http://www.celiac.com. Accessed July 2000.

Internet site: http://www.celiac.org. Accessed July 2000.

Lowell, J.P., Against the Grain. New York: Henry Holt and Company, 1996.

Ryberg, R., The Gluten-Free Kitchen. California: Prima Publishing, 2000.

Shils, M.E., Olson, J.A., Shike, M., Ross, A.C., eds. Modern Nutrition in Health and Disease. 9^th edition. Baltimore: Williams & Wilkins, 1999.

Wendy Bazilian, DrPH, MA, RD • www.oneinabazilian.com

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