What foods can you eat if you have a wheat allergy

Main articles: Gluten-related disorders, Gluten-sensitive enteropathy-associated conditions, and Gluten-sensitive idiopathic neuropathies

«Gluten-related disorders» is the umbrella term for every diseases triggered by gluten, which include celiac disease (CD), non-celiac gluten sensitivity (NCGS), wheat allergy, gluten ataxia and dermatitis herpetiformis (DH).[10]

Wheat allergy

Main article: Wheat allergy

People can also experience adverse effects of wheat as result of a wheat allergy.[52] As with most allergies, a wheat allergy causes the immune system to abnormally reply to a component of wheat that it treats as a threatening foreign body.

This immune response is often time-limited and does not cause lasting harm to body tissues.[69] Wheat allergy and celiac disease are diverse disorders.[52][70] Gastrointestinal symptoms of wheat allergy are similar to those of celiac disease and non-celiac gluten sensitivity, but there is a diverse interval between exposure to wheat and onset of symptoms. An allergic reaction to wheat has a quick onset (from minutes to hours) after the consumption of food containing wheat and could include anaphylaxis.[49]

Celiac disease

Main article: Celiac disease

Celiac disease (CD) is a chronic, multiple-organ autoimmune disorder primarily affecting the little intestine caused by the ingestion of wheat, barley, rye, oats, and derivatives, that appears in genetically predisposed people of every ages.[46] CD is not only a gastrointestinal disease, because it may involve several organs and cause an extensive variety of non-gastrointestinal symptoms, and most importantly, it may be apparently asymptomatic.[4][47] Numerous asymptomatic people actually are not, but own become accustomed to living with a chronic bad health status as if it were normal, and they are capable to recognize that they actually had symptoms related to celiac disease after starting the gluten-free diet and improvement is evident, in contrast to the situation prior to the diet.[47][48][39] Added difficulties for diagnosis are the fact that serological markers (anti-tissue transglutaminase [TG2]) are not always present[49] and numerous people may own minor mucosal lesions, without atrophy of the intestinal villi.[50]

CD affects approximately 1–2% of the general population,[8] but most cases remain unrecognized, undiagnosed and untreated, and at risk for serious long-term health complications.[8][39][51][52] People may suffer severe disease symptoms and be subjected to extensive investigations for numerous years, before a proper diagnosis is achieved.[48] Untreated CD may cause malabsorption, reduced quality of life, iron deficiency, osteoporosis, an increased risk of intestinal lymphomas, and greater mortality.[53] CD is associated with some other autoimmune diseases, such as diabetes mellitus type 1, thyroiditis,[54]gluten ataxia, psoriasis, vitiligo, autoimmune hepatitis, dermatitis herpetiformis, primary sclerosing cholangitis, and more.[46][54]

CD with «classic symptoms», which include gastrointestinal manifestations such as chronic diarrhea and abdominal distention, malabsorption, loss of appetite, and impaired growth, is currently the least common presentation form of the disease and affects predominantly little children generally younger than two years of age.[46][48][51]

CD with «non-classic symptoms» is the most common clinical type[48] and occurs in older children (over 2 years old),[48] adolescents, and adults.[48] It is characterized by milder or even absent gastrointestinal symptoms and a wide spectrum of non-intestinal manifestations that can involve any organ of the body, and extremely frequently may be completely asymptomatic[51] both in children (at least in 43% of the cases[55]) and adults.[51]

Gluten ataxia

Gluten ataxia is an autoimmune disease triggered by the ingestion of gluten.[71] With gluten ataxia, damage takes put in the cerebellum, the balance middle of the brain that controls coordination and complicated movements love walking, speaking and swallowing, with loss of Purkinje cells.

People with gluten ataxia generally present gait abnormality or incoordination and tremor of the upper limbs. Gaze-evoked nystagmus and other ocular signs of cerebellar dysfunction are common. Myoclonus, palatal tremor, and opsoclonus-myoclonus may also appear.[72]

Early diagnosis and treatment with a gluten-free diet can improve ataxia and prevent its progression. The effectiveness of the treatment depends on the elapsed time from the onset of the ataxia until diagnosis, because the death of neurons in the cerebellum as a result of gluten exposure is irreversible.[72][73]

Gluten ataxia accounts for 40% of ataxias of unknown origin and 15% of every ataxias.[72][74] Less than 10% of people with gluten ataxia present any gastrointestinal symptom, yet about 40% own intestinal damage.[72]

Incidence

As of 2017[update], gluten-related disorders were increasing in frequency in diverse geographic areas.[34][38][39][40] This can possibly be explained by one or more of the following: the growing westernization of diets,[38] the increasing use of wheat-based foods included in the Mediterranean diet,[41][42] the progressive replacement of rice by wheat in numerous countries in Asia, the Middle East, and North Africa,[38] the development in recent years of new types of wheat with a higher quantity of cytotoxic gluten peptides,[43][44] and the higher content of gluten in bread and bakery products due to the reduction of dough fermentation time.[43][45]

Non-celiac gluten sensitivity

Main article: Non-celiac gluten sensitivity

Non-celiac gluten sensitivity (NCGS) is described as a condition of multiple symptoms that improves when switching to a gluten-free diet, after celiac disease and wheat allergy are excluded.[56][57] Recognized since 2010,[58][59] it is included among gluten-related disorders.[58] Its pathogenesis is not yet well understood, but the activation of the innate immune system, the direct negative effects of gluten and probably other wheat components, are implicated.[59][32]

NCGS is the most common syndrome of gluten intolerance,[58][60] with a prevalence estimated to be 6-10%.[9] NCGS is becoming a more common diagnosis, but its true prevalence is hard to determine because numerous people self-diagnose and start a gluten-free diet, without having previously tested for celiac disease or having the dietary prescription from a physician.[61] People with NCGS and gastrointestinal symptoms remain habitually in a «no man’s land», without being recognized by the specialists and lacking the adequate medical care and treatment.[62] Most of these people own a endless history of health complaints and unsuccessful consultations with numerous physicians, trying to get a diagnosis of celiac disease, but they are only labeled as irritable bowel syndrome.[62][63] A consistent although undefined number of people eliminate gluten because they identify it as responsible for their symptoms and these improve with the gluten-free diet, so they self-diagnose as NCGS.[62][63]

People with NCGS may develop gastrointestinal symptoms, which resemble those of irritable bowel syndrome or wheat allergy,[58][32] or a wide variety of non-gastrointestinal symptoms, such as headache, chronic fatigue, fibromyalgia, atopic diseases, allergies, neurological diseases, or psychiatric disorders, among others.[53][59][64] The results of a 2017 study propose that NCGS may be a chronic disorder, as is the case with celiac disease.[65]

Besides gluten, additional components present in wheat, rye, barley, oats, and their derivatives, including other proteins called amylase-trypsin inhibitors (ATIs) and short-chain carbohydrates known as FODMAPs, may cause NCGS symptoms.[59]As of 2019, reviews conclude that although FODMAPs present in wheat and related grains may frolic a role in non-celiac gluten sensitivity, they only explain certain gastrointestinal symptoms, such as bloating, but not the extra-digestive symptoms that people with non-celiac gluten sensitivity may develop, such as neurological disorders, fibromyalgia, psychological disturbances, and dermatitis.[66][65][59] ATIs may cause toll-like receptor 4 (TLR4)-mediated intestinal inflammation in humans.[67][68]

Pathophysiological research

The gluten peptides are responsible for triggering gluten-related disorders.[27] In people who own celiac disease, the peptides cause injury of the intestines, ranging from inflammation to partial or entire destruction of the intestinal villi.[28][29] To study mechanisms of this damage, laboratory experiments are done in vitro and in vivo.[30][29] Among the gluten peptides, gliadin has been studied extensively.[27]

In vitro and in vivo studies

In the context of celiac disease, gliadin peptides are classified in basic and clinical research as toxic or immunogenic, depending on their mechanism of action:[27][31]

At least 50 epitopes of gluten may produce cytotoxic, immunomodulatory, and gut-permeating activities.[33]

The effect of oat peptides (avenins) in celiac people depends on the oat cultivar consumed because of prolamin genes, protein amino acid sequences, and the immunotoxicity of prolamins which vary among oat varieties.[35][36][37] In addition, oat products may be cross-contaminated with the other gluten-containing cereals.[36]

Other neurological disorders

In addition to gluten ataxia, gluten sensitivity can cause a wide spectrum of neurological disorders, which develop with or without the presence of digestive symptoms or intestinal damage.[11] These include peripheral neuropathy, epilepsy, headache, encephalopathy, vascular dementia, and various movement disorders (restless legs syndrome, chorea, parkinsonism, Tourette syndrome, palatal tremor, myoclonus, dystonia, opsoclonus myoclonus syndrome, paroxysms, dyskinesia, myorhythmia, myokymia).[11][75]

The diagnosis of underlying gluten sensitivity is complicated and delayed when there are no digestive symptoms.

People who do experience gastrointestinal problems are more likely to get a correct diagnosis and treatment. A strict gluten-free diet is the first-line treatment, which should be started as soon as possible. It is effective in most of these disorders. When dementia has progressed to an advanced degree, the diet has no beneficial effect. Cortical myoclonus appears to be treatment-resistant on both gluten-free diet and immunosuppression.[11]


References

Examples of sources of gluten (clockwise from top): wheat as flour, spelt, barley, and rye as rolled flakesBread produced from wheat grains contains glutenWheat, a prime source of glutenGluten is often used in imitation meats (such as this mock «duck») to provide supplemental protein and in vegetarian dietsMedical animation still showing flattened intestinal villi.A male with gluten ataxia: previous situation and evolution after three months of gluten-free diet

  • ^«Farinograph».

    Wheat Quality and Carbohydrate Research. North Dakota State University. 22 September 2014.

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  • ^ abMolina-Infante J, Santolaria S, Montoro M, Esteve M, Fernández-Bañares F (2014). «[Non-celiac gluten sensitivity: a critical review of current evidence] [Article in Spanish]». Gastroenterol Hepatol. 37 (6): 362–71. doi:10.1016/j.gastrohep.2014.01.005. PMID 24667093.
  • ^Oliver, JR; Allen, HM (January 1992). «The prediction of bread baking performance using the farinograph and extensograph». Journal of Cereal Science. 15 (1): 79–89. doi:10.1016/S0733-5210(09)80058-1.
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    «Coeliac disease and autoimmune disease-genetic overlap and screening». Nat Rev Gastroenterol Hepatol. 12 (9): 507–15. doi:10.1038/nrgastro.2015.136. PMID 26303674.

  • ^Woychick, JH; et al. «The Gluten Proteins and Deamidated Soluble Wheat Protein». Retrieved 8 September 2009.
  • ^ abSakhare, S. D.; Inamdar, A. A.; Soumya, C; Indrani, D; Rao, G. V. (2013). «Effect of flour particle size on microstructural, rheological and physico-sensory characteristics of bread and south Indian parotta».

    Journal of Food Science and Technology. 51 (12): 4108–4113. doi:10.1007/s13197-013-0939-5. PMC 4252461. PMID 25477689.

  • ^ Sahlstrom, S. & Brathen, E. (1997). «Effects of enzyme preparations for baking, mixing time and resting time on bread quality and bread staling». Food Chemistry, 58, 1, 75–80. Effects of wheat variety and processing conditions in experimental bread-baking studied by univariate and multivariate analysis.
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    Philosophical Transactions of the Royal Society B: Biological Sciences. 357 (1418): 133–142. doi:10.1098/rstb.2001.1024. PMC 1692935. PMID 11911770.

  • ^ abcdeZis P, Hadjivassiliou M (26 February 2019). «Treatment of Neurological Manifestations of Gluten Sensitivity and Coeliac Disease». Curr Treat Options Neurol (Review). 21 (3): 10. doi:10.1007/s11940-019-0552-7. PMID 30806821.
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Is eating bread giving you bloating and other digestive symptoms? If so, you could be sensitive to wheat. Cutting out bread or changing the type you eat may help.

More and more of us claim to suffer from a wheat allergy, so we shun bread and other wheat-based foods, love pasta and cereals.

Experts tell genuine food allergy is, in fact, rarely to blame. But wheat sensitivity (also known as wheat intolerance) or simply trouble digesting wheat is increasingly common.

Is eating bread giving you bloating and other digestive symptoms?

If so, you could be sensitive to wheat. Cutting out bread or changing the type you eat may help.

More and more of us claim to suffer from a wheat allergy, so we shun bread and other wheat-based foods, love pasta and cereals.

Experts tell genuine food allergy is, in fact, rarely to blame. But wheat sensitivity (also known as wheat intolerance) or simply trouble digesting wheat is increasingly common.


Bread-related gut symptoms

«Probably a third of patients in my allergy clinic complain of digestive symptoms such as bloating, diarrhoea, vomiting and stomach pain after eating bread,» says Isabel Skypala PhD, specialist allergy dietitian at the Royal Brompton and Harefield NHS Foundation Trust.

She says allergy is unlikely to be the culprit, but bread-related symptoms are genuine, and wheat could be to blame.

«Some people discover certain foods are simply hard to digest, and wheat appears to be one of those,» she explains.

Read more about food intolerance.


What to do if wheat triggers digestive symptoms

If your symptoms are severe and long-lasting, especially if you own blood in your poo (stools), vomiting or painful stomach cramps, see your doctor to law out a medical condition.

If you own bloating or other minor symptoms after eating bread, Dr Skypala recommends trying an elimination diet. This is where you completely cut out wheat from your diet for 4 weeks, then gradually bring it back in to see if symptoms reappear.

«When you bring wheat-based foods back in, I recommend trying Weetabix or pasta first for a few days before starting on bread. It’s better to start with wheat in a more pure form, as bread has so numerous other ingredients,» Dr Skypala says.


Uses

Imitation meats

Further information on the use of gluten in cooking: Wheat gluten (food)

Gluten, especially wheat gluten, is often the basis for imitation meats resembling beef, chicken, duck (see mock duck), fish and pork.

When cooked in broth, gluten absorbs some of the surrounding liquid (including the flavor) and becomes firm to the bite.[23][24] This use of gluten is a favorite means of adding supplemental protein to numerous vegetarian diets. In home or restaurant cooking, wheat gluten is prepared from flour by kneading the flour under water, agglomerating the gluten into an elastic network known as a dough, and then washing out the starch.[2]

Bread products

Gluten forms when glutenin molecules cross-link via disulfide bonds to form a submicroscopic network attached to gliadin, which contributes viscosity (thickness) and extensibility to the mix.[2][12] If this dough is leavened with yeast, fermentation produces carbon dioxide bubbles, which, trapped by the gluten network, cause the dough to rise.

Bakingcoagulates the gluten, which, along with starch, stabilizes the shape of the final product. Gluten content has been implicated as a factor in the staling of bread, possibly because it binds water through hydration.[13]

The formation of gluten affects the texture of the baked goods.[2] Gluten’s attainable elasticity is proportional to its content of glutenins with low molecular weights, as this portion contains the preponderance of the sulfur atoms responsible for the cross-linking in the gluten network.[14][15] Further refining of the gluten leads to chewier doughs such as those found in pizza and bagels, while less refining yields tender baked goods such as pastry products.[16]

Generally, bread flours are high in gluten (hard wheat); pastry flours own a lower gluten content.

Kneading promotes the formation of gluten strands and cross-links, creating baked products that are chewier (as opposed to more brittle or crumbly). The «chewiness» increases as the dough is kneaded for longer times. An increased moisture content in the dough enhances gluten development,[16] and extremely wet doughs left to rise for a endless time require no kneading (see no-knead bread). Shortening inhibits formation of cross-links and is used, along with diminished water and less kneading, when a tender and flaky product, such as a pie crust, is desired.

What foods can you eat if you own a wheat allergy

The strength and elasticity of gluten in flour is measured in the baking industry using a farinograph. This gives the baker a measurement of quality for diverse varieties of flours when developing recipes for various baked goods.[2][17][18]

Added gluten

In industrial production, a slurry of wheat flour is kneaded vigorously by machinery until the gluten agglomerates into a mass.[19][failed verification] This mass is collected by centrifugation, then transported through several stages integrated in a continuous process.

About 65% of the water in the wet gluten is removed by means of a screw press; the remainder is sprayed through an atomizer nozzle into a drying chamber, where it remains at an elevated temperature for a short time to permit the water to evaporate without denaturing the gluten.[citation needed] The process yields a flour-like powder with a 7% moisture content, which is air cooled and pneumatically transported to a receiving vessel. In the final step, the processed gluten is sifted and milled to produce a uniform product.[19]

This flour-like powder, when added to ordinary flour dough, may assist improve the dough’s ability to increase in volume.

The resulting mixture also increases the bread’s structural stability and chewiness.[20] Gluten-added dough must be worked vigorously to induce it to rise to its full capacity; an automatic bread machine or food processor may be required for high-gluten kneading.[21] Generally, higher gluten levels are associated with higher overall protein content.[22]

Other consumer products

Gluten is often present in beer and soy sauce, and can be used as a stabilizing agent in more unexpected food products, such as ice cream and ketchup.

Foods of this helpful may therefore present problems for a little number of consumers because the hidden gluten constitutes a hazard for people with coeliac disease and gluten sensitivities. The protein content of some pet foods may also be enhanced by adding gluten.[25]

Gluten is also used in cosmetics, hair products and other dermatological preparations.[26]


Labeling

People with gluten-related disorders own to remove gluten from their diet strictly, so they need clear labeling rules.[76] The term «gluten-free» is generally used to indicate a supposed harmless level of gluten rather than a finish absence.[77] The exact level at which gluten is harmless is uncertain and controversial.

A 2008 systematic review tentatively concluded that consumption of less than 10 mg of gluten per day is unlikely to cause intestinal damage in people with celiac disease, although it noted that few dependable studies had been done.[77] Regulation of the label «gluten-free» varies.[76]

European Union

In the European Union, every prepackaged foods and non-prepacked foods from a restaurant, take-out food wrapped just before sale, or unpackaged food served in institutions must be identified if gluten-free.[81] «Gluten-free» is defined as 20 parts per million of gluten or less and «very low gluten» is 100 parts per million of gluten or less; only foods with cereal ingredients processed to remove gluten can claim «very low gluten» on labels.[81]

All foods containing gluten as an ingredient must be labelled accordingly as gluten is defined as one of the 14 recognised EU allergens.[82]

Brazil

By law in Brazil, every food products must display labels clearly indicating whether or not they contain gluten.[79]

Canada

Labels for every food products sold in Canada must clearly identify the presence of gluten if it is present at a level greater than 20 parts per million.[80]

International standards

The Codex Alimentariusinternational standards for food labeling has a standard relating to the labeling of products as «gluten-free».

It only applies to foods that would normally contain gluten.[78]

United States

In the United States, gluten is not listed on labels unless added as a standalone ingredient. Wheat or other allergens are listed after the ingredient line. The US Food and Drug istration (FDA) has historically classified gluten as «generally recognized as safe» (GRAS). In August 2013, the FDA issued a final ruling, effective August 2014, that defined the term «gluten-free» for voluntary use in the labeling of foods as meaning that the quantity of gluten contained in the food is under 20 parts per million.[83]


The health problems caused by wheat

There are 3 key health problems caused by wheat:

  1. Coeliac disease – a condition where the intestine lining can’t absorb and is damaged by gluten-containing foods including wheat, barley, oats and rye.

    See your GP for a blood test.

  2. Wheat allergy – reactions generally start within minutes and include itching, sneezing and wheezing. See your GP for referral to an NHS allergy clinic.
  3. Wheat sensitivity – symptoms love bloating, cramps, diarrhoea and sickness come on fairly slowly, generally hours after eating wheat. There’s no diagnostic test.


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