Wheat and Digestive Symptoms: Is It Gluten or Something Else?

In recent years, gluten-related disorders have gained significant attention, leading to a surge in people following gluten-free diets and new gluten-free products on store shelves. This has been driven by the increasing number of people experiencing digestive problems after consuming wheat, a primary source of gluten. However, there is widespread confusion surrounding whether these symptoms are truly due to gluten or related to other components in wheat.

In this blog post, we’ll explore the complex relationship between wheat, gluten, and other potential triggers of digestive upset, such as FODMAPs. By the end, you’ll have a clear understanding of the different causes of digestive symptoms related to eating wheat.

Understanding Wheat and Gluten

Wheat is a staple grain in many cuisines worldwide and is found in foods like bread, pasta, and cereals. It contains several proteins, with gluten being the most notable. Gluten is made up of two proteins: gliadin and glutenin. These proteins help dough rise, maintain its shape, and provide elasticity to wheat-based foods. Gluten is also found in rye, barley, and triticale.

In people with certain conditions, gluten can trigger various digestive symptoms, including gas, bloating, diarrhea, constipation, and abdominal pain. However, gluten is not the only component in wheat that may cause these symptoms. This has led to a growing interest in understanding other factors that might be at play.

Gluten-Related Disorders

Two of the most common gluten-related disorders are celiac disease and non-celiac gluten sensitivity.

Celiac Disease

Celiac disease is a well-known autoimmune disorder in which eating gluten damages the small intestine. It’s estimated that about 1% of people worldwide have celiac disease. When someone with celiac disease eats gluten, their immune system mounts an attack on the villi, which are small, finger-like projections that line the small intestine and are essential for nutrient absorption.

Symptoms of celiac disease vary widely, ranging from digestive issues like diarrhea and bloating to non-GI symptoms like anemia, fatigue, skin rash, and joint pain. In fact, there are over 250 known symptoms of celiac disease! The only effective treatment for celiac disease is a strict, lifelong gluten-free diet, which allows the intestines to heal and symptoms to improve.

Diagnosing celiac disease typically involves blood tests to look for specific antibodies, followed by a biopsy (taking a small sample of tissue) of the small intestine to confirm that the villi have been damaged. Early diagnosis and treatment are important for preventing long-term complications like osteoporosis.

Non-Celiac Gluten Sensitivity

Not everyone who experiences symptoms after eating gluten has celiac disease. Non-celiac gluten sensitivity (NCGS) is a condition where people experience similar symptoms but lack the autoimmune response and intestinal damage seen in celiac disease. NCGS is thought to be more common than celiac disease, but its exact prevalence remains unclear due to the lack of a definitive diagnostic test.

Symptoms of NCGS include bloating, abdominal pain, fatigue, and headaches, which typically improve after eliminating gluten from the diet. However, unlike celiac disease, NCGS does not require a lifelong gluten-free diet. Some people with NCGS may tolerate small amounts of gluten or certain gluten-containing grains better than others.

If you suspect you have NCGS, it’s important to work with a healthcare provider to rule out celiac disease and wheat allergy before attempting a gluten-free diet. This is because the tests to diagnose celiac disease do not work if you’re not currently eating gluten.

Beyond Gluten: Other Wheat Components and Digestive Symptoms

Some people who struggle with wheat may have other conditions that don’t necessarily involve gluten, such as wheat allergy or irritable bowel syndrome.

Wheat Allergy

Wheat allergy is another condition distinct from celiac disease and NCGS. It’s an allergic reaction to some of the proteins found in wheat. Wheat allergy is more common in children but can also affect some adults. The immune system in a person with wheat allergy mistakenly sees wheat proteins as harmful, which triggers an allergic reaction.

Wheat allergy symptoms can range from mild, such as hives and nasal congestion, to severe, including anaphylaxis – a potentially life-threatening reaction requiring immediate medical attention. Wheat allergy is diagnosed through skin prick tests, blood tests, or an oral food challenge conducted by an allergist.

Managing a wheat allergy involves avoiding all forms of wheat and carrying emergency medication like an EpiPen. Unlike celiac disease, wheat allergy does not necessarily require the elimination of gluten from non-wheat sources, such as barley or rye.

FODMAPs

FODMAPs are short-chain carbohydrates that are poorly absorbed by the human gut. This leads to fermentation by the gut bacteria and digestive symptoms like gas, bloating, and changes in bowel movements. Fructans, a type of FODMAP, are found in wheat and are believed to contribute to digestive discomfort in some people, especially those with irritable bowel syndrome (IBS).

When fructans reach the large intestine undigested, they are fermented by bacteria, producing gas and drawing water into the gut. This leads to bloating, pain, and changes in bowel movements. This explains why some people who believe they are sensitive to gluten may actually be reacting to the fructans in wheat.

One way of managing fructan intolerance is the low-FODMAP diet. The low-FODMAP diet involves temporarily eliminating high-FODMAP foods, such as wheat, then systematically reintroducing them to identify specific triggers. It should only be followed under the guidance of a dietitian to ensure nutritional adequacy.

Interestingly, some people with IBS can tolerate sourdough bread made with wheat flour because the fermentation process reduces the amount of fructans present in the bread. During sourdough fermentation, the naturally occurring bacteria and yeast break down complex carbohydrates like fructans into simpler compounds. This reduction in FODMAPs makes sourdough bread easier to digest. However, tolerance can vary from person to person, so it’s important to monitor symptoms when trying sourdough bread if you have IBS.

Tips for Identifying the Culprit

If you suspect that wheat or gluten might be contributing to your digestive symptoms, consider the following strategies:

• Keep a food diary and symptom tracker: Keep a detailed record of what you eat and how you feel afterward. This can help you identify patterns and potential food triggers.

• Try an elimination diet: An elimination diet involves removing the foods you suspect are causing your symptoms, such as gluten or high-FODMAP foods, from your diet for a period of time and then gradually reintroducing them. This can help pinpoint foods that are causing symptoms. It’s best to work with a healthcare provider while undertaking an elimination diet to ensure you’re still getting the nutrients you need. Also, it’s important not to eliminate gluten until celiac disease has been ruled out.

• Work with a registered dietitian: Consulting with a registered dietitian who specializes in digestive disorders can help you identify triggers and ensure your diet remains balanced and nutritionally adequate.

Final Thoughts

Navigating the complexities of wheat and digestive symptoms can be challenging. While gluten is a well-known culprit, it’s important to consider other components of wheat, such as fructans, that might be contributing to your digestive problems. A personalized approach guided by a registered dietitian is key to effectively managing these symptoms.

For more in-depth information, practical guidance, and a personalized approach to gut health, consider booking an appointment with our dietitian at Blue Tree Nutrition.