Who Shouldn't Eat Wheat? A Guide to Wheat Sensitivity

Celiac disease affects approximately 1% of the global population [1]. For many individuals, wheat can be a trigger for various health issues, ranging from digestive problems to severe allergic reactions. This guide explores who shouldn't eat wheat and why.

Quick Summary

Several medical conditions make wheat consumption problematic. This article details celiac disease, wheat allergies, and gluten sensitivity. Understand the symptoms, diagnosis, and dietary needs of those who may need to avoid wheat.

Key Points

• Celiac Disease: An autoimmune disorder requiring lifelong, strict gluten avoidance due to intestinal damage [4].

• Wheat Allergy: An IgE-mediated immune reaction to wheat proteins, with rapid onset symptoms that can be severe, including anaphylaxis [7].

• Non-Celiac Gluten Sensitivity (NCGS): A condition causing celiac-like symptoms without intestinal damage or specific antibodies, diagnosed by exclusion [9].

• Diagnosis is Crucial: Do not begin a wheat-free or gluten-free diet before medical testing, as it can interfere with accurate diagnosis of celiac disease [13].

• Other Conditions: Wheat may also be avoided by individuals with Dermatitis Herpetiformis, Gluten Ataxia, or FODMAP sensitivities related to IBS [4, 11, 12].

Understanding Wheat Sensitivity

Wheat sensitivity encompasses a range of conditions where individuals experience adverse reactions after consuming wheat. These conditions vary in their mechanisms and severity, affecting individuals differently. Key conditions include celiac disease, wheat allergy, and non-celiac gluten sensitivity (NCGS).

Celiac Disease

Celiac disease is an autoimmune disorder triggered by gluten, a protein found in wheat, barley, and rye. When individuals with celiac disease consume gluten, their immune system attacks the small intestine, causing damage to the villi, which are responsible for nutrient absorption [4]. This damage can lead to a variety of symptoms and long-term health complications.

Symptoms of Celiac Disease

Symptoms can vary widely, but common signs include:

• Digestive issues: abdominal pain, bloating, diarrhea, constipation
• Fatigue and weakness
• Skin rashes (dermatitis herpetiformis)
• Unexplained weight loss or malnutrition
• Neurological symptoms

Diagnosis of Celiac Disease

Diagnosis typically involves a combination of blood tests and a small intestine biopsy to assess for damage [5]. It's crucial to be actively consuming gluten when tested; stopping gluten before testing can produce inaccurate results. [13]

Wheat Allergy

A wheat allergy is an IgE-mediated immune response to one or more proteins found in wheat. This means the body's immune system identifies wheat proteins as harmful, leading to an allergic reaction when wheat is ingested, inhaled, or even touched.

Symptoms of Wheat Allergy

Symptoms can range from mild to severe and may include:

• Hives or skin rash
• Itching or swelling of the mouth, tongue, or throat
• Nasal congestion and sneezing
• Difficulty breathing or wheezing
• Anaphylaxis (a severe, life-threatening reaction)

Diagnosis of Wheat Allergy

Diagnosis usually involves skin prick tests or blood tests to identify specific IgE antibodies to wheat proteins. [7]

Non-Celiac Gluten Sensitivity (NCGS)

Non-Celiac Gluten Sensitivity (NCGS) is a condition where individuals experience symptoms similar to those of celiac disease, but without the intestinal damage or specific antibodies associated with celiac disease. [9]

Symptoms of NCGS

Symptoms often overlap with celiac disease and can include:

• Abdominal pain, bloating, and diarrhea
• Fatigue and brain fog
• Headaches
• Joint pain

Diagnosis of NCGS

There is no specific test for NCGS. Diagnosis is often made by exclusion. Doctors rule out celiac disease and wheat allergy before considering NCGS. Symptoms improve with a gluten-free diet. [9]

Conditions That May Require Wheat Avoidance

Beyond celiac disease, wheat allergy, and NCGS, several other conditions may benefit from avoiding wheat.

Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is a chronic, itchy, blistering skin condition that is a manifestation of celiac disease. Avoiding gluten is the primary treatment [4].

Gluten Ataxia

Gluten ataxia is a neurological disorder where gluten triggers an immune response that damages the cerebellum, leading to problems with coordination, balance, and speech. [11]

Irritable Bowel Syndrome (IBS) and FODMAPs

Wheat contains fructans, which are fermentable carbohydrates (FODMAPs) that can trigger IBS symptoms like bloating and abdominal pain. Individuals sensitive to FODMAPs may benefit from avoiding wheat. [12]

Comparison Table: Conditions Related to Wheat Consumption

Feature	Celiac Disease	Wheat Allergy	Non-Celiac Gluten Sensitivity (NCGS)	Dermatitis Herpetiformis	Gluten Ataxia	IBS (FODMAPs)
Immune Response	Autoimmune (gluten triggers immune attack)	IgE-mediated (allergic reaction)	Unknown	Autoimmune (related to celiac disease)	Autoimmune (gluten damages cerebellum)	Not primarily immune-related (fermentation)
Primary Cause	Gluten	Wheat proteins	Gluten	Gluten	Gluten	Fructans (in wheat)
Intestinal Damage	Yes (villi damage)	No	No	Yes (villi damage)	No	No
Symptoms	Digestive, fatigue, skin rashes	Hives, swelling, breathing difficulty	Digestive, fatigue, headaches, joint pain	Itchy blisters	Coordination, balance, speech problems	Bloating, abdominal pain
Diagnosis	Blood tests, biopsy	Skin prick test, blood test	Exclusion (rule out celiac & allergy)	Biopsy	Neurological tests, blood tests	Symptom-based
Treatment	Lifelong gluten-free diet	Avoid wheat	Gluten-free diet	Gluten-free diet	Gluten-free diet	Dietary modifications (low-FODMAP diet may help)

Testing Before Dietary Changes

It is extremely important not to start a wheat-free or gluten-free diet before being tested for celiac disease or a wheat allergy. Removing wheat from the diet can interfere with the accuracy of diagnostic tests. [13] If you suspect you have a wheat sensitivity, consult a healthcare professional for proper evaluation and testing.

Foods to Avoid and Include

Avoiding wheat often means avoiding foods made with wheat flour. This includes bread, pasta, cereals, and many processed foods. Be vigilant about reading labels, as wheat can be hidden in unexpected places. A gluten-free diet excludes wheat, barley, and rye.

Foods to Avoid:

• Wheat-based bread and baked goods
• Pasta
• Cereals containing wheat
• Many processed foods
• Beer (contains barley)

Foods to Include:

• Naturally gluten-free grains (rice, quinoa, corn)
• Fruits and vegetables
• Meats and fish
• Dairy products (if tolerated)
• Gluten-free alternatives (bread, pasta, etc.)

Conclusion

Wheat can be problematic for many, not just those with celiac disease or allergies. If you experience symptoms after eating wheat, consult a healthcare professional to determine if wheat avoidance is right for you. Proper diagnosis and dietary guidance are essential for managing wheat-related conditions and maintaining overall health.

Learn more about celiac disease and gluten-free living from the Celiac Disease Foundation

Frequently Asked Questions

What is the difference between celiac disease and a wheat allergy?

Celiac disease is an autoimmune condition triggered by gluten that damages the small intestine [5]. A wheat allergy is an immediate IgE-mediated allergic reaction to wheat proteins that does not cause intestinal damage but can cause hives, breathing difficulty, or anaphylaxis [7].

Can I develop celiac disease later in life?

Yes, celiac disease can develop at any age after gluten has been introduced into the diet, not just in childhood [5].

Are there tests for Non-Celiac Gluten Sensitivity (NCGS)?

There is no specific test for NCGS. It is a diagnosis of exclusion, meaning doctors must first rule out celiac disease and wheat allergy through specific tests (blood tests, biopsies, allergy tests) before considering NCGS if symptoms improve on a gluten-free diet [9].

What happens if someone with celiac disease eats a small amount of wheat?

Even small amounts of gluten can trigger the immune response and cause damage to the small intestine in people with celiac disease, even if they do not experience immediate symptoms [3].

Is a wheat-free diet the same as a gluten-free diet?

Not necessarily. Wheat is a source of gluten, but gluten is also found in barley and rye. A wheat-free diet avoids only wheat, while a gluten-free diet avoids all three grains (wheat, barley, rye) and any derivatives [3].

Who should I consult if I suspect I have a wheat sensitivity?

You should consult a healthcare professional, such as a primary care doctor or a gastroenterologist, for proper evaluation. It is important not to remove wheat or gluten from your diet before testing [13].

Can people with IBS benefit from avoiding wheat?

Yes, people with Irritable Bowel Syndrome (IBS) may benefit from avoiding wheat because it contains fructans, which are fermentable carbohydrates (FODMAPs) that can trigger symptoms like bloating and abdominal pain in sensitive individuals [12].