Three different reactions to wheat
It is important not to confuse the three states. Celiac disease is an autoimmune disease in which gluten causes damage to the villi of the small intestine, impaired absorption and many long-term complications; Her diet is lifelong and strict. A wheat allergy is an immediate type of immune reaction with rash, swelling, and sometimes anaphylaxis. Non-celiac sensitivity is the third option: there are complaints, but there is no damage to the intestine or specific antibodies, and the severity of the diet is determined by how you feel.
- Celiac disease - autoimmune damage to the small intestine
- Wheat allergy - immediate reaction
- Non-celiac sensitivity - symptoms without damage
- Different dietary strictness for each condition
- Different methods for confirming the diagnosis
Symptoms
Complaints appear within hours or one to two days after eating wheat products and go away when they are eliminated. On the digestive side, this includes bloating, rumbling, abdominal pain, alternating constipation and loose stools, and nausea. General symptoms are also often disturbing: fatigue, brain fog, headache, aches in muscles and joints, irritability. It is the combination of intestinal and extraintestinal complaints during normal tests that is characteristic of this condition. Alarming signs such as weight loss and anemia are not typical for him.
- Bloating and rumbling after meal
- Abdominal pain and unstable stool
- Nausea and heaviness
- Fatigue and decreased concentration
- Headache
- Aches in muscles and joints
How to make a diagnosis
The order of actions is fundamental. First, while on a regular diet with gluten, they are tested for celiac disease, and if the result is positive or questionable, an endoscopy with a biopsy of the duodenum is performed. If you remove gluten in advance, tests will become false negatives, and celiac disease can be missed for years. At the same time, wheat allergy is ruled out. Only then is a trial of gluten elimination carried out for 4-6 weeks, assessing symptoms and then returning the product to ensure the connection.
- Tests for celiac disease on the background of a normal diet
- Endoscopy with biopsy of the small intestine if indicated
- Wheat allergy testing
- Rule out giardiasis, lactose intolerance, SIBO
- Gluten Elimination Trial for 4-6 Weeks
- Controlled product return
What else could be hidden behind complaints?
Very often it is not gluten itself that is to blame. Wheat is rich in fructans - poorly absorbed carbohydrates that are fermented by bacteria and cause bloating; Many people with irritable bowel syndrome respond to them. Similar symptoms are caused by lactose intolerance, bacterial overgrowth in the small intestine, giardiasis and functional digestive disorders. Therefore, if tests for celiac disease are negative, it makes sense not just to remove the bread, but to figure out with your doctor what exactly provokes the complaints.
- Fructans and other fermentable carbohydrates
- Irritable bowel syndrome
- Lactose intolerance
- Bacterial overgrowth in the small intestine
- Giardiasis
- Functional dyspepsia
Nutrition and practical advice
Unlike celiac disease, lifelong strict exclusion is usually not required: many people tolerate small amounts of gluten without symptoms, and the challenge is to find that individual threshold. Try to limit wheat products rather than eliminating all grains: buckwheat, rice, corn, oats, and quinoa remain in the diet. Gluten-free industrial products are often lower in fiber and more expensive, so there is no need to replace your entire diet with them. Make sure you have a sufficient intake of fiber, iron and B vitamins. It is better to build a diet together with a doctor or nutritionist.
- Find your individually tolerated amount of gluten
- Don't eliminate all grains unless necessary
- Keep enough fiber in your diet
- Don't rely on industrial gluten-free products
- Monitor iron and B vitamins
- Keep a food diary to find true provocateurs