Recently the number of people discovering they have a gluten allergy or intolerance has been rising, both because medical diagnostic systems for this issue have improved and because the flours and cereals grown today are not the same as in the past. Modern cereals, in fact, are selected for high productivity and grown with fertilizers and chemical substances that can be harmful to those who are predisposed. When the genuineness of a product is sacrificed for the food industry, issues of food reactivity can arise or the sensitivities to which each individual is prone can intensify.
Intolerance
Gluten is often drastically removed from the diet even in the absence of tests confirming its reactivity, as it is considered the main cause of gastrointestinal disturbances. However, sometimes it is not the gluten itself, but the foods that accompany it that are the real reactive agents. In my book “The Hypo-Histamine Diet” (Tecniche Nuove Editore) I cite the apt example of pasta with tomato sauce: several patients report bloating and heartburn after eating this dish, but the cause of the symptoms is the sauce, not the pasta.
The proof is that the same type of pasta dressed only with olive oil does not trigger the same effects. It should be understood that, unfortunately, for some individuals gluten represents a real trigger of inflammation and, even after clinical testing, they do not obtain a definitive diagnosis of gluten allergy (celiac disease).
In these individuals there is usually either a natural predisposition to a reaction to gluten (gluten sensitivity), or an allergy to wheat proteins or to grasses. Compared with those who are gluten-sensitive, people allergic to grasses show a reactivity to gluten-containing cereals linked to the environmental presence of reactive pollen and, therefore, to the spring-summer period. During that time it is advisable to limit gluten-containing foods as much as possible.
Celiac disease: a permanent autoimmune illness
This is a true chronic condition triggered by gluten consumption that affects the small intestine in genetically predisposed individuals: the immune system attacks the healthy tissue of the intestinal wall. To understand better, the surface of the intestine is lined with millions of villi, finger-like projections that allow the absorption of nutrients. In celiac individuals, gluten activates an immune mechanism that recognizes certain molecules of the intestine as harmful and reacts against them, causing damage, inflammation, and deterioration of the villi. In addition to the well-known gluten sources (pasta, bread, pizza, etc.), it is important to know that gluten is often present in foods in the form of an additive during industrial processing. Therefore we can also find it in:
- sauces
- ready meals
- ice cream
- some types of yogurt
- beer, produced by fermenting barley, should be avoided by people with celiac disease.
Non-celiac gluten intolerance
The symptomatology of non-celiac gluten intolerance overlaps with that of celiac disease, particularly regarding gastrointestinal symptoms: abdominal pain, cramps and abdominal bloating, stomatitis with ulcers, nausea, vomiting, chronic diarrhea (even with traces of blood) or constipation or an alternating pattern. It should be noted that the intestinal disturbances of non-celiac gluten intolerance show notable similarity to those caused by other intolerances (lactose) and to irritable bowel syndrome; not by chance, some patients initially diagnosed with IBS are later diagnosed with NCGS (Non-Celiac Gluten Sensitivity) through genetic testing for the celiac alleles.
How the disorder manifests
The common thread linking both IBS and NCGS is the extra-intestinal manifestations connected to gluten; let’s look at them in detail:
- dermatitis herpetiformis
- joint stiffness and pains
- unexplained weight loss, not due to changes in diet or exercise
- anemia (due to iron malabsorption)
- chronic fatigue
- brain fog and difficulty concentrating
- depression/anxiety
- sleep disturbances
- loss of appetite
- chronic abdominal bloating
Currently, to establish non-celiac gluten intolerance in a person, you cannot rely on specific biomarkers or a single laboratory test. Diagnosis is based on genetic testing indicating the presence of the alleles predisposed to celiac disease (HLA-DQ2/HLA-DQ8 are the most important) and after the doctor has completed evaluations to rule out conditions related to the small intestine or colon, celiac disease (with testing for anti-transglutaminase, anti-gliadin, and anti-endomysial antibodies in the blood) or wheat protein allergy. If gluten emerges as the main cause, a gluten-free diet should be followed for a period to detoxify the body and lower the level of inflammation.
Which grains to eat
In all the above scenarios, a diet that limits or eliminates (in the case of celiac disease) gluten is the way to go. Among all the allowed cereals, rice is the gluten-free staple in every variety (arborio, basmati, carnaroli, wild, whole, red, black…); sorghum is highly digestible and nutrient-rich; millet is rich in fiber and minerals; quinoa contains essential nutrients; amaranth has a high protein content and is rich in lysine; teff originates from Africa and is used as flour, while corn is gluten-free but not recommended for those with allergies because it raises histamine levels and can amplify inflammatory/allergic states.
Common gluten-associated types
- the celiac disease (Celiac Disease, CD)
- the non-celiac gluten intolerance, also known as “non-celiac gluten sensitivity” (Non-Celiac Gluten Sensitivity, NCGS);
- the wheat protein allergy (and to other cereals), which includes cereals containing gluten.
Gluten-containing foods
- Soft wheat and hard wheat
- Whole wheat
- Oats (depends on varieties)
- Spelt
- Kamut
- Barley
- Rye
- Triticale
Pasta, bread, baked goods, flours, bran, couscous or extracts with the aforementioned cereals
Main gluten-free cereals
- Amaranth
- Buckwheat
- Quinoa
- Corn
- Rice
- Sago
- Tapioca/Manioc
- Sorghum
- Millet
- Teff
Wheat protein allergy
To test for wheat protein allergy, a general practitioner or allergist may order skin allergy tests (Prick test) or a search for IgE in blood (RAST): the former indicate allergy after the appearance of a raised, itchy red bump at the site where the specific allergen is injected under the skin (with a tiny needle);
the RAST tests, on the other hand, detect the presence of specific IgE produced by the immune system in response to sensitizing proteins found in cereals, foods, or pollens.
These specific tests must be prescribed and interpreted by a gastroenterology and/or allergy specialist. If the result is negative and genetic testing shows a possible predisposition to celiac disease (not confirmed by antibody testing and/or intestinal biopsy), we are likely dealing with non-celiac gluten intolerance.
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