Sensitivity to gluten, a protein found in many cereal grains, is fast becoming the most talked-about gastrointestinal issue of our time. It's now OK to talk about bloating, diarrhea and gas in polite company if you're talking about gluten intolerance.

Gluten intolerance is the umbrella term for any adverse reaction to gluten, a storage protein found in wheat, rye, barley, triticale, kamut and spelt. Gluten gives baked goods texture and structure. Without gluten, cookies, cakes and bread just don't "taste" the same. Gluten is always in the wheat flour typically used for baking; some kinds of wheat flour have more (like bread flour) and some have less (like cake flour), but they all contain gluten.

Think outside the breadbox

It's a bit of a challenge to untangle all the misinformation about how gluten affects people. It's important to note that there can be any of three distinct processes involved: an allergy to just wheat, an inability to properly digest just wheat, or an inherited trait that makes it impossible for a person to eat any food containing gluten.

Although all three conditions share many of the same symptoms, they are not the same in severity or potential for lasting damage to the body.

1. Wheat allergy: A food allergy is an abnormal immune response to foods that most of us can eat without problem. People with wheat allergy are reactive to wheat but not necessarily to all grains or ingredients containing gluten. Wheat allergy can cause gastrointestinal discomfort, hives and even difficulty breathing. Eating wheat may make susceptible individuals feel sick but it will not usually cause lasting harm and is often outgrown.

2. Gluten sensitivity: Also known as non-celiac disease gluten sensitivity, this condition is not an immune response. It occurs in the digestive tract and causes mainly gastrointestinal symptoms. Gluten sensitivity can probably best be described as a digestive issue.

3. Celiac disease: This inherited autoimmune disease affects millions of people in the United States. Because the common symptoms for wheat allergy, gluten sensitivity and celiac disease--diarrhea, gas, bloating--are so similar to symptoms of other gastrointestinal disorders, celiac is often misdiagnosed as irritable bowel syndrome. Diagnosis for celiac disease cannot be made from symptoms alone; it must be made with an intestinal biopsy that shows damage to the intestinal wall.

Going against the grains

What if you have been having digestive issues and you find that avoiding wheat makes you feel better? Common wheat-containing foods like cereals and breads are really combinations of ingredients; they're not pure wheat. You could be reacting to another ingredient in the food. So giving up pasta or breakfast cereal may make you feel better, but it may not be because you have a problem with wheat or gluten.

In fact, if you suspect that you have celiac disease, the diagnosis can only be made during a "flare up." You must be eating gluten-containing foods regularly in order for a doctor to diagnose the disease. If you do have celiac, it's important to let your relatives know. Other family members may have mild symptoms that they have been ignoring or blaming on habits like overeating. In fact, some people with celiac disease don't have symptoms, but the disease can still cause damage.

Gluten intolerance and celiac disease are under-diagnosed conditions that deserve the media attention they're getting. But if you have gastrointestinal issues, don't try to solve them yourself. Self-diagnosis doesn't work when it comes to complex issues like allergies, intolerances and chronic diseases. Just because you "feel better" when you don't eat bread and pasta doesn't mean that wheat or gluten is the problem. It's best to get a medical diagnosis before you make any major changes to your diet.


Sharon Salomon, M.S., R.D.

Sharon Salomon is a registered dietitian, freelance writer and dedicated eater with professional culinary training. Her articles have appeared in Today's Dietitian, Edible Phoenix, and Sweat Magazine as well as many other food and nutrition publications and websites. Sharon works diligently to meet the challenge of balancing the calories she consumes in the interest of pleasure and research, with sufficient exercise to keep her weight stable.