So, What’s the Deal with Wheat?
Recently, it’s kind of felt like not eating wheat is the “in” thing to do. While there is some controversy, there is a solid evidence base about negative health effects for some individuals with wheat consumption. From celiac disease, to non-celiac wheat sensitivity and wheat allergy, it’s worth trying to understand the potential effects of wheat on our health.
Probably the most well accepted condition related to wheat consumption is celiac disease. Celiac disease is a condition where you have an immune response to gluten, a protein found in wheat, wheat products and other related grains, including barley, rye and triticale. The immune response to gluten often creates symptoms, including bloating and diarrhea. With continued consumption of wheat, the symptoms can become severe, even life threatening. In the general population, celiac disease affects about 1 out of every 100 individuals (Moscoso 2016).
For celiac disease, blood testing can usually identify cases, although confirming the diagnosis requires an intestinal biopsy to visualize damage to the intestinal tract. While most people with celiac disease have symptoms, there are silent cases. Some individuals may have an immune response that is causing damage without specific symptoms. For anyone with celiac disease the standard treatment is lifelong avoidance of wheat and gluten. It’s also worth noting that celiac disease has well known associations with other autoimmune conditions, including psoriasis, dermatitis herpetiformis (a blistering skin condition), type 1 diabetes and autoimmune thyroid conditions (Passali 2020).
Non-Celiac Wheat Sensitivity
Sometimes called non-celiac gluten sensitivity, this condition was finally accepted as a diagnosis only fairly recently and still maintains some controversy. Adding to this, there isn’t a complete understanding of the mechanism of how wheat causes symptoms for individuals with the condition. However, there does appear to be a subset of individuals with digestive symptoms, usually indigestion, bloating, and diarrhea that get better when wheat products are removed. In addition, they have a flareup of symptoms if wheat is reintroduced. Non gastrointestinal symptoms are also common and can include fatigue, headache and anxiety (Roszkowska 2019). To confirm the diagnosis, celiac disease must be ruled out. While some diagnostic markers appear to have weak correlations with the condition, no laboratory testing is considered diagnostic. The exact incidence of the condition is also difficult to nail down, although it’s likely more common than celiac disease itself (Lebwohl 2015).
Treatment again is the elimination of products containing gluten and wheat. Like celiac, a number of other medical conditions are correlated with non-celiac wheat sensitivity. Hashimoto’s thyroiditis, dermatitis herpetiformis, psoriasis and joint diseases (Losurdo 2018). Links with fibromyalgia also appear significant. Close to full resolution of fibromyalgia symptoms has been documented in some patients if they sustain a gluten-free diet long term (Isasi 2014, Pagliai 2020). Interestingly, depression, anxiety and psychosis also show correlations to non-celiac wheat sensitivity.
When people think of food allergies they often think about life threatening reactions in children to peanuts. And while peanut allergies are not uncommon, other foods can present as true food allergies, including wheat. Wheat allergy is less common than some other food allergies, but still can pose problems. Symptoms can include skin rash, inflammation of the lips, mouth and throat, diarrhea, abdominal pain and life-threatening anaphylaxis (Muthukumar 2020). Like other wheat-related conditions, avoidance is the standard treatment approach. Skin and blood tests can help in the diagnosis, but an elimination diet is often used.
Why is Wheat Problematic?
Wheat has been a staple food in the human diet for thousands of years. So why is wheat seeming to be more problematic for certain individuals? It’s a fascinating question with no definitive answers. However, research does suggest some possibilities.
Increased Immune System Reactivity with Newer Varieties
In order to improve crop yields and other desirable characteristics, farmers and corporations have continued to produce new varieties of wheat. There have been theories put forward that these newer varieties have increased immunogenicity—that they cause stronger immune reactions. However, the data supporting the idea is decidedly mixed. Some newer varieties of wheat may be strongly immunogenic. However, some ancient varieties appear to be as well (Kucek 2015).
It’s also been suggested that changes in farming practices play a part in wheat causing more problems. Germination of the wheat kernel can effectively reduce gluten content. However, even with older farming practices where wheat was left out longer in the field, the level of germination necessary to completely eliminate the immunogenicity of gluten is unlikely. The seed needs to fully sprout for eight days to eliminate gluten. Seeds sprouted for that long are difficult to process and use in standard wheat products (Kucek 2015).
It’s also suggested that higher use of herbicides may be to blame. Glyphosate is the most commonly used herbicide in all of farming. Farming practices using glyphosate have changed, where farmers often spray the wheat field just prior to harvest. This causes the wheat to die rapidly, drying the plant and making it easier to harvest. It also likely results in higher residues of glyphosate in wheat meant for human consumption (Samsei 2013). Fish exposed to glyphosate develop gastrointestinal problems that are remarkably similar to celiac disease (Senapati 2009). Other concerning correlations with glyphosate exposure have been seen as well, although it’s clear there’s a need for more research to confirm potential risks (Barnett 2020).
Should Everyone Avoid Wheat?
Avoiding wheat is difficult for most individuals. There’s also solid evidence that fiber from whole wheat helps decrease incidence of a number of different diseases including obesity, heart disease, diabetes and cancer (Liu 2020). Generally, my approach is to consider a gluten free diet in patients with autoimmune conditions, fibromyalgia and in patients with digestive concerns. However, you want to test for celiac disease first.
If patients follow a fully gluten-free diet for a month and don’t get any benefits, I’m less inclined to have them continue. However, celiac disease requires the elimination of gluten and symptom improvement can take much longer. Fibromyalgia also may be slow to respond to the removal of gluten necessitating a longer elimination trial (Isasi 2014).
In addition, if a patient is having symptoms from wheat, it’s not unusual that there are other trigger foods. When doing a gluten free diet, it’s best to evaluate for other common triggers like fructose and lactose, since these are also commonly implicated in symptoms (Vazquez 2020 Schnedl 2020). Another potential trap for patients is the amount of gluten-free junk food that is now available. Removing gluten and replacing it with highly processed gluten-free products is often not a productive approach.
Dietary changes are challenging to implement. And yet some patients can experience profound improvements through diet alone. If you are considering dietary changes to improve your health, it’s often a good idea to consult with a healthcare provider knowledgeable in dietary interventions. Usually, primary care physicians have limited experience implementing dietary changes and an integrative medicine provider or nutritionist familiar with your problems or concerns may be a better choice. For individuals who don’t react badly to wheat directly, it still may be worth considering organic varieties and focusing mostly on whole grain products to maximize health benefits.