Miranda Bone

Accredited Practicing Dietitian

What to Do Before You Cut Out Wheat

These days, going wheat or gluten free is almost fashionable. However, if you have noticed symptoms after eating a big bowl of pasta or a fluffy white pizza base, don’t rush to avoid wheat just yet.

Many Melbourne cafes offer gluten free cakes and friands, and some restaurants have gluten-free pizza bases and bread rolls, ditching wheat has some repercussions, especialliy if you’re not sure why you are doing it. There are several reasons why you may experiance digestive symptoms after eating wheat. You may not tolerate wheat well, but you might also have Celiac Disease yourself, which is more serious, and it gets much harder to diagnose once you stop eating much wheat. Ideally, rule it out while you are still eating wheat.

Coeliac Disease is more serious than wheat intolerance.

Coeliac Disease is not an intolerance to wheat. It is a serious immune reaction to gluten, a protein common to wheat, rye, barley and oats*. A tiny amount of this protein, 50mg (the amount in 1/100th of a slice of bread) is enough to damage the bowel in someone with celiac disease, and cause long term harms as well as short term discomfort. Celiac disease is one of the most common genetic diseases, and can be triggered at any point in the lifecycle, from children to adults. Approximately 1% of Australians suffer from Coeliac Disease, however, 75% of these remain undiagnosed. That means around 160,000 Australians have Coeliac Disease, but are not aware of it. Undiagnosed, untreated Coeliac Disease can lead to chronic poor health.

To diagnose Coeliac Disease, you need to eat wheat.

The first standard test for Celiac Disease is a Blood Test, which screens for antibodies (part of the immune system, present in blood). These particular antibodies are at much higher levels in the blood of people with untreated Coeliac Disease. That is, people who have Coeliac Disease and are eating plenty of gluten. If you are not eating gluten, or not eating much, then your levels of these antibodies will be normal, regardless of whether you have Coeliac Disease. In other words, a false negative. So to make this test show whether you really have Celiac Disease, you need to eat at least 4 pieces of wheat bread (or equivalent) every day, for 4-6 weeks prior to the test.

If this is an increase in wheat eating for you, talk to your dietitian. Symptoms may get worse on the first few days, but often reduce over the next weeks. You dietitian can also check your usual diet to ensure you’re getting enough gluten (eg from pasta, breakfast cereal, grains) if you don’t want to eat much bread.

The final step in celiac disease diagnosis is a small bowel biopsy. This is a short and simple surgical procedure done under light anaesthesia. Several small samples of the small bowel are taken and analysed to check if there is damage to the lining of the bowel, the villous atrophy that is characteristic of celiac disease.

The Exception: Gene test

The only way to avoid eating wheat, and still rule out Coeliac Disease as the cause of wheat-related symptoms is to have a genetic test. You can have the test performed on a blood sample or cheek swab, without having to eat gluten first. It is testing for the genes HLA DQ2 or HLA DQ8, which are responsible for Coeliac Disease. About 30% of Australia’s population has these genes. If you don’t have them, you don’t have Coeliac Disease, and you won’t ever develop it. However, if you do have one of them, you are susceptible to Coeliac Disease, and should proceed with eating wheat and getting proper testing done. 1 in 30 people who have HLA DQ2 or HLA DQ8 will develop Coeliac Disease, so this doesn’t diagnose you with Celiac Disease, but it does indicate further testing should be done.

Just cutting down on wheat doesn’t treat Coeliac Disease

Even when most wheat is removed from the diet, gluten (the real problem in celiac disease) can still creep in. Hidden sources of gluten are found in wheaten cornflour, soy sauce, malt vinegar, beer, spelt or rye breads (often well tolerated in wheat intolerance), and in crumb contamination, amongst others. In someone with an intolerance for wheat, or particular FODMAPS sugars, these tiny amounts would make little difference. But in someone with celiac disease, these amounts may still cause symptoms, or they may “silently” damage the bowel resulting in malabsorption of calcium, iron, zinc, magnesium, vitamin B12, folate. In the long term, that raises the risk of osteoporosis. There is also have a higher risk for lymphoma than if you had well controlled celiac disease, and the auto-immune diseases that are more common with celiac disease may take longer to get diagnosed and treated.

In Short:

Coeliac disease requires a strict, gluten free diet for life. Wheat or FODMAPS intolerance doesn’t. With a good diagnosis, a dietitian can help you get the most from your food, and you can have great quality of life, great food and great health. So check for celiac disease first; then explore other food intolerances.