Wheat intolerance

Food intolerance or non-allergic food hypersensitivity is a delayed, adverse reaction to a food, beverage or food additive caused by mechanisms not involving the immune system.

Symptoms of a food intolerance may be caused by the absence of specific chemicals or enzymes needed to digest a food substance, from reactions to naturally occurring chemicals in foods, reactions to food additives or reactions to contaminated foods.

A food intolerance is therefore an adverse reaction to a food not involving the immune system, whereas a food allergy is an adverse reaction to a food involving the immune system. With a food allergy, the presence of IgE antibodies against the allergenic food will be found in the patient.

Symptoms of a food intolerance are often similar to those of a food allergy and include:

Skin: rashes, urticaria (hives), angioedema, dermatitis and eczema.
Respiratory symptoms can include: nasal congestion, sinusitis, pharyngeal irritations, asthma and an unproductive cough.
Gastrointestinal symptoms may include: mouth ulcers, abdominal cramp, nausea, flatulence, intermittent diarrhoea, constipation and irritable bowel syndrome.

It can be difficult to determine the offending food causing a food intolerance because the adverse response generally takes place over a prolonged period of time. Food intolerance symptoms usually begin about half an hour after eating the food in question but may be delayed up to 48 hours.

As the immune system is not involved, food intolerance cannot be diagnosed by a skin or blood (specific IgE antibody) test. Some food intolerances can be easily identified if a food is causing an obvious reaction. If a patient is struggling to isolate foods causing symptoms, a dietician should be consulted for help. A food intolerance is diagnosed with the help of a medical history, food history or food diary, followed by elimination and reintroduction of the suspected food. An elimination diet and double blind placebo controlled food challenge may also be useful in the diagnosis of food intolerance.

Long term dietary adjustments are only justified after a proper diagnosis has been made. It is important to make sure that any diet being followed in the long-term is complete and nutritionally balanced. A dietician can help in the planning of a diet which still provides your body with the nutrients it requires on a daily basis, while eliminating or limiting a food to which one is intolerant.

After two or more weeks of following a prescribed diet, free of the offending food, and after symptoms have improved, challenge testing can begin. Small amounts of the offending food are reintroduced slowly into the diet to see how much of this food can be tolerated. Often small quantities of the offending food can be very well tolerated.

What follows are some guidelines for food choices for patients suffering from wheat intolerance.

FOODS CONTAINING WHEAT, WHICH SHOULD BE LIMITED IF WHEAT INTOLERANT (NOT NECESSARILY TO BE TOTALLY AVOIDED) INCLUDE:

MILK AND DAIRY PRODUCTS: Malted milk, some flavoured milk drinks (particularly chocolate), some processed cheeses.

EGGS: Scotch eggs rolled in bread crumbs

MEAT FISH AND CHICKEN: Breaded, crumbed or flour coated meat, fish or chicken; commercial preparations containing fillings (e.g. sausages, polony, viennas, frankfurters, hamburger patties, chicken loaf, meat loaf, fish cakes), canned meat, canned fish in sauce, pickled fish, fish paste, meat spread (e.g. liver pâté), meat pies, bread stuffing’s.

BREADS AND CEREALS: Many baked goods, all commercial and homemade breads, cakes, biscuits and rusks containing wheat or baking powder, wheat bran, cereals containing wheat (e.g. whole wheat cereals, puffed wheat, bran flakes), some baby cereals, certain  baking powder (check label), wheat rice, pasta, cous cous, breadcrumbs, pies, pastries, pancakes, waffles.

FRUIT AND NUTS: Only those coated or in a dish containing wheat (e.g. fruit fritters in a batter with cake flour)

VEGETABLES: Pumpkin or sweetcorn fritters, crumbed vegetables or vegetables in a sauce

FATS AND OILS: Commercial salad dressings and mayonnaise unless known to be wheat-free, batter fried foods.

SOUPS AND SAUCES: Most packet or canned soups and sauces, soups containing noodles, instant sauces and meat fixes, gravy powders, mustard, curry powder, piccalilli, soy sauce, many bottle sauces, stick cubes and powders, any sauce made with wheat flour.

DESSERTS: Ice-cream, ice-cream cones and wafers, all puddings made with wheat flour, semolina, some instant puddings

BEVERAGES: Some instant coffees, malted milk products 

MISCELLANEOUS: Some peanut butters and spreads, some chocolates (particularly those with wafers), some sweets, nougat.

Remember to check food labels!

FOODS FREE OF WHEAT WHICH CAN BE EATEN IF WHEAT INTOLERANT INCLUDE:

MILK AND DAIRY PRODUCTS: All types of plain milk, pure cheeses, some processed cheeses, buttermilk, maas, sour milk, plain yoghurt, condensed milk and evaporated milk.

MEAT, FISH AND CHICKEN: Any fresh or frozen meat, fish and chicken prepared without wheat flour. Tinned fish in water, brine or oil.

BREADS AND CEREALS: Rye, oats, maize, barley, rice, mealie rice, rice cakes, oats porridge, mielie meal, mabella, corn flakes, puffed rice, some baby cereals, corn flake crumbs, popcorn, corn tortillas, some potato crisps, homemade bread, cakes and biscuits using a wheat-free flour (e.g. mealie meal, corn flour, potato flour, rice flour, soya flour).

FRUIT AND NUTS

All fresh, frozen, canned and dried fruits; all types of nuts, soya beans, dried beans and lentils, tinned beans (unless in a sauce).

VEGETABLES: All fresh and frozen vegetables prepared with crumbs, batter or a sauce, tinned vegetables (unless in a sauce).

FATS AND OILS: Butter, cream, margarine, oil, suet, lard, some mayonnaises.

SOUPS AND SAUCES: Clear bouillon, homemade soups or sauces thickened with corn flour, some packet soups.

DESSERTS: Some custard powders, some instant puddings, Creme Caramel, meringues, crumble puddings using cornflakes, oats or corn flour.

BEVERAGES: Tea, pure coffee, Nesquick, Cocoa, fruit juices, cordials.

MISCELLANEOUS: Sugar, jam, honey, some peanut butters, some sandwich spreads, some chocolates, boiled sweets, salt, pepper, pure herbs, pure spices, vinegar and corn flake crumbs.

Coeliac Disease (also referred to as gluten-intolerance)

Often Coeliac Disease is confused with wheat intolerance. People with Coeliac disease cannot eat foods containing gluten, a protein found in wheat, barley, rye and some other grains. With Coeliac disease, the body’s immune system responds to gluten by damaging the lining of the small intestine. Most of the nutrients in food are absorbed through the small intestine. Damage to the small intestine means that nutrients cannot be absorbed fully by the body. This can lead to nutrient deficiencies.

Coeliac disease is a disease of genetic origin. If a family member has Coeliac disease one’s risk of having Coeliac disease increases.

Some symptoms of Celiac Disease include: flatulence, diarrhoea, stomach pain, fatigue, joint pain, weight loss and an itchy skin rash called dermatitis herpetiformis.

Properly diagnosing Coeliac disease includes a medical review of symptoms, a blood test looking for high levels of certain auto-antibodies(IgA and or IgG anti-gliadin antibodies), confirmed by a biopsy of tissue from the small intestine and the success of a gluten-free diet.

The only treatment for celiac disease is to eat a gluten-free diet. It is important to consult with a registered dietician to ensure that one still obtains all the vitamins and nutrients that you need on a daily basis– particularly iron, calcium, fibre and the B-vitamins thiamine, riboflavin, niacin and folate while following a gluten-free diet. Weight gain can be a side effect for people with coeliac disease once they start following a gluten-free diet, as the body is now absorbing more nutrients and calories from food. It is therefore important to watch out for weight gain.

    Article written by Brindy Watson ((RD) SA  - Dieticians at work