World without wheat: thousands of food products are taboo for millions of Americans who can't tolerate gluten. Should you be going cold turkey on wheat?

Natural Health, Nov, 2004 by Janis Jibrin

WHEAT, ESPECIALLY WHOLE WHEAT, is a cornerstone of a healthful diet. Yet it's problematic--and, at worst, downright dangerous--to those whose immune systems can't handle wheat proteins.

At age 40, Mark Dumas, a California banker and father of two, realized he had lost 25 pounds in 18 months without even trying. He felt OK, but he was getting very bloated after meals, with more and more emergency trips to the bathroom. Tests came back normal, except for a low level of protein in the blood. Finally, his G.P., trained as a gastroenterologist, put the clues together and ordered two final exams. The diagnosis: a genetic autoimmune disorder called celiac disease or celiac sprue.

In celiac, the consumption of gluten, a protein found in wheat and a few other gains, causes the body to attack the intestines. Antibodies produced in reaction to gluten ultimately attack other tissues and organs, such as the liver and skin. Dumas had a rash that doctors insisted was rosacea, which disappeared, along with his other symptoms, once he eliminated gluten.

"Now that doctors are recognizing other symptoms as celiac, they've been diagnosing many more people," says Sara Fazio, M.D., instructor in medicine at Harvard Medical School and a member of the NIH celiac panel.

Once considered rare, celiac disease actually afflicts about 1 percent of the population, according to a panel convened by the National Institutes of Health this year. Add in people who have wheat allergies or intolerances and you're looking at millions who should pass on the breadbasket. (See "Wheat's Your Problem?" on page 40.)

is it an allergy?

Although a wheat allergy involves the immune system, it's very different from celiac. "In allergies, the body decides--usually in early childhood--that one or more wheat proteins are harmful and it creates IgE antibodies," says Scott Sicherer, M.D., associate professor of pediatrics at Mt. Sinai School of Medicine in New York. "The next time the child eats wheat, the immune system releases massive amounts of chemicals, such as histamine." The resulting symptoms affect the skin, gastrointestinal tract, and/or the respiratory or cardiovascular systems.

More difficult to diagnose are food intolerances. "It could be an allergic reaction or an inability by some people to digest components of wheat properly," says Robert Wood, M.D., professor of pediatrics at Johns Hopkins School of Medicine. Stress also may be a factor.

"For decades, I suffered from nasal congestion and chronic sinusitis, and was given antibiotics that had a profoundly poor effect on my digestion--it just got worse and worse," says Carol Fenster, Ph.D., author of Wheat-Free Recipes & Menus. "Finally, a food allergist suggested I stop eating wheat. It worked; as long as I avoid wheat, I have no symptoms. I don't have a classic allergy, and I don't have celiac, so I must be reacting to wheat in some other way"

traces of wheat

The solution seems obvious: Once you find you have a sensitivity to a food, give it up. But, as Mark Dumas discovered, it isn't easy. "After I was diagnosed, I went to my pantry and there wasn't one thing I could eat," he says. "Everything had a trace of wheat in it--even the vitamins."

Eating out isn't just ordering a burger without a bun. "Most sauces are thickened with wheat," Dumas sighs. "The other day I quizzed a waiter on the halibut, which was topped with sun-dried tomatoes. It sounded good, until it came with the tomatoes entrusted with bread crumbs." He also has to be wary of cross-contamination; for example. french fries, which he can have, may harbor wheat from breaded nuggets cooked in the same oil.

The safest approach is to cook your own food. "Since his diagnosis, I've become a pretty good cook, or at least an inventive one," says Alicia Dumas, Mark's wife. "Most of our meals look like the South Beach Diet: chicken, fish, lots of vegetables. Fortunately, Mark likes potatoes and rice, and I've found a rice pasta that's pretty good, especially if it's smothered in sauce." She even gets separate butter tubs, so no crumbs get in Mark's spread.

The couple scans health-food stores and gluten-free Internet sites. Among their favorite finds: Chopin potato vodka, Newman's Own gluten free Fig Newmans, and gluten-free frozen entrees from Amy's Kitchen. Baking mixes have been disappointing.

That's why you've got to make them yourself, says Fenster. She's developed a number of wheat-flour substitutes based on corn, rice. or bean flour, sorghum, and potato starch. "My "two golden rules of wheat free baking: Use xanthan gum to prevent foods from crumbling or hardening, and use potato starch, which makes for a light texture," Fenster says. "People often mix this up with potato flour, which is very heavy. Get that one straight!"

Body Wisdom--Healthy Appetites

wheat-filled

There's wheat in some hot dogs, imitation crab, even ice creams. This summer, legislation was passed requiring that by 2006, food labels must clearly state whether a product contains wheat, peanuts, or other food allergens. Until then, sensitive people must be familiar with the many names indicating the presence of wheat or gluten--including barley, rye, triticale, durum, enriched flour, graham flour, semolina, spelt, kamut, einkorn, farina, and faro. Oats don't contain gluten, but may he grown and processed in conjunction with wheat and could be contaminated. The following items or ingredients contain wheat or gluten: