The little sister of celiac disease

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Anyone who suffers from flatulence, abdominal pain and diarrhea after a plate of pasta often believes they are gluten-sensitive or even gluten-intolerant, i.e. they have celiac disease. But there can also be another - lesser known - disease behind it: wheat sensitivity.

For years, the number of Germans who do without wheat and the like has been increasing: The public is sensitized, eating habits are changing and diagnostic methods are also becoming more and more sophisticated. Every supermarket these days offers a whole range of gluten-free products. These are primarily aimed at patients with celiac disease - but people with wheat sensitivity also benefit.

Flatulence, migraines, bone pain

Wheat sensitivity, like celiac disease, manifests itself in gas, pain and diarrhea. But headaches, migraines, lethargy and chronic fatigue can also be the result. In extreme cases, attention deficit disorders, hyperactivity, muscle complaints, and bone and joint pain can also occur.

These symptoms are caused by an innate immunity to certain wheat components. However, gluten is not suspected here - those affected are therefore not gluten-sensitive - but the so-called ATIs (amylase trypsin inhibitors). Like gluten, these natural proteins are found in wheat and other types of grain - so "gluten-free" still helps. "ATIs activate certain cells of the innate immune system and the body produces inflammatory substances that ultimately cause the symptoms," explains Professor Detlef Schuppan, head of the Institute for Translational Immunology and the Outpatient Clinic for Celiac Disease and Small Bowel Diseases at Mainz University Hospital.

Increased symptoms

Wheat sensitivity is apparently particularly dangerous for people with existing chronic inflammation and autoimmune diseases. “In animal studies, ATIs strengthen existing inflammatory and autoimmune reactions by activating innate immune cells,” explains Schuppan. There is evidence that these wheat proteins make symptoms of diseases such as multiple sclerosis or inflammatory bowel disease worse.

Diagnosis based on the principle of exclusion

The German Society for Gastroenterology, Digestive and Metabolic Disease (DGSV) recommends people who cannot tolerate wheat, rye or barley to undergo a thorough diagnosis. Doctors are currently determining whether someone is sensitive to wheat using the exclusion principle: if celiac disease and wheat allergy can be ruled out on the basis of blood and allergy tests and an examination of the small intestine, wheat sensitivity is likely. But the researchers have a new detection method in their quiver: "We are hoping for a serum test that is currently being developed," reports Schuppan.

Gluten free helps

Those who are sensitive to wheat should follow a gluten-free diet, similar to people with celiac disease, recommends the DGVS in its guideline “Celiac disease, wheat allergy and wheat sensitivity”. Because gluten and ATIs are found in the same products.

However, it is important to know whether you have celiac disease, a wheat allergy or a wheat sensitivity, emphasizes the DGVS, because the diet recommendations differ. “In contrast to celiac disease, no strict diet is necessary with wheat sensitivity,” explains Schuppan. In order for the annoying symptoms to disappear, a reduction in gluten and thus ATI-containing foods by around 90 percent would probably be sufficient.

Badly tolerated carbohydrates

Regardless of this, around 20 percent of those affected who have fewer symptoms with a wheat-free diet may be intolerant to otherwise harmless carbohydrates, the so-called fermentable oligo-, di- and monosaccharides and polyols (FODMADS), warn the experts. These carbohydrates are found in legumes and certain types of fruit, vegetables and grains including wheat.

Despite the steadily increasing number of people with intolerance, the DGVS emphasizes that the consumption of wheat is still harmless for over 90 percent of the population.

Sources:

Felber J. et al :: Results of an S2k consensus conference of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) together with the German Celiac Society (DZG) on celiac disease, wheat allergy and wheat sensitivity

Press release of the German Society for Gastroenterology, Digestive and Metabolic Disease (DGVS) from June 2015

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