interview with dr megan rossi: the gut health doctor

Confused by all the anti-wheat hype? Here’s the low down on the evidence behind whether or not wheat is for you. Grain-based foods, including wheat, are an important source of nutrients, such as B vitamins needed for cell metabolism and dietary fibre for gut health. In addition, any diet that unnecessarily restricts food groups can create nutritional imbalances. In fact, many foods advertised as wheat-free have added sugar and fats to compensate for the functional qualities of wheat. So typically my answer to the common question “Is wheat bad?” is no! Whole-grain wheat (which is the minimally processed type of wheat) is healthy for the majority of people.

HOWEVER, there is a subset of the population who don’t tolerate wheat, which is typically related to one of three wheat components:

1) Gluten (type of protein in certain grains including wheat, rye and barley) main conditions: Coeliac disease- requires strict avoidance (effects 1% of the population- See Ref 1); & Non-coeliac gluten sensitivity (NCGS)- newly defined condition with mechanism poorly understood (effects 1-6% of the population – See Ref 2)


2) Wheat proteins (proteins in wheat, other than gluten) main conditions: Wheat allergy- requires strict avoidance (>0.2% prevalence in adults – See Ref 2); & Non-coeliac wheat sensitivity (NCWS)- suspected crossover with NCGS.2


3) Fructans (fermentable carbohydrates found in many foods not exclusive to wheat) condition: Irritable Bowel Syndrome (IBS) (15% prevalence- See Ref 3)- does not require strict avoidance of wheat nor is it known to carry any long-term health risk, although the associated gastrointestinal symptoms can be debilitating.

Non-coeliac gluten/ wheat sensitivity is a newly defined condition that recognises a wide spectrum of gastrointestinal and extra-intestinal symptoms including brain fog and fatigue. Given the co-existence of gluten and other wheat proteins in many foods identifying the culprit component ie. gluten vs. other wheat protein such as amylase-trypsin inhibitor (ATI) can be difficult which is why the terms NCGS and NCWS are often used interchangeably. The gold standard method to diagnose NCGS and NCWS is a placebo-controlled food challenge using isolated gluten and wheat protein.

 If you suspect you react to wheat your first step should be to rule out coeliac disease and wheat allergy with your General Practitioner. It’s important you take this step so that you can determine how strict you need to be with your gluten/wheat exclusion, for instance, even traces of gluten from cross-contamination using a chopping board or toaster can have serious consequences for people with coeliac disease and wheat allergies. Once these have been ruled out the next step is to see a registered dietitian who can help identify whether you have NCGS/NCWS or instead are reacting to fructans (which may form part of a larger group of food exclusions known as FODMAPs- not heard of FODMAPs before? Check out my recent blog). Unfortunately, there is no blood/breath/stool test that can accurately determine food intolerances, other than lactose intolerance (so please don’t waste your time or money!).

If you want to know more about different allergies and intolerances check out www.allergyuk.org for credible information. They also have a helpline and live chat messaging system to address your concerns.

Reference:

1. British Allergy Foundation. 2016. www.allergyuk.org.

*Canavan et al. The epidemiology of irritable bowel syndrome. Clin Epidemiol 2014; 6:71-80.

*Giorgio et al. Sensitivity to wheat, gluten and FODMPAs in IBS: facts or fiction? Gut 2016; 65:169-178.

Dr Megan Rossi is a Registered Dietitian with a PhD in the area of Gut Health. Megan works as a Research Associate at King’s College London and Consultant Dietitian across industry, media and has just opened up a Gut Health clinic on Harley Street in London.

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