Jo Waters June 26, 2017

If you regularly eat a plate of pasta or a sandwich for lunch and then worry you look pregnant because you're so bloated, you're probably wondering what's going on.

You may also have noticed cramping pains, diarrhoea and other gut symptoms that appear to be related to your starchy carbohydrate intake.

Most people with these symptoms tend to struggle on – but there are good reasons why you shouldn't dismiss them as trivial and find out if something more serious might be causing them.

Could it be coeliac disease?

Coeliac disease is an autoimmune condition where your immune system mistakes gluten, a protein found in wheat, barley and rye as a threat and produces antibodies to destroy it. It affects around one per cent of the population, but 76 per cent of cases (500,000 people in the UK), are estimated to be undiagnosed.

Symptoms include bloating, diarrhoea, stomach cramps, constipation, sudden weight loss and wind. Undiagnosed coeliac disease makes absorption of nutrients difficult and can, if left untreated, lead to long-term complications, including anaemia and tiredness, osteoporosis, unexplained infertility and a slightly higher risk of developing certain cancers and lymphomas.

Your GP can diagnose it with a blood test, but this needs to be confirmed with a gut biopsy. If you have coeliac disease, the villi that line your stomach and absorb nutrients will have been damaged by antibodies and a biopsy should detect this. Treatment is simple – just avoid gluten and your symptoms will disappear.

Non-coeliac gluten sensitivity

There's increasing recognition these days of another condition called non-coeliac gluten sensitivity (NCGS), which has similar symptoms to coeliac disease, but crucially does not involve the autoimmune system. This means gut biopsy tests will not detect any changes to the gut villi. But, like coeliac disease, if you avoid gluten the symptoms do go away.

In November 2012, gastroenterologist Dr Kamran Rostami wrote in the British Medical Journal describing a patient who had abdominal pain, diarrhoea, bloating, joint pain, fatigue and many other symptoms. Although he tested negative for coeliac disease his health subsequently improved dramatically after he cut out gluten.

Dr Rostami said it was estimated that for each one person with coeliac disease there may be at least six or seven more with NCGS. Based on these figures, he estimated NCGS may affect six to 10 per cent of the population, between four and seven million people in the UK.

Experts have described NCGS as a combination of irritable bowel syndrome-like symptoms (IBS) including abdominal bloating and pain, bowel habit abnormalities and other symptoms which affect different parts of the body including a foggy brain, headaches, fatigue, muscle and joint pain, leg or arm numbness, dermatitis, depression and anaemia.

Not all doctors accept NCGS is a separate medical condition, though.

Experts say it's important to be tested for coeliac disease before cutting out gluten, so ask your GP for a test if you believe you have the symptoms. If you test negative but your symptoms persist and are associated with eating foods such as bread and pasta, then you can experiment with a gluten-free diet to see if it makes any difference. Gluten-free versions of bread, pasta, cakes and biscuits are now widely available.

Wheat allergies and intolerances

Lots of people describe themselves as having a wheat allergy – but a true allergy to wheat is uncommon and involves a full-blown response from the immune system usually triggered within a few seconds or minutes of eating wheat (although it's also possible to have a delayed response). Symptoms include, diarrhoea, vomiting, wheezing, hives and other allergic symptoms. Wheat can be harder to avoid than gluten, but if tests confirm you have a true allergy, you will need to eliminate it from your diet.

What is more common is wheat intolerance, where you develop gut-related symptoms after eating wheat which don't get better if you eat gluten-free products as you are intolerant to other components of wheat. Unlike coeliac disease, you might be able to re-introduce wheat after a period of elimination.

Supplements

Probiotics help to restore and maintain the natural balance of bacteria in the gut and prevent colonisation by harmful bacteria.

Aloe vera may help with digestive discomfort, and studies show it can help manage certain symptoms of IBS.

Vitamin C has antihistamine properties, which may be helpful if you have allergies.

Vitamin D is also thought to play a role in allergies. One Australian study found that infants with low vitamin D were more likely to have egg or peanut allergy, compared to those with normal vitamin D levels. A 10mcg a day supplement is now recommended for everyone aged one and over in the UK during autumn and winter.

References

https://www.coeliac.org.uk/frequently-asked-questions/how-common-is-coeliac-disease/

http://www.bmj.com/content/345/bmj.e7982.long

http://www.bmj.com/content/345/bmj.e7982.long

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507091/

https://www.allergyuk.org/allergy-to-wheat-and-other-grains/allergy-to-wheat-and-other-grains

https://www.allergyuk.org/allergy-to-wheat-and-other-grains/allergy-to-wheat-and-other-grains

https://www.ncbi.nlm.nih.gov/pubmed/26405698

http://www.umm.edu/health/medical/altmed/condition/allergic-rhinitis

https://www.ncbi.nlm.nih.gov/pubmed/23453797

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