By Dr Anjali Mukerjee September 2007 Not necessarily, says the author, while suggesting tasty options Every day there seems to be a story in the newspapers, magazines or on TV about foods causing unpleasant reactions. In fact, the terms food allergy and intolerance are much misused and apparently misunderstood by the general public. This can create a lot of confusion and may lead people to think, wrongly, that they are ‘allergic’ to certain foods, including wheat, which they may then cut out, though it may be an essential part of a healthy balanced diet. Wheat sometimes provokes allergic reactions in some individuals. Ideally speaking, wheat flour should be used right after grinding, or else it needs to be kept in an airtight container, refrigerated, and used within two-three weeks. Some people are allergic to refined flour products (maida). However, if eating whole wheat causes bloating, stomach pain, or excessive mucus, it is best avoided. Conditions like celiac disease (a serious allergic reaction to gluten, the protein contained within wheat), or wheat allergy (a rare disorder) require you to cut off wheat from your diet. Adverse reactions may be mild to life-threatening, short-term to life-long. So what is wheat intolerance and how do you know if you are affected? Wheat antipathiesRather than being one condition, health problems caused by wheat actually fall into three main groups – wheat allergies, gluten intolerance, and wheat intolerance. Wheat allergyWheat allergy refers specifically to adverse reactions involving immunoglobulin E (IgE) antibodies to one or more protein fractions of wheat, including albumin, globulin, gliadin and glutenin (gluten). SymptomsThe common symptoms involve the skin (urticaria [hives], eczema, angioedema [swelling due to allergy]), the gastrointestinal tract (abdominal cramps, nausea and vomiting, oral allergy syndrome), and the respiratory tract (asthma or allergic rhinitis). TreatmentMedication is ineffective in treating this condition. Avoidance of wheat and wheat-containing foods is the only treatment. This may be difficult to maintain, particularly as wheat protein may be “hidden” in other foods. Rice or maize may be substituted as alternative cereals. Gluten intolerance Celiac Disease (CD), also called Gluten Enteropathy, has until recently been known as Gluten Intolerance. CD is a hereditary disorder of the immune system in which eating gluten leads to damage of the mucosa (lining) of the small intestine (small gut). This results in malabsorption of nutrients and vitamins. CD is the result of IgA and IgG antibody responses to gluten. It is important to differentiate between CD, mediated by IgA and IgG antibodies, and wheat allergy, which is mediated by IgE antibodies. SymptomsTypically CD presents at the age of 6-24 months with symptoms of intestinal malabsorption, impaired growth, abnormal stools, abdominal distension, muscle wasting, poor muscle tone (hypotonia), poor appetite or irritability, following the introduction of cereals into the diet. In adults, the symptoms of CD may be quite varied, from severe weight loss, diarrhea, and bulky, offensive stools to subtle complaints of cramps, abdominal bloating, flatulence, and even constipation. These individuals are often mistakenly diagnosed as having Irritable Bowel Syndrome. Treatment Medication is ineffective in treating this condition. The only treatment available is the complete removal of gluten from the diet. This usually entails life-long avoidance of all cereals containing gluten, including wheat, oats, rye and barley. Individuals on any avoidance diet are at risk of developing deficiencies of micro-nutrients (e.g., thiamine, riboflavin, niacin, iron, selenium, chromium, magnesium, folacin, phosphorus and molybdenum). It is therefore essential that patients be managed in collaboration with a qualified nutritionist. Wheat intoleranceWheat intolerance does not involve an immune response. The reasons why people suffer from wheat intolerance are not entirely understood. Some experts believe it occurs when some people are short of the enzymes necessary for the proper digestion of wheat. Symptoms of wheat intolerance can include bloating, headaches and joint pains. Alternatives to wheat If you suffer from Celiac Disease or gluten intolerance, it is important to cut out all gluten from your diet. Gluten is present in wheat, oats, barley and rye. This means it is found in bread, biscuits, cakes, pastries, breakfast cereals, pasta, beer, and most soups. Wheat allergy sufferers are advised to eliminate wheat from their diet – but can still eat oat, barley and rye products. People who think they could be wheat intolerant can eat wheat in small doses. Alternatively, try eliminating it for a month before reintroducing it. Here are some wheat alternatives:Pasta: Pasta made from rice, containing B vitamins is available. Rice noodles and rice seviah (vermicelli) are available at grocery stores in Southern parts of India, and in select stores in the rest of India.Biscuits: A selection of maize, millet biscuits – similar to a digestive biscuit – are available as sweet or savoury, and are ideal with a slice of cheese or with green tea.Cereals: Muesli made from raisins, corn flakes, rice flakes, banana chips, coconut chips and dried fruit is a great alternative to wheat. Porridge – made from rice flakes and millet is also available. All cereals contain B vitamins and iron. Celiacs must read labels carefully when purchasing any packaged or canned products. Ingredients marked as additives, cereals, and cereal grains, colourings, emulsifiers, derivatives of gluten, flavourings or malt, hydrolysed plant protein (HHP), hydrolysed vegetable protein (HVP), preservatives, starches, and modified food starches, vegetable gum, and vinegar—may be derivatives of a gluten-containing grain and should be avoided. Specific recommendationsAccording to Chinese medicine, wheat calms the mind, helps focus, reduces palpitations, insomnia, irritability, and brings about emotional stability. It encourages growth, and is especially good for children. However, it should be eaten in small quantities. One of the most important things for you to remember is that wheat flour has many nutritional benefits. Now that you find you must avoid wheat, be sure you replace these nutrients from other sources. Wheat contains calcium, iron, niacin, and thiamin, and is also a source of fibre. These vital minerals and vitamins should be replaced, and other starchy, fibrous sources should be incorporated into your diet. Following a wheat-free diet if you have a genuine wheat allergy is a tough health choice to make. It’s not a decision that should be made lightly and something that you should never embark on alone without guidance. A correct diagnosis must be made as the treatment, dietary avoidance, is often very difficult, and if incorrectly applied, can lead to vitamin deficiencies or malnutrition.It is thus imperative that a definite diagnosis be made rather than a fad followed. There are, however, many great alternatives: Rice: This is the alternative flour most people try first. It’s fairly bland, which makes it good for all-purpose use. Rice flour is a good thickener and can be used to make muffins and bread. Rice bread is often described as heavy and dense. White or brown rice give pretty much equal results. Sorghum or jowar: Nutritionally, this grain is high in carbohydrates, fibre, phosphorous, potassium, B vitamins and protein. Sorghum tends to have a gritty texture. As a result, when used for baking breads, sorghum doesn’t hold together well. It works best when blended with other flours. Try it when baking flat bread, cookies, crackers or pancakes. Amaranth: The seeds from this broad-leafed plant are used in their whole grain form, milled into flour or puffed into kernels. This flour is high in protein, fibre, calcium and iron. Use amaranth in cereals, pastas, and baked goods. Add water sparingly when using this mildly, nutty-tasting fine flour for baking bread. It can get crusty on the outside before the dough on the inside is done. It also tends to make baked goods brown more quickly. Maize flour: Provides smoothness when mixed with rice flour. Also makes a light dough, but a very fragile one. Use tapioca starch if corn is a problem for you. No pronounced flavour. Tapioca starch or sabudana provides a ‘chewiness’ and helps smooth out rice flour. It can substitute for potato starch and cornstarch. No pronounced flavour. Potato starch is not the same as potato flour. Potato starch provides moister dough, prevents crumbling. No pronounced flavour. Soy flour: Used in small amounts, it adds moistness. However, in larger amounts, the flavour is very pronounced and can be overpowering. If you are allergic to everything else, you can mix 1/3 part soy flour with 2/3 rice flour and it will work reasonably well. Oat flour makes dense but flavourful and tender baked goods. Oat flour can be used, if you are allergic to wheat only, but not to other grains as it does contain gluten. Oat flour works well in things like quick breads, muffins, etc. Buckwheat is not a form of wheat; rather, it is an herb, and is suitable for most people with wheat in tolerance. Tasty optionsOnce you have adjusted your taste buds (along with your investigative label reading and recipes) you’ll find that avoiding wheat isn’t nearly as daunting as it may seem now. In fact, I am sure you’ll find many healthy and tastier replacements. Gram flour chillas (gluten free)Ingredients100 gram chickpea flour1/2 tsp salt 3 tbsps chopped spinach2 tbsps grated tofu/cottage cheese1 tsp shredded and crushed ginger350 ml iced water 1 tsp of oil MethodMix flour, salt, vegetables and spices together. Gradually add iced water until you get a smooth batter. Heat a
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