Gives gluten puffing

Hypersensitivity to wheat

Many people complain of abdominal pain, gas, diarrhea or constipation after consuming grain products. The symptoms are often attributed to gluten intolerance. But this is not always actually the case. Prof. Dr. med. Yurdagül Zopf explains other causes.

Gluten intolerance as a trigger?

Many people do not tolerate grain products well. Shortly after consuming them, stomach pain, gas, diarrhea or constipation develop. One possible cause of these complaints is celiac disease (gluten intolerance). Gluten is a protein found in some types of grain. In people with a corresponding genetic predisposition, the protein causes inflammation of the intestinal mucosa. As a result, the intestinal mucosa is restructured, its surface area is reduced and the intestine absorbs less nutrients. The result is nutrient deficits. The diagnosis of celiac disease can be reliably confirmed or excluded by a colonoscopy.

Other causes: the NZNWWS

But gluten is not always the trigger for complaints after eating cereals. Another possible cause is the so-called non-celiac-non-wheat allergy-wheat sensitivity, or NZNWWS for short. Prof. Dr. med. Yurdagül Zopf, an expert in clinical and experimental nutritional medicine at the University Hospital Erlangen, reports on this disease at the MEDICA EDUCATION CONFERENCE 2015.

NZNWWS and celiac disease: what are the differences?

The symptoms of NZNWWS correspond to the symptoms of celiac disease: abdominal pain, gas, diarrhea or constipation. In contrast to celiac disease, however, the intestinal mucosa is not inflamed in a NZNWWS. The NZNWWS is also not a chronic disease. The symptoms appear shortly after consumption and improve quickly if grain-based foods are avoided. "Celiac disease, on the other hand, usually develops slowly," explains Prof. Zopf. "There is only improvement when the intestinal mucosa has recovered."

Proteins and carbohydrates under suspicion

So far, research is not certain which components of the grain trigger NZNWWS. The suspicious substances include special proteins: the amylase trypsin inhibitors. "These proteins, which plants use to ward off pests, are mainly found in modern and highly cultivated types of grain," reports Prof. Zopf. The scientist's assumption: The human intestine cannot break down amylase trypsin inhibitors. When it comes into contact with the mucous membrane, the immune system is briefly activated, which explains the symptoms.

A number of carbohydrates contained in wheat flours are also suspected to be responsible. The researchers refer to them as FODMAP (fermentable oligo-, di-, monosaccharides and polyols). "FODMAPs are not absorbed by the intestine," explains Prof. Zopf. Instead, they are fermented, i.e. their structure is converted by enzymes. “Fermentation produces gases and the binding of water can have a laxative effect. This plausibly explains the flatulence and diarrhea described by the patients, ”says the expert.

Avoid foods containing grain

Scientists are working on strategies to treat the cause of grain intolerance. Until a therapy is found, the avoidance principle applies. Those affected should avoid foods that they cannot tolerate well. Which products these are exactly can vary depending on the cause. Here it means testing.


Sandra Göbel / AWMF | last changed on at 09:37