As the world of people who are wheat-free continues to grow, I am witnessing a range of weird re-exposure reactions when people, intentionally or inadvertently, get re-exposed.
Among the peculiar reactions:
Congestive heart failure–A woman with a clear-cut syndrome of wheat intolerance that was evidenced by diabetes, excessive expression of small LDL particles (around 2000 nmol/L at the start), high triglycerides, gastrointestinal distress, widespread joint pain, and a peripheral neuropathy (impaired coordination, reduced sensation to the legs), and negative blood markers for celiac disease, improved substantially across the entire collection of symptoms. She lost around 40 pounds of weight, reduced HbA1c substantially, dropped small LDL dramatically (to zero), triglycerides to double-digit values, with modest improvement in coordination and peripheral neuropathy, marked improvement in joint discomfort. With each re-exposure, e.g, a couple of bites of birthday cake at her grandson’s birthday party, she experienced water retention and congestive heart failure of 27-30 pounds but developing over 7 days. This happened 4-5 times with water retention developing over the precise same time course. On each occasion, she responded to diuretics, losing the 27-30 pounds of retained water, with no other cause identified (no change in left ventricular ejection fraction, no change in kidney status, no change in serum albumin or protein levels, no change in thyroid status, etc.).
Functional achalasia–A young man had been wheat-free for over one year inadvertently had wheat in the form of orzo, mistaking it for rice (since orzo is rice-shaped pasta). Within minutes, food became trapped in his esophagus, necessitating an endoscopy to extract the food. No pathologic findings were seen: no esophageal stricture, inflammation, ulcer, or tumor. There was also no evidence nor history to suggest eosinophilic esophagitis.
Delayed acute abdominal painWhile abdominal pain from wheat consumption is common, given the many gastrointestinal disruptive compounds in modern wheat (e.g., intact alpha gliadin molecules, gliadin-derived peptides, wheat germ agglutinin, glutenins, omega-gliadins, alpha amylase and trypsin inhibitors, etc.), it usually expresses itself as heartburn/acid reflux, cramping and bowel urgency of irritable bowel syndrome, or through the inflammatory conditions ulcerative colitis and Crohn’s disease.
A 50-some year old man with repeated and incapacitating bouts of mid-abdominal pain underwent repeated endoscopies, colonoscopies, multiple upper intestinal and stomach biopsies, barium swallows, gallbladder imaging, etc. with no explanation uncovered, including negative blood markers and biopsy for celiac disease. Various anti-anxiety and antidepressants were therefore prescribed by his gastroenterologists. At my repeated urgings, he finally eliminated all wheat from his diet with complete relief obtained. Occasional indulgences were followed by sudden excruciating abdominal pain, sufficient to double him over and prompt emergency room visits, again with no diagnosis made. He finally noticed that recurrences occurred 3 days after a wheat indulgence, even testing the proposition himself: As expected, 3 days later, he experienced acute, severe abdominal pain. He is now meticulously wheat-free with no pain whatsoever.
That’s just a sample. Making cause-effect associations for some of these less common wheat re-exposure reactions can be tricky, especially when there is a delay between exposure and reaction, such as the consistent 7-day delay of heart failure described in the first woman.
If you have observed unique wheat re-exposure reactions of any kind, inadvertent or intentional, please share your story!