The number of people who are intolerant of bread, pizza or pasta is growing all the time.

More of us seem to be exhibiting an intolerance reaction to the storage protein gluten, which is primarily found in native cereal types, and are therefore subject to the chronic condition known as celiac disease. Others may suffer from gluten sensitivity—and the range of symptoms and signs may explain the popularity of gluten-free diets. The complain can manifest itself in the form of bloating, constipation, diarrhea, an irritable colon, chronic inflammatory intestinal illness, inflammatory skin diseases, joint pain, tiredness, depression, unexplained weight loss or weight gain, or  headaches.

Celiac disease is one of the autoimmune diseases and may emerge at any age. It tends to be passed on within families and, once it has made its appearance, continues throughout the sufferer’s life. The pathology is extremely complex. According to an international cohort study published in the New England Journal of Medicine, the causes of celiac disease can be found both at the level of genetic predisposition and in environmental influences. Thus more than a quarter of the examined children who possessed a variant of the immunity gene HLA had, by their fifth year, developed autoantibodies that point to the development of a celiac disorder. However, the risk of the emergence of these antibodies was very different in the various countries that participated in the study, thus suggesting that environmental factors play a significant role.

 

 

Patterns of development –In its “classical” or “typical” form, celiac disease develops during childhood, usually a few months after the introduction of food that contains gluten. Typical symptoms include chronic diarrhea combined with clinical signs of malabsorption, leading to weight loss, loss of appetite and protruding belly.

In the case of mono- or oligosymptomatic celiac disease, sufferers are affected by only one or more symptoms such as an iron deficiency or osteoporosis.

So-called silent or asymptomatic celiac disease, usually revealed by screening studies or a chance diagnosis, is relatively frequent. There are no symptoms or the symptoms are only weak. Even though people with silent celiac disease feel no discomfort, their physical and intellectual capabilities may improve following the introduction of a gluten-free diet.

The rare form of the disease known as atypical celiac disease is characterized primarily by uncharacteristic extraintestinal complaints. Even though typical serological and histological changes can be detected, this clinical pattern is rarely considered in differential diagnostic studies. However, because sufferers respond well to a gluten-free diet, greater attention should be paid to atypical celiac disease.

Treatment – In the journal Nature Chemistry (2013), the researchers presented a highly promising new method which makes it possible to protect therapeutic enzymes in the digestive tract against destruction and effectively stabilize these. To do this, they coupled polymers to enzymes and showed for the first time in living organisms that this can enable enzymes in the stomach and small intestine to remain active for much longer.

The idea of helping people who cannot tolerate certain dietary components by administering certain enzymes goes back a long way. So far, however, attempts to use enzyme therapy have generally failed due to the specific conditions found in the digestive apparatus. This is because this is designed for the efficient splitting of all proteins into their respective components – even in the case of helpful enzymes. As a result, normal enzymes in the digestive tract become inactive, and consequently useless, within just a few minutes.

Thanks to the protection given by the polymers used, it is now possible to stabilize enzymes for up to three hours. The polymer used is characterized, among other things, by the fact that it adheres particularly well to the mucous membrane of the stomach and small intestine. As a result, the enzymes also stay exactly where they are needed for longer.

Even though this is basic research involving experiments that have so far been limited to studies in animals, and despite the fact that the market readiness of a corresponding drug still lies far in the future, the researchers consider the initial results to be extremely promising. They believe that therapeutic enzymes will, in the future, be used to treat food intolerances, and in particular celiac disease, for which no treatments have been available in the past. Thus, in the future, therapeutic enzymes that have been stabilized by means of polymer protection could break down the gluten present in food into harmless fragments before it releases its damaging effects.

At present, the only safe way to respond to celiac disease is to adopt a strict, life-long gluten-free diet. This means that cereals that contain gluten – such as wheat, rye, barley, spelt, emmer and khorasan wheat – as well as the produts made from them, have to be avoided.

What is more, gluten is also often used in the manufacture of ready-made food products because it possesses many positive properties that are valued by the food industry: it acts as an emulsifier, binds water, stabilizes and is also a good carrier for flavorings. As a result, it can be found, for example, in ready-made soups, tinned fish, cold meats, processed cheese, tomato ketchup or even chocolate. It is therefore vital that celiac sufferers read the ingredients of any ready-made food products they consume.

We constantly read that oats can be used unproblematically as part of a gluten-free diet. In fact, oats contain considerably less gluten than wheat, and studies in Scandinavia have shown that some celiac sufferers are able to tolerate oat products. However, a special type of oats was used for these studies.

The average mixed diet consumed by a healthy person contains approximately 13 g of gluten per day and one slice of bread (40 g) contains some 2.5 g of gluten. The consumption of just 50 – 100 mg of gluten per day can damage the mucous membranes of celiac patients.

Despite the considerable restrictions in the choice of foods available, a gluten-free diet can be tasty and varied. This is because many foodstuffs are naturally gluten-free. For example, fruit, vegetables, potatoes, rice, meat and fish contain no gluten. Milk and dairy products, eggs, nuts and seeds, as well as vegetable oils can also be eaten without any misgivings.

Alternatives to gluten-bearing cereals can be found in the form of the pseudocereals such as millet, amaranth, quinoa, buckwheat, or by turning to dishes involving rice, corn, potatoes, sweet chestnuts, chickpea flour and soya.

When baking, it is often possible to use grated nuts or almonds instead of flour.

A strict gluten-free diet improves well-being, usually in two to four weeks.

by Silvia Bürkle

Metabolic Balance®

Sources:

1. Fuhrmann G., Grotzky A., Lukic R.,: Sustained gastrointestinal activity of dendronized polymer-enzyme conjugates. Nature Chemistry (June 2013)
2. Henker J, Laass M, Baretton G et al. (2008) Fallstricke bei der Zöliakiediagnostik. Zeitschrift für Gastroenterologie 46: 675 -680
3. Hartmann P (2009) Glutenfreie Ernährung in der Praxis. OM & Ernährung 128: 11-12
4. Krieger T (2009) Zöliakie Update – Deamidierte Gliadin-Antikörper verbessern die Diagnostik. Med Welt 60: 83-86
5. Deutsche Zöliakie Gesellschaft (published by) DZG Medizin. 5. Fully revised and extended edition (2010)
6. Caspary WF (2008) Gluten-Vorkommen und Toxizität bei Zöliakie. Zeitschrift für Gastroenterologie 46: 675-680