Wheat and Celiac

Scientists and doctors alike are making strides in how to produce safer wheat-based products for celiac sufferers and ways to treat children with the disease more effectively. 

Wheat, which is one of the most widely consumed grains in the world, contains gluten—a mixture of proteins that can be toxic for people with celiac disease. According to a study published in the journal Food Chemistry, by examining proteins in wheat sourced from several countries, analysts are taking steps to identify toxic components of breads, pasta and other products containing gluten. Through genetic modifcation, manufacturers would be able to eventually create wheat-based foods that are safe for celiacs.

"We hope this study enables products to be developed that are safe for celiacs with detoxification processes that combat the poor nutritional and technological characteristics of gluten-free products and thereby contribute to improving patients' quality of life," Marta Rodríguez-Quijano, a researcher at the Technical University of Madrid, told sciencedaily.com.

Meanwhile, in Boston, doctors studying children with celiac disease were surprised at the number of kids who still had persistent intestinal damage, even though these children avoided gluten. The study from MassGeneral Hospital for Children and Boston Children’s Hospital found one in five children with celiac disease sustained persistent intestinal damage, despite strict adherence to a gluten-free diet.

The findings are consistent with recent research in adults, which showed that more than 33 percent of adult patients on a gluten-free diet have persistent intestinal damage. Long-term risks for children with persistent intestinal damage are not clear, but such damage in adults has been linked to an increased risk of lymphoma, low bone density and fracture. The study authors also note, “malabsorption and inflammation in children may have negative repercussions on physical and cognitive development.”  

The recent analysis is prompting doctors to change procedural guidelines that help screen and monitor kids with celiac disease.

“In the 1970s, pediatricians would perform three endoscopies: one at diagnosis, one after a year on the gluten-free diet and a third during the following six months to check for healing after the patient had been re-exposed to gluten and monitored for symptoms,” said Alessio Fasano, MD, director of the MGHfC center and co-senior author of the study. “When we developed robust blood screening tools in the 1990s, the number of endoscopies required for standard care was reduced to one and, most recently, to none in a subgroup of patients. We assumed that healing would occur once a patient was put on the gluten-free diet."

“Now that we have learned that this is not the case for all celiac patients, we are changing our clinical practice by repeating the endoscopy after one year of the implementation of the gluten-free diet.”

Digestive-related conditions affect more than 70 million Americans and account for 48.3 ambulatory care visits each year. To alleviate digestive discomfort, some impacted individuals from this growing group have eliminated gluten from their diets. However, as noted in this recent research, following a gluten-free diet has not been the cure some had hoped for. Researchers have identified a gray zone of non-celiac gluten sensitivity. 

There is no reliable test for non-celiac gluten sensitivity yet, but if the blame has been wrongly on gluten, some are redirecting their focus to FODMAPs. A low-FODMAP diet does not eliminate gluten. Instead, it negates foods high in wheat or fructans. Wheat contains fructans; gluten does not.