Source: Adapted from Comments from Canada, CCNFSDU 1995, Proposed Draft Revised Standards for Gluten-Free Foods, Codex Committee, April, 95 Bonn Bad Godesberg, Germany - Leon H. Rottmann.
Lifeline, Sumer 1995, Vol XIII, No 3, pp 1-2
The ingestion of small amounts of gluten by gluten intolerant individuals can lead to morphological changes in the gut that may increase the risk of lymphoma, other forms of cancer and reduced bone mineralization. Celiac disease and dermatitis herpetiformis, a skin condition closely related to celiac disease, are the primary diseases treated with a gluten-free diet.
The present evidence suggests that a zero level of gluten in gluten-free foods will enable those individuals with gluten intolerance to have a greater opportunity to avoid serious long-term health risks. Since protection of individuals with celiac disease is the rational of the Codex Standard, the Celiac Sprue Association, USA and (CCA) the Canadian Celiac Association have continued to strongly recommend a reconsideration of the proposed 200 ppm of gluten for a gluten-free food and instead to represent gluten-free as containing no wheat, rye, barley, oats, or triticale or parts thereof.
Recent evidence shows that the prevalence of celiac disease is much higher that was previously thought (Cavell et al., 1992; Catassi et al., 1994) and that the sequelae are more serious, even though many individuals may be free from overt symptoms. Following is a summary of recent research on the importance of a strict gluten-free diet for individuals with gluten intolerance.
Catassi, et al. (1993), in a study of the effect of small amounts of gliadin on children with celiac disease, reported significant increases in intraepithelial lymphocyte counts and decreased mucosal villi height, both early of intestinal damage. They concluded that chronic ingestion of small amounts of gluten causes dose-dependent damage to the lining of the small intestine. Similar findings were reported by Montgomery et al. (1988), Mayer et al. (1991), Marsh (1992) and Uil et al. (1994). Mayer found that symptom-free teenagers with celiac disease, who ingested small amounts of gluten, had morphological changes in the intestinal mucosa.
Holmes et al. (1989), McCarthy (1991) and Ciclitira (1994) reported that the incidence of lymphoma is higher in celiac patients. However, the incidence is decreased on a gluten-restricted diet.
Anderson and Mobacken (1992) reported that patients with dermatitis herpetiformis were symptom-free when placed on a strict gluten-free diet for six months. However, individuals consuming large or small amounts of gluten showed little mucosal improvement. Reunala and Nuutinen (1993), also studying patients with dermatitis herpetiformis, reported that daily intakes of gluten (at the present Codes gluten-free level of 0.3% caused active skin rash. When their patients were placed on a totally gluten-free diet, the rash decreased in 9 out of 10 patients, and their average dapsone medication was reduce from 30-50%.
Severe reduced bone mineralization has been reported as another serious complication of untreated celiac disease and dermatitis herpetiformis (McFarlane et al., (1994); Marsh, (1994); Molteni et al., (1990); Mora et al., (1993): Valdimarsson et al., (1993), even though adult patients with celiac disease were asymptomatic (Marzure et al., (1994). All of these researchers have stressed the need for early diagnosis followed by a strict gluten-free diet.
Goddins and Kelleher (1994) showed that in gluten-sensitive individuals, non-compliance to a gluten-free diet increased both malignancy and severe bone disease, thus confirming the need for gluten avoidance. Marsh (1994) stressed the need to act, to treat and to prevent the serious bone disease associated with gluten sensitivity by the use of early diagnosis and treatment with a gluten-free diet.
It is evident that a strict gluten-free diet is needed to decrease the risk of developing serious preventable health conditions for gluten-sensitive individuals (Trier, (1991); Mayer et al., (1991); Penttila et al., (1991), McCarthy, (1991); Mara et al., (1993); Ciclitira, (1994).)
Skerritt et al. (1990) reported that the levels of protein in well-washed wheat starch are reported to be between 0.2 to 0.3% and that wheat starch proteins could have some toxicity for individuals with celiac disease. Hekkens and Twist-de Graaf (1990) indicated that products made with wheat starch as a basis for the manufacture of gluten-free foods remains in serious doubt.
Confounding this problem are the limitations of the assay method presently used for the quantitative determination of the gluten-content of wheat starch and other foods containing gluten (Skerritt and Hill, (1991). The test methods used to analyze gluten must be highly sensitive and very precise for the accurate determination of all four protein fractions (Marsh, (1992), which have toxic effect in celiac patients (Weiser, (1991); Howdle et al., (1984). These methods should accurately determine the content of the toxic plolamins of oats (avenin), barley (hordein), rye (secalin) and wheat (gliadin).
The present ELISA assays underestimate the actual gliadin content of wheat starch and other wheat-containing foods. More information is required about the accuracy of the ELISA assay methods for determining the toxic prolamins of barley, rye and oats.
CSA Note: For more information on the Codex standards and the definition of gluten free, Click Here.
CSA Library Series is a collection of articles that pertain to celiac disease and dermatitis herpetiformis. Most of these articles have appeared in CSA’s quarterly newsletter, Lifeline, which all CSA members receive. Historic articles included in these resources may or may not include updated notes. Updated information indicated in red type. Articles represent the work of the author.