People have been contacting me a lot about wheat and gluten lately. In reading many of the articles, the only thing I’ve found of much interest was this interview with Dr. Alessio Fassano, the Medical Director for The University of Maryland’s Center for Celiac Research.

Dr. Fassano says that a major protein in gluten, called gliadin, contains some protein fragments that humans cannot digest. He says we cannot digest them because we do not have an enzyme to break the bond between the amino acids glutamine and proline. These fragments don’t get digested and can end up in the blood where our system might react against them producing illness. In the case of celiac disease, our body reacts in a way that destroys the cells lining the intestines.

I had never heard that humans cannot digest the glutamine-proline bond, nor could I verify it. However, I did find this interesting article, Grains in Relation to Celiac (Coeliac) Disease, that has images showing the protein fragments that are a problem in celiac disease as well as the molecular structure of gliadin.

Some people who react negatively to wheat do not have celiac disease but instead have gluten sensitivity. The symptoms can be similar, though usually not as intense: digestive problems, inflammation, fatigue, joint pain, etc. (the interview with Dr. Fassano lists more). If you suffer from these symptoms, gluten could be a problem for you and it might be worth eating gluten-free for a while to see if it helps.

In terms of gluten being unhealthy for everyone – I remain rather skeptical. Here are a couple posts on grains that readers might find of interest. The research on wheat versus other grains and their relation to chronic illness or weight gain is currently lacking.

After my post about Leaky Gut Syndrome, I had an interesting exchange with a reader:

“Did you, by any chance, read this article in the August issue of Scientific American, concerning celiac disease and leaky gut?

“Later in the article, it is mentioned that the medical profession had treated the concept of leaky gut with skepticism, but now it is known that there is such a thing, and how zonulin can change the permeability of the small intestine.

“Concerning my own history, which may be relevant, I have a long history of inhalant and food allergies; took allergy shots for 40 years. Since 9 months ago, when my doctor put me on the following regimen, I have been virtually allergy free for the first time in memory, not only to foods, but to inhalants like pollen, dust, mold, etc., and was able to quit the allergy shots – which weren’t doing that much good anyway. Also, I have not experienced any asthma attacks during the past 9 months (which is unusual). My whole life has been spent with a Kleenex in hand because of a constant nasal drip, but not anymore!

“The regimen is prescription enzymes, Pancrelipase 20000 3 x day, plus HCL (650 mg) with every meal (3 to 5 caps depending on size of meal). You start out with 1 HCL and then work up gradually to determine your limit because you don’t want to overdose and burn your stomach. Unfortunately, the enzymes are not vegan. [Note: "Pancrelipase" sounds like it would only digest fat, but it also contains enzymes to digest protein and carbohydrate.]

“The whole point I find interesting is how my chronic allergies could be so tied to poor digestion, and possibly a leaky gut – which I was told I had by alternative therapists in the 60′s and 70′s. The “real” docs just put me on allergy shots.

“Also, my main food allergies were dairy and eggs (found by RAST test done by “real” doctor) and were making me constantly ill, so I gave them up. It was so easy to become vegan after that.

“It’s a shame about the animal source enzymes, probably the only non-vegan thing I’m doing though – except for feeding my cats meat (yuck!).

“One other thing about the enzymes and HCL: For a long time I thought I was gluten intolerant because of digestive problems (bloating, gas) whenever I ate wheat. Now, gluten products don’t bother me at all! So I wonder if a lot of the gluten intolerance craze is really a problem with poor digestion?

“The HCL alone works for digestion, but the digestive enzymes seem to be crucial in reducing allergic inflammation, like stuffy sinuses, asthma, runny nose, etc. None of the plant enzymes I have tried are as powerful.

“I started taking the prescription pancreatic enzymes 1 week before I started the HCL regimen. My head cleared up immediately upon taking the first enzyme capsule, and stayed clear, with no more nasal drip. It appears that I no longer have any inhalant allergies. I feel wonderful and more energetic because I can finally breathe. I’ve had no asthma or any other allergic symptoms during this time. It’s unbelievable considering my vast allergy history.

“All the plant enzymes I have tried before would cause my head to clear up for just a minute or two on a few occasions, but did not have lasting effects on my usual allergies. I have not yet experimented with megadoses of plant enzymes, however – so that might be something to try in the future.

“I was shocked to find that I can take as many as 7 HCL capsules during a large meal with no burning at all! That must mean I produce almost no HCL. My husband, on the other hand, experiences burning with even 1 capsule – so his HCL level is apparently normal. It’s very important to start with only 1 capsule and then work up, because you could do some serious damage with HCL. [Note to readers: You should only use HCL under the guidance of a physician.]

“Since being on both of these supplements, I seem to be digesting everything better and no longer worry about gluten or any other foods except [a couple brands of soy ice cream].

“Unfortunately, here is another glitch. I take Solaray Betaine HCL with Pepsin 650 mg. From what I can tell, the pepsin is not vegan either – darn! I don’t know if the HCL alone (if you can find it) would be as effective. More and more, I like VO’s stated philosophy of not sweating small non-vegan ingredients. Surely, if we are all vegan in the future, pancreatic enzymes, lipase, and pepsin will be able to be humanely synthesized.”

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The article referred to above from Scientific American suggests that many autoimmune disorders might be triggered by an underlying case of celiac disease and/or a leaky gut. Celiac disease is an autoimmune disorder triggered by eating gluten and related proteins in some grains. The article says that about 1% of people have celiac disease, although most do not know it.

Zonulin is a protein that is released by intestinal cells and causes the gaps between intestinal cells to be more permeable and allow undigested proteins to seep through, where an immune response will be mounted against them. Many people with autoimmune diseases have unusually high levels of zonulin and high intestinal permeability. In cases of celiac disease, gluten causes an increase in zonulin.

Alvine Pharmaceuticals is in the process of creating digestive enzymes that break down gluten fragments that are normally resistant to digestion. I do not know if they could be considered vegan.

The author of the Scientific American article, Alessio Fasano, co-founded Alba Therapeutics which is working on a drug, Larazotide, that inhibits zonulin. They are currently conducting clinical trials.

Question:

“You’re generally good about paying attention to peer-reviewed literature and scientific evidence, which is why I was surprised at your suggestion that people should limit their wheat intake and that ‘eating too much gluten might actually trigger celiac disease.’ What is this based on?”

Answer:

There have been mentions of large amounts of gluten triggering celiac in articles I’ve read over the years. As far as I know, it was all theoretical or anecdotal. The website I linked to in my post, from the National Digestive Diseases Information Clearinghouse, also implied this possibility:

“The length of time a person was breastfed, the age a person started eating gluten-containing foods, and the amount of gluten-containing foods one eats are three factors thought to play a role in when and how celiac disease appears.”

It make sense that the more someone is exposed to something that can trigger an autoimmune reaction, the more likely that reaction is to be triggered. But to reiterate what I said in my original post, this can only happen if someone is genetically predisposed to celiac disease.

It is true that I try to limit my recommendations to peer-reviewed literature, but in many cases it isn’t possible; there are too many things that have not been studied rigorously. In these cases, I have to go with what I believe to be true in giving recommendations, though I should point out when I’m not aware of research verifying what I recommend.

I did not mean to imply that this is a well-established fact, and that is why I said it “might” trigger rather than it “can” trigger. However, when I re-read that sentence, I can see that it might be taken to mean that it definitely triggers celiac in some cases but might not in other cases. So, to be clear — eating large amounts of gluten might never trigger celiac disease, but I tend to think there is a greater possibility that it can.

Finally, I would feel negligent not to let vegetarians know of this possibility given that they could easily eat very large amounts of gluten if they think there is no reason not to do so.

In my post How can I get plant protein without eating soy? I suggested that people limit their intake of wheat gluten products to 2 to 3 servings a day. Someone asked me why gluten should be limited.

Gluten should be limited because eating large amounts of the same protein day after day can, in some cases, lead to developing an intolerance to that protein. Gluten, in particular, appears to be a protein to which many people develop an intolerance. In the worst-case scenario, eating too much gluten might actually trigger celiac disease in someone who is genetically predisposed.

About 1 in 133 people in the U.S. have celiac disease. Celiac disease is when gluten causes someone’s immune system to mount a reaction against their intestinal tissue. It is very unpleasant and means that for the rest of someone‘s life they will have to avoid foods with gluten. You can read more on celiac at the National Digestive Diseases Information Clearinghouse.

Wheat, barley, and rye contain gluten. If someone has celiac, they have to be very careful about all sorts of products that would not at first seem like they have gluten. But for people without celiac disease to vary the proteins in their diet as much as possible, here are some foods that do not contain gluten:

Corn
Rice
Oats
Quinoa
Buckwheat
Teff
Amaranth
Millet
Tapioca
Wild rice

Although buckwheat doesn’t contain gluten, many buckwheat products are a mixture of buckwheat plus regular wheat. However, Eden Foods’ soba noodles are pure buckwheat.

Teff is the grain from which the Ethiopian bread, injera, is made (note that some restaurants mix wheat into their injera, so people with celiac disease should ask). Teff can also be cooked much like cream of wheat and has a similar consistency.

Finally, I want to mention my friends at Sun Flour Baking Company in Sacramento who are supporters of Vegan Outreach and also make a line of gluten-free, vegan cookies, brownies, and bars.