Diet diary: Latest treatment modalities for increasing Celiac and Non-Celiac gluten sensitivity

09/01/2018

With a rise in diagnosis of gluten sensitivity and celiac disease, an increasing number of people are adopting a gluten-free lifestyle. The rising incidence of obesity, diabetes, digestive, autoimmune problems and general wellness is also driving a trend towards such lifestyle choices. Therefore, it is not surprising that the sales of gluten-free products has shot up exponentially over the last decade, and as per US data reported by the National Health and Nutrition Examination Survey (NHANES), continues to do so.
The treatment for Celiac disease or Non-Celiac Gluten sensitivities is a lifelong, strict gluten-free diet. As of now, knowledge of grain science and elimination is the only available and accepted treatment. Alternate grains like rice, millets, jowar, bajra, ragi, quinoa, potato and starches are safe options. However, compliance to a gluten-free diet is difficult, especially for adolescents. It is highly burdensome to patients and has its limitations as most of our favourite foods contain gluten. In other words, it is easier said than done in the urban lifestyle. Therefore, new strategies for prevention and treatment modalities, other than following a gluten-free diet, are greatly needed.
Extensive research in this field is being conducted across the world for treatment and prevention. Enzyme treatment and vaccinations are some of the options being assessed. Interesting new areas which are emerging include traditional baking techniques, by longer baking periods, with acidified dough.
Traditional sourdough fermentation for making leavened baked goods, was almost completely replaced by the use of baker’s yeast and chemical leavening agents in the last century. Recently, it has been rediscovered by the scientific community. Acidification, protein breakdown and activation of enzymes cause several changes during sourdough fermentation, carried out by lactic acid bacteria and yeasts. These are believed to positively affect the overall quality of the baked goods. In other words gluten protein undergoes degradation through bacteria and enzymes making it easier to tolerate.
In fact, a recent publication in 2011 by Greco et al, in Clinical Gastroenterology and Hepatology Journal, demonstrated that dough baked with such microorganisms contained less than 20 ppm of gluten making it safe for consumption by those who are intolerant. However many more large-scale studies are required to demonstrate the safety and recommendations for such products.
A conflicting study published in the journal of Nutrients (2015) suggests that traditional sour dough fermentation, leading to a partial gluten breakdown of wheat flour proteins, might at best be helpful to eliminate the risk of cross-contamination of gluten-free products but not to completely eliminate the toxicity of wheat flour.
Other strategies underway include genetic engineering grains to eliminate immunogenic gluten fragments, probiotics and food grade enzymes to detoxify dietary gluten and strengthening of intestinal barrier protection (by enzyme zonulin). Novel therapies have shown the potential to be effective and safe, but true efficacy and long-term benefits are still uncertain. Further research will be required before they can be part of recommendations in the management of gluten sensitivity.
The gluten-free diet still represents the best and safest treatment for such people. Once the diagnosis of Celiac disease or Non Celiac gluten sensitivity is established, the therapy is adherence to a gluten-free diet for life.

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