Gluten, the protein that makes bread so deliciously stretchy, is also what prevents people with celiac disease from enjoying it.
For the estimated 1 percent of people with celiac disease, consuming even trace amounts of gluten can cause adverse reactions, including anemia and damage to the lining of their internal organs.
But scientists in Spain say they may have found a solution.
While the prospect of being able to eat gluten without adverse effects is no doubt appealing to those with celiac disease, it’s probably not a realistic option, according to a specialist interviewed by Healthline.
“It’s promising and could help people with gastrointestinal problems,” Dr. Shaista Safder, a specialist in pediatric gastroenterology at the Arnold Palmer Hospital Center for Digestive Health and Nutrition, told Healthline.
“But for the true celiac patients, I’m a little skeptical about how it would impact,” Safder added.
Celiac versus gluten sensitivity
While many people have some degree of sensitivity to gluten, there’s a big difference between celiac disease and gluten sensitivity.
Celiac disease is a hereditary autoimmune disorder that can lead to long-term adverse side effects, including damage to the gastrointestinal (GI) tract.
For people with celiac disease, the body sees gluten as a foreign agent and activates the immune system, similar to the way the immune system responds to an infection.
“What’s happening is it’s trying to fight off the protein, but in the process there’s cross-reactivity with the small intestine, and that’s what causes injury to the small intestine,” explained Safder. “The small intestine develops what’s called villous blunting, where the lining of the intestine is damaged, and when that lining gets damaged, the absorption of nutrients — which is the main function of the small intestine — is affected.”
Those who are sensitive to gluten may experience adverse side effects from consuming the protein, but the long-term damage is far less severe.
“Non-celiac gluten sensitivity, which is more of a gluten intolerance, is a medical condition where you don’t necessarily have an autoimmune reaction or small bowel damage with trace amounts of gluten, but there is a gluten intolerance in the sense that when patients are consuming large amounts of gluten, they have abdominal distension and bloating and GI discomfort, but they don’t have autoimmune damage to their small bowel,” said Safder. “So they’re two different conditions.”
To diagnose a patient with celiac disease, as opposed to non-celiac gluten sensitivity, there are a few methods, including blood work and genetic testing.
But Safder says the gold standard for diagnosis involves taking a tissue sample from the small intestine and analyzing it for the inflammatory changes that occur in those with celiac disease.
Down to the parts per million
While the low-gluten wheat is an intriguing development, it likely won’t be suitable for people with celiac disease.
That’s because, for these people, even trace amounts of gluten can cause side effects.
“If you’re using a toaster in which you are putting in regular bread, people with celiac disease can’t use the same toaster oven or use the same knife to cut the loaf of bread, because even that small amount of cross contamination could be enough to cause them to have high antibodies and ongoing small bowel damage,” said Safder.
In 2013, the Food and Drug Administration (FDA)
The agency stated that these products cannot contain more than 20 parts per million of gluten.
“If you have celiac disease and are looking at foods that contain gluten, it’s not like, ‘Oh, I can eat a little bit of this,’” said Safder. “The answer is that you can eat none of it because as long as you’re having small amounts of it, your immune system will remain activated and the injuries will continue.”
“And again, this is different from a non-celiac gluten sensitivity. Those patients have no villous damage or injuries, but they do have a difficult time digesting the gluten protein. I think in those individuals, using these low-gluten food products probably would benefit and help with some of their GI symptoms and discomfort.”
Bad news, good news
There’s no magic bullet on the horizon for people living with celiac disease.
The only recommended way to deal with the condition is to avoid gluten entirely.
The good news is that there are more gluten-free food products available to consumers than ever before.
“That, I think, has been the single biggest benefit for a lot of my patients who have celiac disease,” said Safder. “I think restaurants are a little bit more savvy when it comes to meal preparation, and I think supermarkets, grocery stores and the food industry in general are better than they were at understanding what gluten-free truly means. A lot of progress has been made, because the availability of gluten-free products is definitely more mainstream than it was 10 or 15 years ago.”
With the increased availability of gluten-free products — and the FDA’s strict regulations regarding what constitutes “gluten-free” — it’s best for patients with celiac disease to steer clear of products that contain even low amounts of gluten.
Safder concludes, “For somebody who has an autoimmune genetic condition with an active immune system, I think going gluten-free and being careful about cross-contamination is the way to go.”