Expert Postings
October 1996


Table of Contents

Disclaimer: Verify this information before applying it to your situation.
 
This file contains postings made by the following professionals: 
 
Karoly Horvath, M.D.--an associate professor of pediatrics at the 
   University of Maryland at Baltimore.  Dr. Horvath set up the 
   Pediatric Gastrointestinal and Nutrition Laboratory, and is now 
   director of this lab. 
 
Frederik Willem Janssen--Head of the Chemistry Department, Food 
   Inspection Service, a subsidiary of the Inspectorate of Health 
   Protection (similar to the FDA in the USA), in Zutphen, The 
   Netherlands.  His lab has an interest in the biochemical analysis of 
   food proteins and contaminating allergens.  Special interests include 
   modified gluten, edible packaging materials (which may contain 
   gluten), and detection of hidden gluten in foods, including the 
   development of improved detection methods. 
 
Donald D. Kasarda, Ph.D.--a research chemist with the United States 
   Department of Agriculture.  Dr. Kasarda has worked on grain proteins 
   in relation to grain quality for 30 years.  He has colloborated with 
   medical groups working on celiac disease for about 25 years and has 
   often been used as an informal consultant by support groups. 
 
Vijay Kumar, M.D.--president of IMMCO Diagnostics, one of the labs that 
   performs celiac antibody blood tests. 
 
Joseph Murray, M.D.--a gastroenterologist at the University of Iowa, 
   USA, where they have a mutidisciplinary service for the clinical care 
   of people with celiac disease.  They are also involved with clinical 
   research and medical education related to celiac disease. 
 
Kalle Reichelt, M.D.--senior researcher at the Department of Pediatric 
   Research, University of Oslo, Norway.  Dr. Reichelt is looking into 
   the impact of gluten intolerance on certain individuals with 
   developmental delays. 
 
Phil Sheard, Ph.D.--researcher in the Developmental Biology Unit, 
   Department of Physiology, University of Otago Medical School, in 
   Dunedin, New Zealand. 
 
Other expert posting files are available.  The naming convention is: 
 
========================================================================= 
Date:         Wed, 2 Oct 1996 10:10:10 PDT 
From:         "Donald D. Kasarda" (kasarda@PW.USDA.GOV) 
Subject:      Re: F.W. Jannsen/zero gluten/response 
 
I would very much like to know how the Canadian Agricultural Department 
tests for gluten in Ted's products.  I am personally skeptical about the 
meaningfulness and reliability of tests for low-levels of gluten in food 
products.  By low levels, I mean in the range of 0 to 10 milligrams of 
gluten per 100 grams of product. 
 
Don Kasarda, Albany, CA 
 
)Finally our products are tested by the Canadian Agricultural department 
)for gluten around 3 times a year. We passed every time. 
) 
)Ted Wolff 
========================================================================= 
Date:         Wed, 2 Oct 1996 13:51:44 +-200 
From:         "F.W.Janssen" (teizjanz@PI.NET) 
Subject:      Codex Alimentarius explained 
 
Hi all, 
 
Got a number of  emails regarding the Codex Alimentarius GF standard and I 
concluded that it might be helpful to explain the status of Codex and about 
what it is up to. In addition I did write down some thoughts on GF foods 
that may be of interest to you. I will deal with three categories in 
separate postings. 
 
-     Foods officially labeled as "gluten free" 
-     Foods from a gluten free shopping list 
-     Foods which do not fall within the above categories 
 
With respect to the first category: 
 
   In the EU there is a Directive on foods for special dietary uses 
(89/398/EEG), and this directive is the basis for all national legislation in 
the countries of the European Union.  Though the directive deals with 
glutenfree foods there is no assigned limiting level of gluten for GF food 
yet, so it is up to the national regulatory bodies of the member states to 
set their own level.  There is however an international body handling this 
matters:  Codex Alimentarius. 
 
   Codex Alimentarius is a Geneva based International organization jointly 
run by the WHO and the FAO, and its aim is to establish world-wide standards 
for foods in the most broadest sense.  Food legislation in many countries is 
based on Codex Standards, although it is not mandatory to implement them in 
all cases.  There are Codex committees producing standards on food labeling, 
on hygiene, on composition etc., etc.  There is a committee on Foods for 
Special Dietary Uses (FSDU) and ... there is a Standard on Glutenfree Food! 
 
   The oldest Standard dates from 1981 and it says that foods may be labeled 
as "glutenfree" if the nitrogen content of the protein derived from wheat is 
less than 50 mg N/100 gm on dry matter, which may be equivalent to about 
20-30 mg gliadin in wheat starch (The calculation is quite complicated by the 
fact that most of the protein in wheat starch is "starch granule protein" and 
not gluten (If you are interested in getting a more detailed explanation, 
please send me an e-mail). 
 
   There is a new Codex Standard in preparation and there is a proposal to 
set the limiting level of gluten to 200 mg gluten/kg (20 mg/100 g) glutenfree 
food on dry matter (If we assume that half of the gluten is gliadin, this 
equals 10 mg gliadin/100 g o.d.m., so the level has gone down by a factor two 
in comparison to the "old" standard).  If accepted, the new standard will be 
valid for end products and not for raw materials.  In my previous posting I 
already mentioned that there are comments on the proposal from Sweden (20 
ppm "GF" and 200 ppm for "gluten reduced"), and from the European celiac 
societies 40 ppm for "GF").  Another proposition was to change the units 
again to mg/100 g rather than ppm's (mg/kg). 
 
   One of the reasons why the level in the Standard has not yet been effected 
(the proposal has been dealt with already two years ago) is that there is no 
validated analytical method (ring-tested) available to check compliance to 
this level.  Though it might look rather simple to analyse gluten (it is in 
general done with an Enzyme Linked Immuno Sorbent Assay - ELISA), this is a 
very tricky method for gluten, especially as the term gluten is very 
imprecise:  gluten is a mixture of gliadin and glutenin - each composed of 
several sub-fractions - and its composition with respect to sub-fractions is 
cultivar dependent.  There is also an effect of heat processing of the food 
on the recovery and although excellent work has been done by dr Skerrit of 
CSIRO in Australia to circumvent this problem by designing a method based on 
omega gliadin, which is the most heat stable gliadin fraction, there is a 
feeling that this method still needs to be improved.  Remember that agencies 
charged with enforcement of food laws must be able to bring suits against 
producers of non-complying GF foods.  So analytical methods needs to be 
robust and accurate. 
 
   Codex Alimentarius bases its standard on scientific facts and that's why 
there is no zero tolerance: there is simply no scientific evidence that 
this is required (at least there is no concordant view among scientists 
about the maximum tolerable gluten intake), and it is reasoned that any 
unduly reduction in the permissive level will reduce the number of GF food 
available unnecessary. 
 
   Though Codex Alimentarius has been criticized in the past for being a food 
producer driven body (in 1993 the National Food Alliance (an UK NGO) produced 
a report titled "Cracking the Codex" in which it was stated that even though 
the voting in Codex is nation-wise - and quite often by consensus, there is a 
large impact of the producer lobby, especially in the preliminary stages of 
decision making), it is the only world-wide forum for food standards, and its 
role within the framework of the GATT and WTO makes its work of sterling 
importance in settling trade disputes. 
 
   Even though there is no implemented standard in national legislation many 
countries will stick to the Codex Standard.  The conclusion is that in many 
countries food labeled as "gluten free" will almost definitely contain gluten 
as regulatory agencies of most countries will not press charges against 
producers of GF foods if the level is below the Codex Standard limit (though, 
as said, some countries may have lower regulatory levels, Codex Standards do 
not have the status of national laws). 
 
Frederik Willem Janssen, Zutphen, The Netherlands. 
========================================================================= 
Date:         Thu, 3 Oct 1996 18:55:38 +-200 
From:         "F.W.Janssen" (teizjanz@PI.NET) 
Subject:      status GF shopping lists 
 
Hi all, 
 
Though perhaps not of interest for those on the other (left side? of the 
pond).  I wrote down some thoughts about the three main sources of food 
celiacs use. I will deal with them in three separate postings. 
 
-     Foods labeled as "gluten free", with or without GF symbol. 
-     Foods from a gluten free shopping list 
-     Foods which do not fall within the above categories 
 
With respect to the second category: 
 
   There is a lot of controversy regarding the use of databases vs. more 
adequate labeling in dealing with allergies and so on. 
 
   Though many patients societies opt for more adequate labeling, for the 
time being an allergy database seems to be a nice compromise.  There are 
however a number of drawbacks which I should like to deal with explaining 
the Dutch situation.  Data for our gluten free shopping list are collected 
by our national allergy database ALBA which is subsidized by the Dutch 
Government.  Food producers are asked to send in detailed data regarding 
the composition of their food products with respect to many known 
allergens, gluten included, and these data are compiled and published 
periodically (a one year base) by our national information center on food 
hypersensitivity's (LIVO).  These data even can be "personalized, i.e. 
several list may be combined into one list 'tailored" to the needs of the 
allergy patient.  A drawbacks is that there is only one issue a year, and 
by consequence in-between changes in food composition will not be available 
until a year later.  A further (and major) problem which limits the value 
of these lists is that participation in the system is on a voluntary basis. 
So the list only comprises a selection of all foods available. 
 
   The most serious problem is however that nobody knows about the fidelity 
of these lists.  If a regulatory food control agency would plan to check 
these lists for trueness and eventually would try to bring a suit against a 
producer for inadvertently having put his foods on the list, the list would 
probably evaporate.  Producers fear to be sued for product liability.  So 
this all is a very fragile business and may be regarded as a certain kind 
of service from the producers to some consumers (and celiacs).  There is 
not much sales volume to gain for them as the number of celiacs is low. 
Unless the system can be made compulsory, there will always remain doubts 
about the level of confidence one can have in these lists. 
 
Frederik Willem Janssen, Zutphen, The Netherlands 
========================================================================= 
Date:         Thu, 3 Oct 1996 21:41:36 PDT 
From:         "Donald D. Kasarda" (kasarda@PW.USDA.GOV) 
Subject:      smoking and celiac disease 
 
I came across an abstract recently (from Gut, a reputable journal) that 
reported an interesting finding on a subject that I think came up on the 
list recently--smoking and celiac disease. I thought it might be of interest 
to cite it here. 
 
The article by Snook et al. (Adult coeliac disease and cigarette smoking, 
Gut 39:60-62, 1996) concluded from a study of 86 recently diagnosed adult 
coeliac disease patients as compared with 172 controls matched for age and 
sex that "...cigarette smoking, or a factor closely linked to it, seems to 
exert a major protective effect against the development of symptomatic adult 
onset coeliac disease.  The implication is that gliadin exposure is not the 
only important environmental factor involved in the pathogenesis of this 
condition." 
 
I vaguely recall reading of and hearing of an apparent protective effect of 
smoking in inflammatory bowel disease, but this is the first report I have 
seen that relates such a protective effect in celiac disease. 
 
Please don't conclude that I am recommending that celiac patients take up 
smoking--especially those under 5 years of age! Just reporting a curious 
finding. 
 
Don Kasarda, Albany, CA 
========================================================================= 
Date:         Fri, 4 Oct 1996 20:42:47 +-200 
From:         "F.W.Janssen" (teizjanz@PI.NET) 
Subject:      EU  general food labelling 
 
Hi all, 
 
This is the third posting in a series about GF food. I hope you got some 
useful information. 
 
-     Foods officially labeled as "gluten free" 
-     Foods from a gluten free shopping list 
-     Foods which do not fall within the above categories 
 
With respect to the third category, the foods not falling in the two 
categories dealt with above: 
 
   In the European Union it is mandatory to list all ingredients on the label 
of a pre-packaged food product.  However, if a composite ingredient (e.g. 
mustard) is present in the end product at a level below 25% then the 
ingredients (mustardseed, vinegar, salt) of this ingredient (mustard) need 
not to be mentioned (with the exception of additives with an assigned E 
number).  This is of course a major flaw in the labeling legislation and it 
corrupts its value for celiacs to a great extent.  Another flaw is that it is 
not mandatory to mention the botanical origin of any starch, in contrary to 
flour! 
 
   There are rumors (Codex, EU?)  that in the future this level of 25% will 
be reduced to 5%, with even a compulsory splitting up in the ingredient 
labeling below that level if there is an ingredient which might be regarded 
as potentially hazardous (e.g.  as an allergen).  Peanut was mentioned as 
such an ingredient (there has been recently a number of fatal cases with 
anaphylactic shock caused by exposure to low amounts of peanuts).  It is 
expected that gluten will be regarded as potentially hazardous too.  Though 
the change from 25% to 5% will benefit celiacs in the EU, as more hidden 
gluten will show up in the ingredient list, it is by no means a panacea. 
Even the 5% may still contain ingredients with a considerable amount of wheat 
gluten.  The proposed compulsory labeling of allergens is meeting opposition 
from the food producers as they fear product liability.  It could in fact be 
also a threat to the business of producers of GF food, because with a 
mandatory labeling of the slightest amount of wheat there would be no reason 
for celiacs to buy special Gf food. 
 
   Of course, neither labeling nor shopping list, nor more sophisticated 
labeling is a remedy against contamination.  Contamination poses a major 
problem in The Netherlands, and presumably not only there.  In the last 
couple of years we analyzed about 500 foods labeled as "glutenfree" and we 
found that about 20% of the buckwheat based, and 12 % of the corn based 
flours were contaminated with wheat at levels exceeding the Codex Standard of 
200 ppm gluten (= 100 ppm gliadin = 10 mg gliadin/100 g on dry matter).  In 
fact these levels were much higher than the level of residual gluten which is 
genreally found in wheat starch. 
 
   By consequence celiacs in Europe have the choice between ingestion of 
chronically low amounts of gluten when using wheat starch and adventitious 
high amounts of gluten when consuming buckwheat or corn flour.  Unfortunately 
there are no scientific data pertaining to which of these alternatives is 
best. 
 
Frederik Willem Janssen,  Zutphen, The Netherlands. 
========================================================================= 
Date:         Wed, 9 Oct 1996 11:55:08 PDT 
From:         "Donald D. Kasarda" (kasarda@PW.USDA.GOV) 
Subject:      Re: cigarette smoking 
 
I most certainly wasn't implying that anyone should take up smoking--just 
passing on some interesting observations, the meaning of which isn't at all 
clear.  I could even imagine that the correlation found might result from 
some sort of personality trait that is genetically linked to the 
susceptibility genes for celiac disease whereby celiac patients (as a group, 
of course, not all individuals) are less drawn to cigarette smoking than the 
population as a whole. Thus, there might not be an actual physiological 
effect, although that is certainly also a possibility. 
 
Don Kasarda 
Albany, California 
========================================================================= 
Date:         Fri, 11 Oct 1996 14:00:31 PDT 
From:         "Donald D. Kasarda" (kasarda@PW.USDA.GOV) 
Subject:      beer 
 
We seem to be going around yet again on beer.  I don't have time to do major 
comments right now, but if someone is willing to do a search for past 
postings on beer, it might help the people who think that Modelo Negro and 
Sapporo are safe for celiac patients. I would say that the general 
conclusion last time around was that no beers brewed from barley or wheat 
are safe, even though the amount of harmful peptides in them may be very 
small. I would guess that any beer that is made from hops is also based on 
barley or wheat, but I could be wrong.  We didn't deal directly with 
Sapporo, but someone checked on Modelo Negro and posted that it was brewed 
from barley. 
 
Don Kasarda 
Albany, CA 
========================================================================= 
Date:         Sat, 12 Oct 1996 20:51:34 +-200 
From:         "F.W.Janssen" (teizjanz@PI.NET) 
Subject:      Codex meeting: the square brackets 
 
Hi all, 
 
Just returned from the Codex meeting in Bonn -  Bad Godesberg where 
representatives from countries all over the world discussed the "Proposed 
draft revised standard for gluten-free foods", which is at step 3 of the 
procedure. 
 
Though there has been a lot of discussion about the draft standard, only 
minor progress has been made. 
 
Most discussions were focused on the definition of glutenfree and on the 
acceptable level of contamination. 
 
-    The definition of "gluten-free food" now has been changed in such a way 
that apart from wheat, rye, crossbred varieties of these (triticale), barley 
and [oats] now also the proteins from all other triticum species including 
spelt and kamut are excluded (i.e.  included in the list of toxic cereals). 
The definition has been modified in such a way that it will only apply to 
cereal based product (including arrowroot, tapioca etc.).  I.e.  it will not 
be possible to market a T-bone steak as "gluten-free" because it is not a 
cereal based food. 
 
-    The Codex Committee put "oats" in the definition now between square 
brackets (a proposition of the Finnish delegation) which means that it will 
probably be considered as non-toxic in the final version of the standard. 
(My personal opinion about this is that although there has been a number of 
excellent reports from Irish and Finnish groups about the toxicity 
(non-toxicity) of oats, yet some doubts remain, and in any case one should be 
well aware of contamination.  Producers of "rolled oats" in Europe state 
"typical" levels of 10 wheat/rye or barley seeds / 100 gm oats and this 
clearly results in more than 200 ppm gluten.  As oats will have to be 
considered as "glutenfree by nature" (see next section), the lower 
contamination limit mentioned there would apply.  By consequence there will 
be little chance that oat-based products will meet the requirements of the 
standard, even if they would be considered as non-toxic in the final version 
of the standard.  Anyway they should be produced with dedicated transport and 
production lines) 
 
-    Another item which has been addressed was the gluten content of foods 
labeled as "gluten free by nature", which are foods like buckwheat, corn or 
rice flour.  There was much opposition against setting the limit for this 
group at the same level as for the group of gluten free foods derived from 
gluten containing cereals rendered gluten free, e.g.  wheat starch.  It was 
argued that there should be an impetus to producers to avoid contamination. 
Delegations agreed that the level for this category should go down to [20] 
ppm.  The square brackets however mean that all these values are provisional, 
and they will remain so until a reliable method of analysis has been 
validated. 
 
There has been a lot of lobbying around in the corridors by representatives 
of the industry and the Union of European Celiac societies, but to my 
perception in the end nobody was completely satisfied with the results 
achieved.  Producers of GF food fear that it will be very hard to get raw 
materials sufficiently free from contaminating gluten to produce gluten-free 
baking mixes at a reasonable costs and the Celiacs Societies still favor a 
somewhat higher but uniform level (50 ppm).  The proposal has now proceeded 
to step 5 of the Codex procedure.  In 1998 further discussions will take 
place. 
 
PS Remember that Codex Standards serve as a guideline to help national 
governments to set up national legislation, i.e. the Codex recommendations 
always have to be implemented before coming into force. 
 
I will put the final text of the proposal on my homage as soon as I have it 
at my disposal. I let you know where and when. 
 
Frederik Willem Janssen, Zutphen, The Netherlands. 
========================================================================= 
Date:         Sun, 13 Oct 1996 17:35:03 PDT 
From:         "Donald D. Kasarda" (kasarda@PW.USDA.GOV) 
Subject:      Re: [Fwd: beer] 
 
Comments from Joyce Miller 
) 
)        I agree with that statement but Sapporo is not made from barley 
)or wheat, It is made in Japan and is made from rice. 
) 
 
Reply by Don Kasarda, Albany, CA 
 
Because I have tried Sapporo beer from time-to-time and it sure tasted like 
a barley-based beer to me, I searched for Sapporo on Excite and, although 
the web connections were not working for the many Sapporo sites listed, the 
information listed in regard to one site included the following comment from 
Sapporo: 
 
)Sapporo uses only top quality ingredients in producing our beers: primary 
)ingredients (barley, hops, yeast); subingredients (rice, cornstarch, and 
)purified water.
========================================================================= 
Date:         Sun, 13 Oct 1996 20:41:55 -0400 
From:         "F.W.Janssen" (teizjanz@PI.NET) 
Subject:      Re: beer 
 
)I foolishly tried the Sapporo beer last week, I have not been that ill for 
)many years. 
 
To make beer you need a fermentable sugar. In cereals these sugars are not 
present by nature. They may be formed however by a starch splitting enzyme. 
In most cereals this enzyme is formed during germination (which is also the 
first stage of malting). Almost any cereal can be malted. During the 
brewing process many other cereals are sometimes added, e.g. to modify the 
taste, as the starch splitting activity of the malt is quite sufficient to 
split the starch in these cereals too. Perhaps the Sapphoro beer is 
produced with malted barley or wheat as a base with a large amount of rice 
added. 
 
Though the proteins co-extracted during brewing are usually removed by 
splitting them with proteolytical enzymes (to prevent chill haze) the 
(toxic) peptides still may be present. As Dr Kasarda mentioned in a 
previous posting it is very difficult to establish whether these peptides 
are still toxicl. There are however immunoreactive proteins and peptides 
present in many types of beer (especially in the wheat based beers like the 
Belgian Gueuzes and the German Weizenbier) which suggest that it might be 
safe  to avoid any beer unless it can be made sure that it is produced 
exclusively form non toxic cereals. 
 
Frederik Willem Janssen, Zutphen, The Netherlands 
========================================================================= 
Date:         Tue, 15 Oct 1996 11:17:02 -0400 
From:         Joe Murray (Murray@INTMED-PO.INT-MED.UIOWA.EDU) 
Subject:      A gluten free diet for non-celiac disease 
 
If someone has a suspicion that they may have celiac disease it is important 
to identify that disease as it has specific implications for future health 
and provides some handles on which to judge healing.  If celiac disease is 
identified then there is risk for other family members having it, as well 
as a risk to the patients health if the person does not adhere to the diet. 
On the other hand if someone has been shown not to have the damage of celiac 
disease, then there is not a risk for many of the metabolic complications of 
CD. 
 
The family risk may not apply and damage is not caused to the intestine by 
exposure to the gluten. Many people with stress induced bowel dysfunction may 
be improved by avoiding wheat as it is not very well digested in some, but 
does not cause damage.  There are many controversial areas like schizophrenia 
and autism in which a damaging role of gluten has been suggested.  A gluten 
free diet is not a cure -all but it is in the main a safe diet, so long as it 
is not combined  with other extensive restrictions.  It is expensive and 
can be a major endeavor, but everyone on this knowns that. Joe Murray 
========================================================================= 
Date:         Sat, 2 Nov 1996 18:24:40 PST 
From:         "Donald D. Kasarda" (kasarda@PW.USDA.GOV) 
Subject:      Sapporo 
 
Mike Jones has asked me to comment on the following statement from the 
Sapporo Brewery people: 
 
)This statement is being distributed by Sapporo Breweries: 
) 
)    "A representative from Sapporo Breweries, Ltd./Tokyo has advised 
)    that Sapporo beer does contain barley.  However, after the barley 
)    is boiled, the gluten is filtered out along with the barley skins. 
) 
)    The representative assured me that although the barley itself does 
)    contain gluten, their brewing process effectively removes all the 
)    gluten from their beer." 
 
Comments from Don Kasarda, Albany, California 
 
The reason that this doesn't make sense for celiac patients has to do with 
the digestion of the barley hordeins, the proteins that are similar to wheat 
gliadins in barley. During the malting and fermentation processes, the 
barley hordeins are broken down into smaller pieces called peptides.  It is 
true that no intact hordein proteins can generally be found in beer. 
However, the smaller pieces of these proteins resulting from enzymatic 
digestion are often quite water soluble so that they remain in the beer 
throughout the complete processing to the final product. (Remember that beer 
is not a distilled product as are whiskey or vodka. Filtration of the beer 
will not remove these small water-soluble hordein polypeptides.)  A barley 
hordein might have a polypeptide chain including 300 amino acids in its 
sequence, yet it is reasonably well established by experiments that 
polypeptides with as few as 13 amino acid residues in the chain can still 
retain toxicity for celiac patients. These small pieces of the original 
proteins can (and do) have very different properties from the original 
larger proteins.  In the strict sense, Sapporo is correct that there are no 
more intact hordeins in their beer.  What they cannot claim is that there 
are no hordein peptides in the beer that might harm celiac patients. 
 
There is some evidence from analytical methods involving antibodies prepared 
to gliadins that there are peptides in beer that react with these 
antibodies.  It is not proved beyond any doubt that the peptides in beer are 
actually toxic to celiac patients, but it is quite possible that the 
peptides remaining in any barley-based or wheat-based beer, Sapporo 
included, are harmful to celiac patients.  The amount of harmful peptides, 
if they are present, is likely to be small, but there is no satisfactory 
analytical data, in my opinion, that defines the amount exactly.  So it 
could be in a range that would be harmful to a celiac patient drinking beer 
on a regular basis.  My guess is, and I emphasize that I can't back this up 
with scientific results, that a glass of beer once every few months would 
not do lasting harm to the average celiac patient.  By average celiac 
patient, I mean those who have no obvious allergic character to their 
disease and do not notice any immediate reaction when they ingest gluten. 
========================================================================= 
Date:         Mon, 4 Nov 1996 11:32:42 +0000 
From:         Phil Sheard (phil.sheard@stonebow.otago.ac.nz) 
Subject:      chelation 
 
Hi everyone, just though I might contribute to the discussion on chelation, 
and add a little to the recent post by Ellen Switkes.  I think Ellen was 
correct in her summary of what chelation does.  It was developed around the 
time of the first world war to treat soldiers who had been poisoned 
(largely by lead) during that conflict.  I think it worked reasonably well 
and many treated soldiers were able to return to the front lines to be 
killed by a more direct method.  The substance used (EthyleneDiamineTetra- 
Acetic acid, or EDTA) was indeed developed to bind some substances and 
enable their easy removal from the body.  It (EDTA) is widely used in 
today's research labs as a means of "cleaning up" solutions used in 
biological studies, particularly to remove calcium from solution 
(scientists usually need to know exactly how much calcium is in the 
solution that bathes their experimental tissues, since calcium is so 
critical to many cellular processes).  Of course, whether chelation therapy 
works in the way it is sometimes promoted remains open to debate.  I think 
an important point to mention is that, as long as it is not over used, it 
is probably not harmful.  Recent evidence, however, suggests that it may be 
of little use to those with some vascular problems (see below).  As always, 
we have to review the evidence and make up our own minds. 
 
The following summary comes from a recent study done here, in Dunedin. I 
guess this means that therapy must be legally available here in NZ, and I 
suspect it is elsewhere also. 
 
 van Rij AM, Solomon C, Packer SG, Hopkins WG, Department of Surgery, 
      University of Otago Medical School, Dunedin, New Zealand. 
 Chelation therapy for intermittent claudication. A double-blind, 
      randomized, controlled trial [see comments]. 
 Circulation 1994 Sep;90(3):1194-9 
 BACKGROUND: The use of repeated intravenous infusions of EDTA, which 
      has become known as "chelation therapy," has been promoted for 
      treating intermittent claudication as well as a wide range of other 
      disorders. Multiple reports of excellent results in large numbers of 
      patients have encouraged the use of this regimen. The lack of 
      well-controlled studies substantiating the benefits of this 
      treatment has limited its use mainly to private clinics. The aim of 
      the study was to assess the benefits of chelation therapy in 
      patients with intermittent claudication. METHODS AND RESULTS: A 
      double-blind, randomized, controlled trial included 32 patients with 
      intermittent claudication who were randomized to a treatment group 
      (15) and a control group (17). Main outcome measures were subjective 
      and measured walking distances and ankle/brachial pulse indices. 
      Other outcome measures included lifestyle and subjective parameters 
      of improvement, cardiac function, ECG, renal function, hematology, 
      blood glucose, and lipid biochemistry. No clinically significant 
      differences in main outcome measures between chelation therapy and 
      placebo groups were detected up to 3 months after treatment. 
      Measures of mood state, activities of daily living, and quality of 
      life factors were not consistently affected by chelation therapy. An 
      equal proportion (13%) of each group thought that they had received 
      the active agent. The proportion of patients showing an improvement 
      in walking distance was not significantly different between the 
      chelation group (60%) and the control group (59%). CONCLUSIONS: 
      Chelation therapy has no significant beneficial effects over placebo 
      in patients with intermittent claudication. 
 
Hope this is helpful 
Phil 
 
Philip Sheard 
Developmental Biology Unit, 
Department of Physiology, 
University of Otago Medical School, 
Dunedin, New Zealand. 
Ph (64 3) 479-7344 
Fax (64 3) 479-7323 
========================================================================= 
Date:         Wed, 6 Nov 1996 12:30:10 PST 
From:         "Donald D. Kasarda" (kasarda@PW.USDA.GOV) 
Subject:      Re: Maltodextrin-- Gluten-Free? 
 
Copy of message from Don Kasarda, Albany, CA 
 
Date: Wed, 25 Sep 96 18:10:42 PDT 
Subject: maltodextrins 
 
Chris, 
 
I haven't personal experience with maltodextrins, but the following is correct 
to the best of my knowledge. 
 
Malt results from the enzymatic hydrolysis of the proteins and starch found in 
whole grains of (usually) barley through partial germination of the grain, 
whereas maltodextrins are a product that is the result of the enzymatic 
hydrolysis of starch alone  (the common thread here is production of the sugar 
maltose from starch in both cases).  Barley malt may have some polypeptides of 
sufficent size resulting from breakdown of the barley hordein proteins so that 
it might have low, but some, toxicity for celiac patients. 
 
Most (possibly all) maltodextrins in the US are produced by the enzymatic 
hydrolysis of corn starch and I have been told that fungal enzymes are generally 
used.  Accordingly, I would say that it might be prudent to avoid barley malt 
until we can get a better handle on just how much of the toxic peptides still 
exist in malt, but maltodextrins seem likely to be OK to me. 
 
The barley hordein proteins are the equivalent of some of the main gluten 
proteins found in wheat. They have some very similar amino acid sequences. 
 
Hope this is of some help. 
 
Don 
 
Update:  Since posting this message, there has been a posting from someone 
else saying that they had information about barley malt enzymes being used 
in maltodextrin production.  This question has still to be resolved. My own 
information had come from inquiries to two different industry people who 
seemed to be knowledgeable about maltodextrin production. 
 
Don 
========================================================================= 
Date:         Fri, 8 Nov 1996 16:21:42 -0500 
From:         IMMTEST@AOL.COM 
Subject:      Re: Stool sample testing 
 
To answer your question, stool tests are used, but are by no means the best 
method of diagnosis of CD. The fat and nitrogen content of stool is 
indicative of malabsorbtion, which may be present in CD, but these tests are 
not specific for CD. 
 
On the other hand, serological tests for endomysial, reticulin and gliadin 
antibodies exhibit a high degree of reliability toward the diagnosis of CD. 
 
Sincerely, 
 
Vijay Kumar 
Research Associate Professor 
========================================================================= 
Date:         Sat, 9 Nov 1996 13:39:41 -0500 
From:         Karoly Horvath (khorvath@UMABNET.AB.UMD.EDU) 
Subject:      Stool test for CD 
 
        There are several different diagnostic stool tests for 
malabsorption, however, there are not specific for CD. Some of the old 
textbooks still suggest stool fat determination as part of the diagnosis 
of CD. A simple fat sample is inappropriate for this purpose. For a real 
guantitative analysis of stool fat content,  the patient should be on a 
well-defined diet, with known fat content two days before the stool 
collection and for three another days when all the stool is collected. The 
laboratory measures the total fat content during the three-day period and 
a the ratio of stool fat / ingested fat is calculated. Normally, more than 
95 % of ingested fat is absorbed in the small intestine. In my experience, 
the sensitivity of this complicated quantitative stool-fat-test was below 
60% in my patients with CD. So I decided not to use it. 
        Other tests are determining unabsorbed sugars in the stool. They 
are also not sensitive and specific. 
        The conclusion is that the stool tests have limited value in the 
diagnosis of celic disease. The blood serology test has a higher 
sensitivity ans specificity, and the intestinal biopsy still remains the 
gold-standard. 
 
Karoly Horvath, M.D. 
Baltimore 
========================================================================= 
Date:         Fri, 29 Nov 1996 02:19:25 -0500 
From:         Don Wiss (donwiss@PANIC.COM) 
Subject:      Dr. Reichelt reply to John Hepler posting to the list 
 
At 02:15 PM 11/28/96 -0500, John Hepler (jhepler@TWLAKES.net) wrote: 
 
)       My interest is the relation of gluten and casein intolerance to 
)asthma and (IgE) allergy. [snipped...] 
 
I forwarded John's article to Dr. Reichelt, and here is the reply: 
 
 
Date: Fri, 29 Nov 1996 08:01:17 +0100 (MET) 
From: K.L.Reichelt@rh.uio.no (Kalle Reichelt) 
Subject: Food intolerance 
 
Hi. 
Your questions are good and to the point but hard to answer. The 
relationship of food proteins, peptides to asthma have not been 
sufficiently examined at all. Dr Jan B Boler (synthesized TRH with Dr 
Folkers and Schally), ran preliminary data on asthma and peptides and found 
very large increases, but had to seek other employment because his meager 
grants ran out. 
 
Nor do I think that IgA relationships in Asthma have been sufficiently 
looked into. IgA is a reasonably good measure of protein transport through 
the mucosa also when no coeliac disease (Biopsy: Nil. Endomycium Ab: Nil) 
is absent. Because we all take up proteins intact (1) any increase in this 
uptake can cause problems. The more so if the break down of the proteins 
fragments = peptides formed are not completely broken down. 
 
Now a series of immune modulating peptides can be formed from casein (2) as 
well as peptidase inhibitors (3-6) further aggravating break down. In 
addition the exorphins like casomorphin would have profound impact on 
immune competent cells because of the opioid receptors on the cells 
involved in the immune reactions. The opioids bind to opioid receptors on 
eg. lymphocytes and phagocytic antigen presenting cells, etc. Far too little 
is as yet established. However, as all new fields of investigation the 
established specialists usually have little sense of looking at new angles 
to the problem. This is universal and has always been so. 
 
That such mechanisms may possibly be important is seen from a recent paper 
in The Lancet on the relationship of IgA antibodies to gluten and gliadin 
and neurological disease (7). Hope this preliminary answer to your difficult 
questions is a start at last. 
 
Ref: 
1: Husby S et al (1985) Passage of undegraded dietary antigen into the 
blood of healthy adults. Scand J Immunol 22: 83-92. 
2: Migliore-samour D and Jollet P (1988) casein, a prohormone with 
immunostimulating role in newborns? Exprientia 44: 88-93. 
3: Kohimura M et al (1990) Inhibition of angiotensin-converting enzyme by 
synthetic fragments of human K-casein. J Agricult Biol Chem 54: 835-836. 
4: Kohimura M et al (1990b) Inhibition of angiotensin-converting enzyme by 
synthetic peptide fragments of various beta-caseins. j Agricult Biol Chgem 
54: 1101-1102. 
5: Muruyama S and Suzuki H (1982) A peptide inhibitor of angiotenisn 
-1-convertingenzyme in the tryptic hydrolysate of casein. J Agricult Biol 
Chem 46: 1393-1394. 
6: Asano M et al (1991) Inhibition of pro|lyl-endopeptidase by synthetic 
peptide fragments of beta-casein. J Agricult Biol Chem. 55: 825-828. 
7: Hadjivassiliou M et al (1996) Does cryptic gluten sensitivity play a part 
in neurological illness? The Lancet 347: 369-371. 
 
There are sveral textbooks now on Neuroimmunology which shows the mututal 
effects of these systems on eachother. 
 
All the best                                    TINY 
 
K. Reichelt 
Pediatric Research Institute 
N-0027 Oslo, Norway 
Tel: +47 22 86 90 45 
Fax: +47 22 86 91 17 
E-mail: K.L.Reichelt@rh.uio.no 
========================================================================= 
Date:         Mon, 2 Dec 1996 11:28:19 PST 
From:         "Donald D. Kasarda" (kasarda@PW.USDA.GOV) 
Subject:      Re: Durham flour 
 
I assume that Stuart is inquiring about durum wheat.  Durum is a tetraploid 
wheat used primarily for pasta--although in this area we can buy bread made 
of durum flour as well.  It is wheat and is not suitable for celiac 
patients. Kamut is a tetraploid wheat that is closely related to durum 
wheat. Bread wheats are hexaploid wheats, but both tetraploid and hexaploid 
wheats have very similar types of gluten proteins. 
 
Don Kasarda 
Albany, CA 
 
)Could anyone tell me what Durham Flour is???  Is it gluten free??? 
) 
)Stuart 
========================================================================= 
Date:         Mon, 9 Dec 1996 14:35:00 CST 
From:         Murray@INTMED-PO.INT-MED.UIOWA.EDU 
Subject:      fatigue and CD 
 
Fatigue is reported to be almost a universal symptom in newly diagnosed patients 
with CD.  It may be due to one or more factors including malnutrition, 
dehydration, inflammation (of the intestine), micronutrient deficiency causing 
anemia, low calcium or magnesium, along with other deficiency states. 
When a patient who has already has the diagnosis of celiac disease for several 
years it can be any of the above, though the imporatant first step in checking 
someone like that out is usually rechecking for activity of the CD. 
Other entities that can cause fatigue that may be seen in higher frequency in 
patients with celiac disease, include depression, vit b12 def, other autoimmune 
diseases in cluding  sjogren's syndrome, lupus, hypothroidism, diabetes, 
addison's among others, 
Of course someone can also develope other illnesses including heart, lung, 
liver, and kidney problems that can all cause fatigue, but are not associated 
with CD 
This is not medical advice and should not be used as such. 
Joe Murray 
========================================================================= 
Date:         Fri, 20 Dec 1996 23:36:00 CST 
From:         Murray@INTMED-PO.INT-MED.UIOWA.EDU 
Subject:      re Helicobacter Pylori 
 
The discovery of helicobacter pylori revolutionalized the way we think about 
peptic ulcers.  I is a very common infection of the stomach and can stay there 
for ever. It infects about 10% of the population being much more common in the 
3rd world and in the elderly.  People have studied the rate of infection in CD 
patients and it seems to be the same as the general population. Of course if yu 
have both It can both confuse the doctor and worsen the abdominal pain and 
indigestion symptoms. As far as i know the blood test for H pylori is not 
interfered with by the presence of CD. The breath test, which will shortly be 
available as a test in the US, is an excelllent test for infection.  The blood 
test reflects infection in the last 6 months or so, and takes a while to become 
negative when the bug has been eradicated. 
Not medical advice 
Joe Murray 
Univ of Iowa 
========================================================================= 
Date:         Mon, 23 Dec 1996 16:29:16 PST 
From:         "Donald D. Kasarda" (kasarda@PW.USDA.GOV) 
Subject:      Re: Suspect: Shiny Apples? 
 
If I am recalling correctly an article that appeared in the magazine "This 
Old House," many foods, possibly apples, can be coated with shellac, which 
is a product derived from some insect or other in India.  Actually, the 
insect can be found elsewhere, but the gathering and initial processing of 
the insects is so labor intensive as to require extremely poor people who 
are willing to do the work for a pittance.  The final processing of the 
polymeric material into shellac is evidently carried out by one large New 
England firm before it is sold to food and pharmaceutical companies for 
coating fruits or pills, and so forth. 
 
Don Kasarda, Albany, California 
 
rswd@CYBERHIGHWAY.NET wrote: 
 
)) It's really a question.... does anyone know what they coat fruits & 
)) veggies with (commercial produce)- the waxy substance on apples, and 
)) cucumbers? I am asking because I ate an obviously waxed Granny Smith 
)) green apple & had a mild reaction- to a piece of fruit! 
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