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  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 (email@example.com) 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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