Expert Postings
Jan - Mar 1998

Copyright by Michael Jones, Bill Elkus, Jim Lyles, and Lisa Lewis 1998 - All rights reserved worldwide.
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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.
 
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.
 

Date: Tue, 6 Jan 1998 18:44:06 -0800 From: Maxwell@LAMG.COM Subject: Gluten content in alcoholic beverages I asked Dr Janssen, a subscriber to our cel-pro discussion group, if he could comment on the gluten content of alcoholic beverages, based upon the experience of his testing lab. I include his reply below (with his permission), along with part of his bio from the cel-pro roster. In his reply, you will see references to milligrams of gluten per liter of beverage. A liter is about a quart. While there is no proven standard of how much gluten a Celiac can safely consume per day, a number of cel-pro members feel 10 mg per day is safe and that 100 mg is not. Bill Elkus Los Angeles ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Frederik Willem Janssen Head of the Chemistry Department, Food Inspection Service in Zutphen, a subsidiary of the Inspectorate of Health Protection (similar to the FDA in America). Our lab has a special interest in.... modified gluten, edible packaging materials (which may contain gluten), and detection of hidden gluten in foods, including the development of improved detection methods. .... I am also a member of the Medical/Scientific Advisory Committee of the Dutch Celiac Society. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dr Janssen replies: Yes, destillation quite effectively removes the gluten and it is very unlikely that splashes of fermented (we call it "moutwijn", i.e. malt wine, can't remember the correct English word for it) will be carried over to the final destillate. If they are present they must have been added afterwards. A couple of years ago we analyzed some distilled liquors for presence of gluten proteins but we couldn't detect any in this set (about 40). The test in beer (a set of 50 different brands) showed that most brands (35) did contain immunoreactive protein in amounts between 1 and 200 mg/liter. Only 15 contained less than 1 mg/liter. There was a strong correlation between the gluten content and whether wheat had been used as an ingredient! I found a report of an investigation published in 1992 in a periodical of the Flemish Celiac Society about immunological determination of gluten in beer and some distilled liquors. This confirmed our findings that the gluten content of beer is quite variable (the authors found levels from zero to 400 mg /liter gluten). They did find gluten in distilled liquors! The levels varied from zero to 200 mg gluten/liter. The highest amount was found in a "Creme de Framboise" (200 mg/liter) but second was a French brandy VSOP with a score of 180 m g/liter. A Dutch gin was negative, which might be an indication that gluten in these type of liquors is not a carry over to the destillate! My guess is that these gluten is derived from the caramel coloring, though there is no proof about this yet. I always advise sensitive patients to abstain from brown colored liquors! I would like to stress that the determination of gluten in these types of products is very unreliable and we have to count with false positive as well as false negative values. The gluten proteins could have been broken down to small (but still toxic) peptides and in that case a sandwich-type ELISA might produce false negative results because in that case you always need to two epitopes (binding sites for the antiserum) on one molecule to get a positive reaction. A competitive type assay would be the choice for this type of product but we haven't tried this type of analysis on it yet (we did use it on a soy sauce which was prepared with wheat gluten and didn't find any gliadin, which might be an indication that gluten had been broken down to very small peptides less than one binding site). gluten = 2* gliadin Best wishes, Frederik Willem Janssen, Zutpen, The Netherlands ========================================================================= Date: Sat, 10 Jan 1998 21:27:04 -0700 From: Bill Elkus (BElkus@JEFCO.COM) Subject: how long must gluten challenge last? The following is a cel-pro post, reprinted with permission, from a discussion of how long a suspected celiac must be eating gluten prior to blood tests and biopsy: Bill Elkus Los Angeles ) It is often necessary to prescribe how much gluten to eat. I Ask ) patients to eat increasing amounts of gluten, starting from a cracker ) building up to 4 slices of whole bread a day and to keep taking that ) so long as they do not get too ill, but should get definite symptoms. ) When i left it up to the patient, it seems they ate less gluten and ) more sporadically. It is sometimes hard to wait to persuade the ) patient to wait long enough for damage to occur. While the standard ) 4 week challenge will pick up most it will not pick up all patients. ) In those patients who remain asymptomatic I continue to wait and ) monitor the antibodies as well as the development of symptoms and ) then biopsy. I also find it useful to review the original biopsy ) material and other primary information on which the original diagnosis ) was based. Sampling problems and interpretation are also issues. ) ) There a few people I will not challenge, People who are so ) nutritionally deplete that might not tolerate the challenge, people ) who give a history of anaphylactic response that could be life ) threatening and possibly those with a history of severe neurologic ) problems. ) ) Joe Murray ) Not Medical Advise ========================================================================= Date: Wed, 14 Jan 1998 07:49:49 -0500 From: Karoly Horvath (khorvath@UMARYLAND.EDU) Subject: Gluten challenge in kids You can buy gluten powder in several food store chains (e.g. Metro etc). I prefer this hidden challenge with gluten powder placed in the foods in children. Karoly Horvath Baltimore ========================================================================= Date: Wed, 14 Jan 1998 19:05:05 -0500 From: Karoly Horvath (khorvath@UMARYLAND.EDU) Subject: Gluten challange in young young KIDS I supposed that everybody who replied to my e-mail have read the original post I answered. I am not talking about adults. The subject of the e-mail is "Gluten challenge in kids" In children there is transient intolerance to gluten (5% of my cases). Especially, children diagnosed below two years if age have this chance. The practice is that these toddlers undergo a rechallenge. My answer was that it is wise to use gluten powder placed into the diet than give back all gluten containing foods. It is sometimes tough to return to the gluten-free diet later. Children at this age group cannot rationalize (understand) these changes. Karoly Horvath, M.D., Ph.D. University of Maryland at Baltimore ========================================================================= Date: Wed, 14 Jan 1998 18:30:03 -0600 From: Joseph Murray (Joseph-Murray@MAIL.INT-MED.UIOWA.EDU) Subject: Irish red setter People may be interested to know that the Irish red setter dogs ( especially the Windhoven? strain) get a gluten sensitive enteropathy. It is likely a little different from human disease. One monkey was described who developed the classic symptoms of CD and got better on a gluten free diet. It probably preferred bananas anyway Joseph A. Murray MD Coordinator, Celiac Disease Clinic Associate Professor of Medicine, University of Iowa IA 52242 ========================================================================= Date: Thu, 12 Feb 1998 08:58:55 -0600 From: Joseph Murray (Joseph-Murray@MAIL.INT-MED.UIOWA.EDU) Subject: need gluten in the diet before biopsy to detect celiac disease It is easily the most common diagnostic dilemma that I am put in is seeing someone who went on gluten free diet for several months felt better then decided they wanted medical confirmation of the diagnosis. They go to a doctor and get biopsies or the serologic blood tests which come out normal. They are then told they don't have it and subsequently get sick on gluten . It is then hard to get permission from the insurance company to go back in to get the biopsies again. THE STATE OF THE DIET IS CRUCIAL TO THE TIMING AND INTERPRETATION OF THE BIOPSIES OR THE BLOOD TESTS WHEN LOOKING FOR CELIAC DISEASE!! EXCLUSION OF GLUTEN FROM THE DIET CAN MASK BOTH THE BIOPSY RESULTS AND THE BLOOD TESTS RESULTS!!! sorry for shouting but my professional frustration reflects your personal frustration with the lack of familiarity with celiac disease in the USA. I am happy to discuss my experience in dealing with these issues with any MD who maybe not as familiar with celiac disease Joseph A. Murray MD Coordinator, Celiac Disease Clinic Associate Professor of Medicine, University of Iowa IA 52242 ========================================================================= Date: Sat, 21 Feb 1998 08:41:08 -0500 From: Karoly Horvath (khorvath@POL.NET) Subject: Re: Reaction to gluten challenge Mary Anne Cripe's question was: " does that mean I could be getting damage without knowing it because I have no obvious reaction?" Based on our studies a typical (biopsy proven flat mucosa, proved immune reactions to gluten) gluten intolerant patient does not react immediately with clinical symptoms for a gluten challenge (J Pediatr Gastroenterol Nutr 1989, 9:176-180).. However, ingestion of GRAMS OF GLUTEN causes several changes in the intestine. 1. There is an accumulation of inflammatory cells 2. One cell type -so called mast cells- releases factors which factors in long-term damage the villi and they also release a factor which 3. Increases the permeability -leakiness- of the intestine, which is a temporarily change after a single ingestion but may be permanent after repeat dietary mistakes. I hope it answers your question, Karoly Horvath, M.D., Ph.D. Baltimore =========================================================================
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