Gluten Microchallenge With Wheat-Based Starch in Coeliac Disease
Background: Wheat-based starch hydrolysates such as glucose syrups, dextrose and maltodextrins are found in more than 50% of European processed food. These products contain low amounts of residual gluten and it has been questioned whether they are safe for coeliac disease patients.
Aim: To investigate whether coeliac disease patients can safely consume wheat-based starch hydrolysate products.
Methods: This randomized, double-blind, placebo-controlled, prospective follow-up study involved 90 coeliac disease patients in remission randomized to consume glucose syrups, maltodextrins or placebo for 24 weeks. Small bowel mucosal morphology and inflammation, symptoms, coeliac serology and malabsorption laboratory data were evaluated at baseline and at the end of the study.
Results: Daily ingestion of wheat-based starch hydrolysates, glucose syrups and maltodextrins, had no deleterious effect on small-bowel mucosal villous architecture or inflammation in coeliac disease patients when compared to the placebo group. Neither were there any significant differences in gastrointestinal symptoms, serology or malabsorption parameters after 24 weeks.
Conclusions: Wheat-based starch hydrolysates, glucose syrups and maltodextrins did not have harmful effect on coeliac disease patients. Coeliac patients can thus safely continue to consume these products.
Coeliac disease is a genetically linked small-intestinal disorder induced by wheat-, rye- and barley-derived gluten. It is a major public health burden in Western countries, as it occurs in approximately 1% of the population. A lifelong gluten-free diet is currently the only treatment for the disease and alleviation of symptoms and recovery of mucosal damage are evident on a strict diet. While it is generally agreed that a gluten-free diet should be as strict as possible, a diet completely devoid of gluten is probably impossible to maintain. The safe threshold for gluten in gluten-free products is under investigation. Industrially purified wheat starch-based gluten-free products have been shown to contain trace amounts of gluten (0-150 mg/kg = ppm gluten). Although the products have proved safe in clinical practice, some authorities recommend only cereals, which are gluten-free by nature (maize, rice, buckwheat), for the treatment of coeliac disease.
In the above-mentioned prospective studies, wheat starch-based gluten-free products consisted solely of flours. In addition, wheat-based starch hydrolysates such as glucose syrups and maltodextrins are formulated in soft drinks, beverages, confectionaries, desserts, infant food and dietetic products and together with maize-based starch hydrolysates, these hydrolysates are found in a wide range of European processed food. Hitherto, these products have been consumed by coeliac disease patients in their daily gluten-free diet. The amount of gluten after ingesting wheat-based starch hydrolysate products is most probably lower than what has been shown in wheat starch-based gluten-free flours. With the present analytical methods for gluten and for protein, in general, technical difficulties are encountered when they are applied to hydrolysed proteins in food products. In wheat-based starch hydrolysates, the residual gluten can also be hydrolysed as a result of the process. The European Commission Directive 2000/13/EC (amended by Directive 2003/89/EC) demands that products derived from cereals containing gluten be labelled with an indication of their botanical origin unless they are proved not to trigger adverse reactions. If this issue is not properly addressed, many products would be unnecessarily labelled as gluten-containing and regarded not suitable for coeliac disease patients. This could jeopardize the treatment of coeliac disease with unnecessary and inconvenient restrictions and might increase the disease burden and reduce the quality of life. However, no clinical trials on wheat-based starch hydrolysates have so far been carried out. On the other hand, it would be unethical to allow the consumption of these products containing tiny amounts of gluten without properly investigating their safety. Clinical and histological recovery in coeliac disease patients cannot always be achieved even with a strict gluten-free diet; it is not known whether such problems may be related to gluten traces.
Our aim here was to establish whether wheat-based starch hydrolysates (glucose syrups and maltodextrins) have untoward effects on small-bowel mucosal morphology or inflammation, serology or symptoms in coeliac disease patients. This was to ensure that coeliac patients can safely continue to consume products containing wheat-based starch hydrolysates in their daily gluten-free diet.
Background: Wheat-based starch hydrolysates such as glucose syrups, dextrose and maltodextrins are found in more than 50% of European processed food. These products contain low amounts of residual gluten and it has been questioned whether they are safe for coeliac disease patients.
Aim: To investigate whether coeliac disease patients can safely consume wheat-based starch hydrolysate products.
Methods: This randomized, double-blind, placebo-controlled, prospective follow-up study involved 90 coeliac disease patients in remission randomized to consume glucose syrups, maltodextrins or placebo for 24 weeks. Small bowel mucosal morphology and inflammation, symptoms, coeliac serology and malabsorption laboratory data were evaluated at baseline and at the end of the study.
Results: Daily ingestion of wheat-based starch hydrolysates, glucose syrups and maltodextrins, had no deleterious effect on small-bowel mucosal villous architecture or inflammation in coeliac disease patients when compared to the placebo group. Neither were there any significant differences in gastrointestinal symptoms, serology or malabsorption parameters after 24 weeks.
Conclusions: Wheat-based starch hydrolysates, glucose syrups and maltodextrins did not have harmful effect on coeliac disease patients. Coeliac patients can thus safely continue to consume these products.
Coeliac disease is a genetically linked small-intestinal disorder induced by wheat-, rye- and barley-derived gluten. It is a major public health burden in Western countries, as it occurs in approximately 1% of the population. A lifelong gluten-free diet is currently the only treatment for the disease and alleviation of symptoms and recovery of mucosal damage are evident on a strict diet. While it is generally agreed that a gluten-free diet should be as strict as possible, a diet completely devoid of gluten is probably impossible to maintain. The safe threshold for gluten in gluten-free products is under investigation. Industrially purified wheat starch-based gluten-free products have been shown to contain trace amounts of gluten (0-150 mg/kg = ppm gluten). Although the products have proved safe in clinical practice, some authorities recommend only cereals, which are gluten-free by nature (maize, rice, buckwheat), for the treatment of coeliac disease.
In the above-mentioned prospective studies, wheat starch-based gluten-free products consisted solely of flours. In addition, wheat-based starch hydrolysates such as glucose syrups and maltodextrins are formulated in soft drinks, beverages, confectionaries, desserts, infant food and dietetic products and together with maize-based starch hydrolysates, these hydrolysates are found in a wide range of European processed food. Hitherto, these products have been consumed by coeliac disease patients in their daily gluten-free diet. The amount of gluten after ingesting wheat-based starch hydrolysate products is most probably lower than what has been shown in wheat starch-based gluten-free flours. With the present analytical methods for gluten and for protein, in general, technical difficulties are encountered when they are applied to hydrolysed proteins in food products. In wheat-based starch hydrolysates, the residual gluten can also be hydrolysed as a result of the process. The European Commission Directive 2000/13/EC (amended by Directive 2003/89/EC) demands that products derived from cereals containing gluten be labelled with an indication of their botanical origin unless they are proved not to trigger adverse reactions. If this issue is not properly addressed, many products would be unnecessarily labelled as gluten-containing and regarded not suitable for coeliac disease patients. This could jeopardize the treatment of coeliac disease with unnecessary and inconvenient restrictions and might increase the disease burden and reduce the quality of life. However, no clinical trials on wheat-based starch hydrolysates have so far been carried out. On the other hand, it would be unethical to allow the consumption of these products containing tiny amounts of gluten without properly investigating their safety. Clinical and histological recovery in coeliac disease patients cannot always be achieved even with a strict gluten-free diet; it is not known whether such problems may be related to gluten traces.
Our aim here was to establish whether wheat-based starch hydrolysates (glucose syrups and maltodextrins) have untoward effects on small-bowel mucosal morphology or inflammation, serology or symptoms in coeliac disease patients. This was to ensure that coeliac patients can safely continue to consume products containing wheat-based starch hydrolysates in their daily gluten-free diet.
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