Health & Fit The Dilemma of the Gluten-Free Diet

20:09  16 april  2018
20:09  16 april  2018 Source:   online.wsj.com

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Test results for someone following a gluten - free diet for any length of time are rendered inaccurate. Carlson faces a dilemma common to those who decide to go on the gluten - free diet first, before getting tested for celiac disease.

Before you know it, your diet hardly resembles a plant-based diet . Fortunately, since so many foods are naturally gluten - free & vegan, I don’t have to make this choice very often. Since I have an intolerance to gluten, but not necessarily eggs, I’d take the

  The Dilemma of the Gluten-Free Diet © siriwat nakha/Getty Images People with celiac disease can still consume enough of the protein to trigger health problems.

It’s not unusual after eating that the symptoms set in for Lee Graham: severe stomach pain and worse.

“It’s always sort of a game of Russian roulette when you go out to eat,” says Ms. Graham, executive director of the National Celiac Association, a Needham, Mass.-based nonprofit that advocates for people with celiac disease.

What’s frustrating for Ms. Graham is that this can happen even when she’s eating what is supposed to be a gluten-free meal.

A new study in the American Journal of Clinical Nutrition shows that eating gluten-free is nearly impossible, underscoring the need for better treatments for patients with celiac disease.

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Those on a gluten - free diet must forgo all products containing wheat, barley, rye, and the various ingredients that contain derivatives of these grains. Those who are gluten - free embrace a diet filled with fruits, vegetables, meats, poultry, fish, beans, and legumes.

The Gluten - Free Dilemma . By Kyle Arsenault. There were a few athletes this week asking about gluten, so I wanted Well, it sure seems that way since many individuals who switch to a gluten free diet end up having more energy, getting better sleep, and obtaining a healthier and stronger physique.

The good news: About half a dozen potential treatments are in the works, ranging from a vaccine to a capsule designed to regulate the gut. But most are at least a couple of years from entering the market. And celiac patients would still have to maintain a gluten-free diet, which is currently the only answer for the disease.

Experts say up to 1% of the global population has celiac disease, an autoimmune condition in which people develop an immune reaction to gluten. Gluten is a protein that appears in any food containing wheat, barley and rye. The immune system reaction results in inflammation and damage in the lining of the small intestine, which can lead to medical complications, such as acute stomach pain and failure to absorb nutrients.

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Blog/Blog/ The gluten - free dilemma | Should I be gluten - free ? And how? The only treatment for celiac disease is complete removal of all gluten from the diet , even down to the tiniest crumb. Living Gluten - Free .

The Diet Dilemma . People avoiding gluten often reach for what seems the next best thing: wheat- free versions of traditional flour-filled items like breads and pastas. Because gluten is the component that makes baked goods light and airy

The odds of getting celiac disease in the U.S. have increased four- to fivefold over four decades, says Peter Green, director of the Celiac Disease Center at Columbia University Medical Center, but have leveled off in recent years.

“There has been this increased rate of diagnosis as well, but there’s still a lot of people with celiac disease who don’t know they have it,” Dr. Green says. He was an author on another study looking at the global prevalence of celiac disease published in 2017 in the journal Clinical Gastroenterology and Hepatology.

Dr. Green says it’s unclear what the lowest level of gluten is that causes intestinal damage in patients. “About 30% of people don’t get better on a gluten-free diet,” he says.

The American Journal of Clinical Nutrition study used data from three prior clinical trials to estimate how much gluten 246 celiac patients were ingesting. The gluten measurements were based on either a stool or urine sample.

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Gluten - Free Diet : Heart Healthy Solutions. Anne Roland Lee MSEd, RD, LD Director of Nutritional Services. All rights reserved. Dilemma of the Alternative Grains. Provide missing nutrients but possibility of cross-contamination. • Oats.

The Gluten - Free Diet . Gluten is a protein particle found in all forms of wheat, barley and rye. The gluten - free diet has quickly become one the fastest growing nutritional movements in America, gaining popularity for its health and therapeutic benefits.

The study found that on average patients were ingesting 200 to 250 milligrams of gluten a day, says Jack Syage, CEO of ImmunogenX, a Newport Beach, Calif.-based biotechnology company, and first author on the study. Someone without celiac disease eats about 7,500 to 10,000 milligrams of gluten a day.

The study didn’t look at where the gluten comes from. Dr. Syage says researchers guess much of it is inadvertently consumed when food is contaminated during processing or preparation.

Those with celiac disease typically need to limit exposure to under 100 milligrams, but the threshold can vary depending on a person’s sensitivity, says Joseph Murray, a professor of gastroenterology at the Mayo Clinic in Rochester, Minn.

  The Dilemma of the Gluten-Free Diet © Image Source/REX/Shutterstock The U.S. Food and Drug Administration requires that packaged foods labeled gluten-free contain fewer than 20 parts per million of gluten—the equivalent of 20 milligrams of gluten in one kilogram of food. Gluten Free Watchdog, a group that tests packaged gluten-free foods, has found that foods test at or above 20 parts per million of gluten about 4% of the time.

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Researchers suggest avoiding the gluten - free diet unless it's absolutely necssary. Timothy Hiatt Getty Images Entertainment. ( Gluten Free Museum). This poses a dilemma , of course, and makes a diagnosis subjective.

The Gluten Free Chef. Our family of four recently started the GAPS diet , which is not only gluten free (and casein free on the strict regime), but completely starch free.

Dr. Murray is working with ImmunogenX on developing an enzyme called latiglutenase, designed to be taken with meals to help patients digest gluten. ImmunogenX acquired the enzyme mixture from Alvine Pharmaceuticals in 2016 after a phase 2 trial failed to demonstrate healing of the small intestine. The study showed improvement of symptoms for a subgroup of celiac patients. The current ImmunogenX trial will focus on the 20% of celiac patients who have persistent symptoms while following a gluten-free diet.

The company is launching a final phase 2 clinical trial in a few months. If successful, it would have to do a phase 3 trial before applying to the FDA for approval as a drug. The earliest a commercially available drug could hit the market is late 2020.

Innovate Biopharmaceuticals in Raleigh, N.C., expects to launch a phase 3 trial later this year for larazotide acetate, a drug taken as a capsule that would be taken before every meal.

Jay Madan, founder and president of the company, says the drug helps regulate the leakiness of the gut. Results from phase 2 clinical trials showed improvement in abdominal symptoms. The drug isn’t absorbed by the body and was well tolerated in more than 500 patients.

Immusant, a Cambridge, Mass.-based biotechnology company, will enter into a phase 2 clinical trial of its vaccine, Nexvax2, this year, says Leslie Williams, president and CEO of the company.

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The gluten - free diet seems to be the latest trend. When I was diagnosed with Celiac Disease four years ago, not too many people were aware of what it was. Now “ gluten - free ” is a buzzword.

The Gluten - Free Diet . Gluten is a protein particle found in all forms of wheat, barley and rye. The gluten - free diet has quickly become one the fastest growing nutritional movements in America, gaining popularity for its health and therapeutic benefits.

The vaccine doesn’t prevent celiac disease but is a therapeutic treatment akin to an allergy shot, she says. It would require self-injecting weekly to maintain non-responsiveness to gluten.

“Our initial approach is to protect patients against inadvertent exposure to gluten,” Dr. Williams says. “Ultimately we will see if we can get them to reintroduce gluten, too.”

Researchers will present the results of phase 2 clinical trials of the drug AMG 714 in June, says Francisco Leon, the co-founder and former CEO of Celimmune, which was recently acquired by Amgen.

Dr. Leon, who now works as a consultant to Amgen, says the drug is an antibody that blocks interleukin-15, a protein that stimulates the immune system in the gut, causing damage and gastrointestinal symptoms.

Researchers tested the drugs in a pair of phase 2 studies. One featured patients with refractory celiac disease type 2, the most severe form of celiac disease. It affects about 1 in 200 celiac patients and is considered lymphoma of the gut. Doctors also tested the drug with a larger population of celiac disease patients.

Several other treatments are in earlier stages of development. Cour Pharmaceutical in Chicago and Takeda Pharmaceutical in Japan are using nanotechnology to try to reprogram the body’s immune system to enable patients to develop a tolerance to gluten and potentially reverse symptoms of the disease.

The companies launched a phase 1 trial in February which they expect to complete in March of 2019.

Write to Sumathi Reddy at sumathi.reddy@wsj.com

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