Safe Bread for Celiacs

Baked goods made from fully hydrolyzed wheat flour, manufactured with sourdough lactobacilli and fungal proteases, are safe for patients with celiac disease, according to the January issue of Clinical Gastroenterology and Hepatology.

Celiac disease is caused by an inflammatory response to wheat gluten. Luigi Greco et al. gave patients with celiac disease natural flour baked goods (127 ppm gluten), extensively hydrolyzed flour baked goods (2480 ppm residual gluten) or fully hydrolyzed baked goods (8 ppm residual gluten) for 60 days. They evaluated the patients’ levels of anti-tissue transglutaminase (anti-tTG) and anti-endomysial (EMA) antibodies to monitor disease activity, along with intestine biopsy samples.

As expected, consumption of native gluten-containing wheat flour caused symptoms and intestinal damage to patients with celiac disease. Baked goods made of wheat flour with lower concentration of gluten did not provoke symptoms, but did increase levels of anti-tTG and inflammation in the small intestinal mucosa.

The patients who ate baked goods made of wheat flour that was extensively digested by lactobacilli and fungal proteases did not develop symptoms, form antibodies against tTG or develop inflammation of the intestinal mucosa. Greco et al. propose that these baked goods are safe because of the primary proteolysis of wheat proteins, followed by transport of medium-sized polypeptides into the lactobacillus cytoplasm, where they are further degraded by peptidases. This extensive breakdown keeps the proteins from inducing an inflammatory response.

Cereal baked goods are manufactured by fast processes in which traditional long fermentation by sourdough (acidifying and proteolytic lactic acid bacteria) was replaced by chemical and/or baker’s yeast leavening agents. Under these conditions, cereal components are not degraded during manufacture. Greco et al. propose that the manufacturing of wheat and rye breads or pasta with durum flours, using selected sourdough lactobacilli, will decreased the toxicity of gluten for patients with celiac disease.

The study is unique in that Greco et al. completely evaluated the clinical, serologic, and histologic features of the patients during their diets. The authors state that indirect methods of determining gluten-induced damage are not adequate to evaluate long-term tolerance to gluten, and that short-term trials (a few weeks) are more likely to frustrate patients than provide solutions.

More Information on Celiac Disease:

Read the article online:
Greco L, Gobbetti M, Auricchio R, et al. Safety for patients with celiac disease of baked goods made of wheat flour hydrolyzed during food processing. Clin Gastroenterol and Hepatol 2011;9:24–29.

Read a related Gastroenterology review:
Schuppan D, Junker Y, Barisani D. Celiac disease: from pathogenesis to novel therapies. Gastroenterology 2009;137:1912–1933.

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About Kristine Novak, PhD, Science Editor

Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology, both published by the American Gastroenterological Association. She has worked as an editor at biomedical research journals and as a science writer for more than 12 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials. She has a PhD in cell biology and an interest in all areas of medical research.
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