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Benefits of Carbohydrase enzyme supplementation for Celiacs?

     Two unrelated postings from medical EMail lists and a
conversation with an enzyme specialist in Madison, Wisconsin all
suggested that carbohydrase supplementation could be of benefit
to people with gluten intolerance.  This prompted me to perform a
literature search on gluten and the enzymes in question, which
disclosed several interesting references.  The conclusions
suggested by this quick literature review and a preliminary test
myself are quite significant: it appears that supplementation
with an enzyme formulation containing maltase, sucrase, and
lactase taken with meals can yield significant benefits for
Celiacs.

     I offer this not as a conclusive finding, but rather as a
hypothesis with some scientific support for critical review by
this mailing list.  I have learned in other medical areas that I
followed much more closely that preliminary conclusions can prove
fallacious, but, on the other hand, well-supported medical
advances effecting uncommon conditions can remain unknown to
general practitioners for years.  I invite critical review of the
points offered and do not recommend the supplement described
until sufficient time has elapsed to elicit other views.

     Here is what I found:

     1) The levels of duodenal and jejunal carbohydrase enzymes
in Celiac adults [1,2] and children [3], specifically maltase,
sucrase, and lactase, is 10-20% of normal levels.  All three
cited studies found that such levels were significantly depressed
in Celiacs even 1-2 years after following strict gluten-free
diets.

     2) The rate of gastric emptying into the intestine is slowed
by glucose, and deficiency of amylase or lactase is associated
with rapid emptying of starch and lactose loads into the small
intestine [4].

     3) Working on the hypothesis that the toxicity of gliadin
arose from carbohydrate side-chains and not the protein core, a
study was conducted in which Gliadin was fed to Celiac subjects
either untreated (control, 1 patient) or pretreated treated with
a mixture of carbohydrase enzymes prepared from Aspergillus niger
(3 patients).  Using biopsies before and after gliadin ingestion
and xylose absorption tests, abnormal changes were found only in
the patient who consumed untreated gliadin; that patient also had
diarrhea while the other three had no symptoms.[5]

     4) An inexpensive enzyme supplement ($30 per 180 capsules)
is available from the NESS company -- not sold directly to
consumers but to physicians, chiropractors, naturopaths, and
other health providers.  The formulation of interest is Ness
formula #21 which contains protease, 20,000 HUT; amylase, 2,000
DU; lipase, 40 LU; lactase, 240 LacU; sucrase, .20 IA; maltase,
270 DPo, and cellulase, 200 CU.

     My "straw man" conclusions from this information, again,
open to challenge, are that such an enzyme supplement with meals
can be of major benefit to Celiacs in three ways: 1) normalizing
typically deficient carbohydrase activities, permitting proper
digestion of carbohydrates; 2) preventing premature dumping of
gastric contents into the small intestine, compounding damage in
that can result from gluten intolerance (which can further
depress carbohydrase activity in a vicious cycle), and 3)
possibly detoxifying accidentally consumed gluten to some degree.

     Note that I would never rely upon such enzymes to detoxify
purposefully ingested gluten--I would want to see several
corroborating studies demonstrating that such detoxification
occurs through oral ingestion of such enzymes at a specific dose
before risking such step.  However, since trace gluten is
ubiquitous, such potential detoxification, even if only partial,
could be helpful; perhaps larger quantities of enzymes could be
ingested after eating something which upon second thought appears
possibly suspicious.

     Anyway, I got hold of some Ness formula #21 and have tried
it with meals over the last few days.  I have felt like I've
digested food for the first time, feeling less ravenously hungry
and more energetic.  I can't draw any meaningful conclusions from
my own experience in such a short period, but did not want to
withhold posting this information pending months to monitor my
own condition.  Since I cannot identify any potential harm from
such enzyme supplementation, I will continue to try it myself,
but again, invite dissenting comments and simply put out this
preliminary information for discussion.  -- David Scheim, Ph.D.


1.   Grefte JM, Bouman JG, Grond J, et al. Slow and incomplete
     histological and functional recovery in adult gluten
     sensitive enteropathy. J Clin Pathol 41:886-91, 1988.

2.   Berg NO, Dahlqvist A, Lindberg T, Norden A. Intestinal
     dipetidases and disaccharidases in celiac disease in adults.
     Gastroenterology 59:575-82, 1970.

3.   Arthur AB. Intestinal disaccharidase deficiency in children
     with coeliac disease. Arch Dis Childh 41:519-24, 1966.

4.   Mallinson CN. Effect of pancreatic insufficiency and
     intestinal lactase deficiency on the gastric emptying of
     starch and lactose. Gut 9:737, 1968.

5.   Phelan JJ, Stevens FM, McNicholl B, et al. Coeliac disease:
     the abolition of gliadin toxicity by enzymes from
     Aspergillus niger.  Clin Sci Mol Med 53:35-43, 1977.