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Hi

I have corresponded with Kemp concerning his recent email regarding
wheat starch. Jeff's email on the same topic has now arrived on my
screen.

List members may be interested in the following:

I have a copy of a formal document ( 1993 ) quoting the National Food
Authority of Australia stating:

`Currently there are foods on the market labelled as "gluten-free".
However, some of these "gluten-free" foods contain small amounts of
gluten and cause coeliacs who are extremely sensitive to gluten to become
ill.'

The concern of the Australian Authority included `Codex defined'
wheat-starch based products.

To repeat. Some coeliacs were becoming ill on such products

Australia and New Zealand have now effectively defined `gluten-free' as
`containing no detectable gluten'. Codex quality wheat starch products
cannot be labelled as `gluten-free' in these two countries.

In NZ, the one such product on the market must now be labelled as
`low-gluten'.


List members may also be interested in the following recent research
items which do indicate problems with Codex quality wheat-starch
products for at least some coeliacs.

Chartrand LJ; Russo PA; Duhaime AG; Seidman EG. Wheat starch intolerance
in patients with celiac disease. J Am Diet Assoc, 97(6):612-8  1997 Ju.n

Abstract: OBJECTIVE: Evaluate in patients with celiac disease the
tolerance of prolonged consumption of small amounts of gliadin contained
in products containing wheat starch. DESIGN: Open 1-year trial of the
addition of wheat starch to a gluten-free diet in a cohort of adult
patients with biopsy-proven celiac disease who had never consumed wheat
starch. The control group consisted of patients with celiac disease who
tolerated wheat starch.

SUBJECTS: Seventeen patients with celiac disease and 14 control
patients, all diagnosed according to criteria of the European Society of
Pediatric Gastroenterology and Nutrition, were recruited from the
Canadian Celiac Association and the Quebec Celiac Foundation.

SETTING: The study was conducted in the outpatient clinic of the
Gastroenterology and Nutrition Service of Ste Justine Hospital,
Montreal,Quebec, Canada.

INTERVENTIONS: Patients were asked to consume four to six portions daily
of a wheat starch-containing product, mainly bread, for up to 1 year.

MAIN OUTCOME
MEASURES: The gliadin content of the wheat starch product
used in this trial was quantified by enzyme-linked immunosorbent assay.
Patient outcome measures included symptoms, nutritional parameters
(anthropometric data, complete blood count, serum folate and iron
levels), and immunologic parameters (antigliadin antibody and
antiendomysiumantibody titers). RESULTS: A quantifiable amount of
immunoreactive gliadin (0.75 mg/100 g) was found in the wheat starch.
The majority of the patients with celiac disease (11 of 17) who had
never consumed wheat starch previously developed symptoms, which
resolved within weeks of discontinuing the product.

Relapse of skin lesions was seen in two of three patients with
coexisting dermatitis herpetiformis. No weight loss or biochemical
changes were observed.  Despite the presence of symptoms, antigliadin
antibody and antiendomysium antibodydeterminations were not useful to
detect the clinical intolerance. APPLICATIONS: The innocuousness of the
long-term ingestion of "gluten-free" products containing wheat starch is
stillunproven, and prolonged use of such products by patients with
celiac disease cannot be recommended.


Faulkner-Hogg KB; Selby WS; Loblay RH. Dietary analysis in symptomatic
patients with coeliac disease on a gluten-free diet: the role of trace
amounts of gluten and non-gluten food intolerances. Scand J
Gastroenterol, 34(8):784-9  1999 Aug.

Abstract: BACKGROUND: Whereas many people with coeliac disease (CD) are
asymptomatic when consuming a gluten-free diet (GFD), a proportion
continues toexperience symptoms. The reasons for this are unclear.

METHODS:
Thirty-nine adult members of The Coeliac Society of New South Wales, all
of whom had persistent gastrointestinal symptoms despite adhering to a
GFD, were evaluated.

Dietary analysis indicated that 22 (56%) were consuming a GFD as defined
by the WHO/FAO Codex Alimentarius (Codex-GFD), in which foods containing
up to 0.3% of protein from gluten-containing grains can be labelled as
'gluten free'.  The remaining 17 were following a no detectable gluten
diet (NDG)-GFD, as defined by Food Standards Australia. All subjects
were required to follow a NDG-GFD during the study. Those in whom
symptoms persisted after changing from a Codex-GFD and thosewho entered
the study already on a NDG-GFD began an elimination diet followed by
open and double-blind challenges to identify specific non-gluten food or
food chemical intolerances. RESULTS: Of 22 patients who switched to a
NDG-GFD symptoms resolved in 5 (23%) and were reduced in 10 others
(45%).  Thirty-one subjects commenced the elimination diet. Symptomatic
improvement was experienced in 24 (77%). Subsequent food or food
chemical challenges resulted in a mean of five positive challenges per
individual. Diarrhoea was the most commonly provoked symptom, followed
by headache, nausea, and flatulence. Symptoms were especially provoked
by amine, salicylate and soy. CONCLUSION: The consumption of trace
amounts of gluten, traditionally allowed in a Codex-GFD, may be
responsible for the continuing symptoms seen in some patients with CD.
Further investigation for non-gluten food intolerances should follow if
symptoms persist after adherence to a NDG-GFD.


Graeme
New Zealand