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Susan,

I am going to post my answer to your question (reproduced at the end of this
rather long communication) to the list as a whole because the information
might be of interest to others.

The connection with wheat (and rye and barley) wasn't recognized until the
1950's so I can't say what system the physicians treating your mother were
following. And it wasn't until the 1960's that intestinal biopsies began to
become commonly used in the diagnosis of celiac disease.  Was your mother
ever diagnosed by biopsy?

With regard to the harmfulness of barley malt, the situation is complicated.
I will give you my best shot with the qualification that the ideal
experiments haven't been done and a definitive statement is not possible at
this time.

Because barley malt is made from barley grain that has been germinated it is
reasonably certain to be less toxic than barley itself.  The hordein
proteins and starch in the endosperm of barley grains, like the equivalent
gluten proteins and starch in wheat, are there for storage purposes.  In a
sense, they provide food for the new plant upon germination.  In order to
use the hordein proteins, the grain releases and generates enzymes upon
germination that break down the storage proteins into their constituent
amino acids.  The problem is that the process is not complete during a short
germination, so some peptides (short pieces of the proteins) remain intact
in malted barley. There is experimental evidence for this.  The resulting
mix of peptides is highly complex.

We know from work described in the scientific literature that relatively
small polypeptide chains can still retain activity in celiac disease and we
know something about a few sequences that seem to be harmful.  But we
probably don't know all the sequences that are harmful and we haven't put
our fingers on the common theme that gives rise to the activity in celiac
disease.  So the question arises as to whether or not the remaining
sequences in malted barley are harmful.

The possibilities that come to my mind are:

a) there are sufficient remaining harmful peptides (with sizes including
approximately 12 or more amino acid residues) to give a significant activity
in celiac disease to barley malt (remember though that barley malt is
usually a minor component of most foods in which it is used and processing
might decrease the amount of harmful peptides in a malt product);

b) there are traces of these peptides, but they are sufficiently minimal so
as to cause no discernible harm; or

c) the key harmful amino acid sequences are completely destroyed by the
enzymes during germination (I can speculate that there might be an important
enzyme, very active, in germination that clips a key bond in active
sequences, thus reducing the concentration of those active sequences to
almost nil while still allowing non-harmful peptides to exist; no evidence
exists for this speculation, but it could be used as a working hypothesis
for experimentation).

There is no completely solid evidence for or against there being a threshold
of gluten consumption below which no harm, or at least no lasting harm,
occurs and above which definite harm occurs (but see my previous post to the
list on starch/malt question).  This is a difficult area to study where zero
consumption is being approached and the arguments that come up are at least
similar to those that have arisen in regard to the question of  whether or
not there is a minimal level of radiation exposure below which no harm is
caused, but above which there is harm that increases with dosage.
Accordingly, celiac patients must choose arbitrarily the path they feel
comfortable with.

Don Kasarda
Albany, California

>Your comments on malt flavouring were much appreciated. My mum who had
>celiac disease in 1924, was given malt by the tablespoon with a strict soy
>based diet. I am assuming that Canadian doctors followed the British way of
>doing things back then.
>Since she survived with this malt regimen, she questions the big hoopla that
>is made about malt. Is it because the barley gluten in malt is not as toxic
>as the wheat gluten?
>
>Susan
>Maple Ridge, B.C.