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In <[log in to unmask]>, on
04/17/00

   at 08:22 PM, Maryellen Durkot <[log in to unmask]> said:

>>Does anybody have any "Facts" about this?  I would like to here from you
>>if you have any facts you can back up with research from experts.

Yes, and below I quote from a previous message of mine to the list. First,
however,  there are several parts to the controversy originally cited.
Confusion between these parts gets in the way of resolving the issue. (1)
What is the remaining level of wheat protein, the gluten portion thereof,
in the washed wheat starch?  (2)  What, if any, non-zero time average
amount of gluten is safe for those gluten sensitive?  (3) What is the true
medical status of those apparently gluten sensitive to whom the starch is
being offered?

With respect to the last issue, I, along with some 75 others in a local
support group, recently learned something from a recognized celiac expert.
I don't have permission to quote this person, but the statement deserves
to be out in the open since it suggests there there may indeed be two
diets, one for three categories of gluten sensitives, another for the
other two. (There are several local support groups in the NY metro area to
further protect his identity.)  He discussed briefly the gradual build-up
of intestinal damage in a celiac when gluten is consumed leading
eventually to the "classic" GI symptoms of celiac disease: diarrhea,
vomiting, abdominal distress, etc.. Afterwards in the question period, I
asked about those who, following a GF diet and apparently with healed
intestines, could have such symptoms for a short time frollowing a single
encounter with gluten. His response was that he didn't know what other or
additional condition caused this, but that it was not celiac disease.

If he is correct then a clean enough wheat starch (or clean enough oats, I
might add) diet is acceptable for those with CD only, and the stricter
diet is for those with this other condition.  I prefer to name this other
condition allergy/intolerance because no one has or should take the
intestinal samples during that short term distress period that would be
needed to distinguish which of these two sensitivities is involved for
those two categories. (Furthermore, list owners allow the distinction
between allergy and intolerance to be abused  in postings so the posted
terms here are ambiguous.)

Enough, the study. Sample size about three times larger than the Candian
study, hence more reliable statistically. 8 years versus 1 year. There
were no intestinal comparisons in the Canadian study. Maximum wheat starch
Codex limit used for the flour to find the "average" daily gluten intake
in the study of 34 mg./day. Canadian study claims to measure their average
at 1.5 mg./day, but, issue (1) above, we'd need Don Kasarda to tell us
whether their gluten measurements are reliable at this level.

>>Nearly all posters to this list seem to think there's only one true celiac
diet for all who are gluten sensitive and ignore the fact that a variety
of other diets, varying by amounts of gluten allowed,  are used outside
the US. One memorable exception was a comment from Canada that surely
intestines being switched to a "GF" diet were the same in Canada as the
US;  so why were the diets different?

Here's some recent evidence from Finland comparing a diet with wheat
starch to one without, a eight year study that included very careful
intestinal comparisons. I don't have a copy of the article yet so I don't
know the average rate of gluten consumption, but can post later. Bear in
mind that the wheat starch involved was likely certified as washed enough
by the Finnish celiac society. Dr. Marku Maki, likely the senior author
of the study, has been and may still be president of that society.

>> Scand J Gastroenterol 1999 Feb;34(2):163-9

Wheat starch-containing gluten-free flour products in the treatment of
coeliac disease and dermatitis herpetiformis. A long-term follow-up study.

Kaukinen K, Collin P, Holm K, Rantala I, Vuolteenaho N, Reunala T, Maki M

Dept. of Medicine, Tampere University Hospital, Finland.

BACKGROUND: We investigated whether wheat starch-based gluten-free
products are safe in the treatment of gluten intolerance. METHODS: The
study involved 41 children and adults with coeliac disease and 11 adults
with dermatitis herpetiformis adhering to a gluten-free diet for 8 years
on average. Thirty-five newly diagnosed coeliac patients at diagnosis and
6 to 24 months after the start of a gluten-free diet and 27 non-coeliac
patients with dyspepsia were investigated for comparison. Daily dietary
gluten and wheat starch intake were calculated. Small-bowel mucosal
villous architecture, CD3+, alphabeta+, and gammadelta+ intraepithelial
lymphocytes, mucosal HLA-DR expression, and serum endomysial, reticulin,
and gliadin antibodies were investigated. RESULTS: Forty of 52
long-term-treated patients adhered to a strict wheat starch-based diet and
6 to a strict naturally gluten-free diet; 6 patients had dietary lapses.
In the 46 patients on a strict diet the villous architecture, enterocyte
height, and density of alphabeta+ intraepithelial lymphocytes were similar
to those in non-coeliac subjects and better than in short-term-treated
coeliac patients. The density of gammadelta(+)cells was higher, but they
seemed to decrease over time with the gluten-free diet. Wheat starch-based
gluten-free flour products did not cause aberrant upregulation of mucosal
HLA-DR. The mucosal integrity was not dependent on the daily intake of
wheat starch in all patients on a strict diet, whereas two of the six
patients with dietary lapses had villous atrophy and positive serology.
CONCLUSION: Wheat starch-based gluten-free flour products were not harmful
in the treatment of coeliac disease and dermatitis herpetiformis.

PMID: 10192194, UI: 99206412 <<

--                   Kemp Randolph
-----------------------------------------------------------
"Kemp Randolph" <[log in to unmask]>