Elisabeth Phillips PhD and Antony Haynes BA, RNT explore the role and nature of digestive enzymes, to unlock some of the mystery around their role in human health and supplementation.

Digestive enzymes catalyse (cause or accelerate (a reaction) by acting as a catalyst) the breakdown of food in the mouth and gut so nutrients are released and can be absorbed across the intestinal barrier into the blood stream. Therefore, one of the main functions of digestive enzymes is to increase the bioavailability of nutrients.

Dr Carrie Decker ND, explores the possible risk reduction benefits achieved by enzymatic breakdown of inadvertant exposure to gluten peptides. Individuals who experience coeliac disease or Non-Coeliac Gluten Sensitivity (NCGS) are at risk for exposure to gluten in many settings. Although the home setting can be fairly well controlled by elimination gluten or utilising cooking strategies to separate gluten-containing foods from those that are gluten-free, many restaurants and homes of friends and family often are not as well versed in making foods that are gluten-free.

Dr Carrie Decker ND, explores the potential management of indavertent ingestion of gluten, which for those people needing to exclude exposure to these proteins and lead a life that includes eating foods that have not been prepared at home, can be a significant risk to well being.

Coeliac disease (CD) is the most studied and broadly recognised disease associated with the immune reaction to gluten consumption, however other types of ‘gluten sensitivity’ also exist. These conditions are broadly known as Non-Coeliac Gluten Sensitivity (NCGS). The immune response to gluten proteins and polypeptide regions varies, but may involve the innate immune system, class I or class II mediated reactions, and antibody recognition.[1] The topic of NCGS is being increasingly studied, as is evidenced in the following quote extracted from an article in Nutrients:- “Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders”[2]:

The Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity (COT) are both advisory committees of independent experts that provide advice to the Department of Health and Food Standards Agency in the United Kingdom.[1]

In March 2011, the committees jointly completed an in-depth review examining the most appropriate time to introduce gluten into an infant’s diet. They considered the available evidence to see whether the time that gluten is introduced into an infant’s diet affects the likelihood of developing coeliac disease and type 1 diabetes mellitus.

One of the questions that crops up in the clinical management of patients suspected of having coeliac disease, is: If my patient has been gluten free, or is going to try an exclusion from gluten containing foods, how long should they be free of gluten before undertaking a gluten challenge test?An article in GUT looks to explain this in some detail [1]

Our understanding of the pathophysiology of coeliac disease has advanced with associated improvement in diagnostic modalities. Recent studies have placed the prevalence of coeliac disease in Western populations at between 1:250 and 1:67. Coeliac disease is common throughout the world and most cases go undiagnosed. Understanding the risk factors, clinical presentations and diagnostic modalities is necessary to identify and treat patients with this commonly misdiagnosed disorder.

As a Nutritional Therapist the concepts of gluten reactivity outside of the diagnosis of coeliac disease has been an easy leap of faith. Over the last few years as a greater understanding of different gluten sensitivity conditions have been uncovered, many scientists are revisiting conditions to see if there may be a correlation of clinical relevance.

In one study published in the open access journal PLOS researchers have found elevated antibodies to gluten proteins of wheat in children with autism in comparison to those without autism. The results also indicated an association between the elevated antibodies and the presence of gastrointestinal symptoms in the affected children.[1] They did not find any connection, however, between the elevated antibodies and coeliac disease, an autoimmune disorder known to be triggered by gluten.

But…. it also appears to offer far more than simply compressing overall body mass. For some time the world of gluten sensitivity as well as the pathology coeliac disease have been experiencing a substantial amount of increased scientific and lay interest. The long held critique that most Nutritional Therapist suggest avoiding gluten in the absence of CD is a needless and just a fallacious recommendation has come under increasing credibility attack.

…..Is the title to the BMJ’s Editor’s Choice article this week (Dec 12th 2012) and whilst we in the Nutritional Therapy world find the concept that physicians still deny the empirical evidence of people recovering post gluten and often lactose excluding diets as NOT being indicative of there being a problem, Fiona Godlee does recognise a problem exists.[1]

Examples of macroscopic features of villous atrophy detected by wireless capsule endoscopy in coeliac disease: A) Normal villi, B) scalloping of the mucosa on circular folds, C) fissuring of the mucosa, D) mosaic pattern. © Mayo Clinic

Researchers from the USA, Europe and other research centres are suggesting that Coeliac Disease has increased up to 4 x in the last 30 years.

They suggest that as much as 1% of the adult and child populations may have CD, and as we know there are many others that have yet to have the disease diagnosed, but experience problems with gluten and are diagnosed as being intolerant or sensitive.

Let’s be clear about what gluten intolerance is. ‘It isn’t a food allergy’. It’s a physical condition in your gut. Basically, undigested gluten proteins (prevalent in wheat and other grains) lurk around your intestines and are regarded by your body as a foreign invader, irritating your gut and flattening the essential microvilli along the small intestine wall. This reduces the surface area available to absorb the nutrients from your food. This can result in symptoms of malabsorption, including chronic fatigue, neurological disorders, nutrient deficiencies, anaemia, nausea, skin rashes, depression, and more.

Whilst there are better screening techniques today than there were in the 1980’s, we must also recognise that there are many other factors at work here, one of which is the changing levels of gluten in grains from hybridisation techniques.