Gluten digestive enzymes: playing with fire

 Someone I know who follows a gluten-free diet said that he saw an ad for this product called GlutenCutter, an supplement that claims it helps people digest gluten, on Facebook. I would assume he "likes" many gluten-free/paleo/etc. blogs on Facebook that that is why he saw this ad. I looked at the product out of curiosity and it is a bit worrying, particularly the FAQ:

Q: Is Gluten Cutter intended for those with Celiac Disease?

A: It is recommended that those with Celiac Disease first consult with a doctor prior to using Gluten Cutter.

I would only hope they have a competent doctor who tells them the truth, which is that while some research is being done on using enzymes that would possibly allow a celiac to digest gluten, this is in very preliminary stages. There is currently no safe accepted dose of gluten for a person with celiac disease.

Furthermore with the state of our health care systems, I would worry that people with celiac symptoms would use this product. People who haven't had celiac ruled out. In the US I meet many people like this who cannot afford the diagnostic tests, particularly since the gold standard if it's not ruled out otherwise is biopsy that is performed as a surgical procedure. In places like the UK, it is often hard to obtain these tests as well, as it is not easy to see a specialist. 

The supplement industry often thrives by filling in the gaps of the healthcare system, and sometimes in unsafe ways. I would not use this kind of product if it were possible that I might have celiac. 

I have used Glutenease in the past, but celiac is ruled out in my own case. Glutenease mainly contains one of the enzymes under study, which is dipeptidyl peptidase IV (DPPIV). It seemed to help me transition out of a gluten-free diet, but I stopped taking it late last year and haven't had any problems. I think if i had continued to need it, it would have indicated the possibility of a more serious problem since low levels of it in the body are tied not just to celiac, but to other diseases that cause mucosal damage.

Compared to Glutenease, Glutencutter contains a host of other supplements which might have unintended side effects. One of the many reasons I think people experimenting with supplements should avoid bundled supplements and just supplement what they need in doses that are adjustable. 

It just reminds me that gluten is probably a major public health issue in our time because

  • it is ubiquitous in the food supply
  • current tests for celiac disease are inaccessible to many (if not most) people at risk for celiac
  • even the screening tests are rarely done for people at risk, even those with symptoms
  • like other food allergies, celiac disease seems to be increasing in prevalence
  • many at-risk populations are in some developing countries

Not being gluten-free anymore has significantly broadened my ability to travel, eat-out, and go to social gatherings. And that's kind of a sad fact considering not everyone has that choice. 

In developing countries, this problem is magnified:

Wheat and barley are major diet constituents with few acceptable alternatives, rendering the convincing of parents that bread is the cause of diarrhea very hard. Also, convincing patients with atypical CD to adhere to a GFD is difficult. Finally, lack of information about CD manifestations, lack of benefit from a GFD and lack of encouragement to adhere to such a diet may contribute. More than 10% of adults with CD do not adhere strictly to long term GFD and more than 30% who believe they are, are actually consuming grams of gluten daily.

 

Interestingly, some of the most at-risk populations come from the "Fertile Crescent" where wheat agriculture originated. Rather than poor adaptation to grains, celiac might be more of a legacy of more recent evolutionary trade-offs, an issue explored in Aaron Sam's dissertation (PDF). The crop that these early farmers so successful may also have ended up being a curse on their wide-ranging descendants.