Summary Attention is drawn to the different effects of different kinds of cereals and starches on patients with coeliac disease. The effect of wheat flour is unfavourable while that of wheat starch is harmless. The harmful effect is produced by a still unknown substance and not by starch. The substance in question is provisionally called the “wheat factor.” The effect of this factor is judged according to its ability to produce or aggravate anorexia, vomiting, diarrhoea and steatorrhoea. Several conclusions as to the significance of this factor are presented.

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Summary In 3 children suffering from chronic diarrhoea in which all normally occurring causes (including coeliac disease) were ruled out, the absence (or defective functioning) of invertase and/or maltase was proved to be the cause. The diarrhoea was arrested with a monosaccharide diet, and in the case of invertase deficiency also an invertase preparation helped. The observation of Holzel et al. that a chronic diarrhoea—without excretion of lactose with the urine—also can be caused by lactase deficiency could be confirmed in another child. The criteria were the severity of the diarrhoea, the pH of the faeces and the excretion in the stools of lactic acid and the volatile lower fatty acids, gas‐chro‐matographically differentiated into formic acid, acetic acid, propionic acid, (iso)‐butyric acid, (iso)valeric acid and caproic acid. It appeared that for the diagnosis of diarrhoeas caused by carbohydrate intolerance, the lactic acid content of the faeces is especially valuable. Differentiation of the faecal flora gives no help. In no case more than traces of sugar where excreted with the urine.

In some of the previous articles (5, 6 , 1 2 , 1 3 ) it has been shown that wheat flour has a harmful effect on patients with coeliac disease. On being given wheat flour, the patients deteriorate clinically, possibly even leading to a crisis, while the fat excretion in the faeces increases considerably in this period. At the same time, however, it appeared that wheat starch [ = Amylum tritici), like rice flour, potatoes and maize flour, had no harmful influence, while the fat excretion in the faeces did not alter (5). This is contrary to the opinion of ANDERSON (1) and SHELDON (9), who considered that all starch-containing foods must be avoided. Afterwards however SHELDON (10) has confirmed our results.Since we could find no sign of any harmful effect of the carbohydrates of wheat, it was necessary to discover which constituent of wheat caused this effect.For this purpose various fractions were prepared from the same wheat as that used in the previous experiments (Dutch wheat, consisting of a mixture of the varieties Staring, Koga, Alba and Minister, extraction degree about 72 %, ash content calculated on dry substance 0.60 Yo). The following fractions were prepared: 1) Gluten. A dough was prepared by kneading, and by further kneading under running water, the starch was washed out and the gluten remained (100 g wheat = about 7 g gluten).2) Gluten washwater. The washwater used in the gluten preparation was collected. This washwater contains the water soluble proteins, including a fraction of the gliadin (washwater A). To prevent any dissolving of gliadin, another sample of flour was washed with a 10 % solution of NaCl (BAILEY, 4) in which gliadin is insoluble. After removing the starch by centrifuging, the washwater thus prepared contains practically no gliadin (washwater B).3) Gliadin and glutenin. The gluten, prepared by kneading with NaCl 10 %, was further differentiated into gliadin and glutenin by shaking with ethanol 50 for 3 hours at room temperature (BAILEY, 4). By this means the gliadin dissolves, while the glutenin remains. The ethanolio gliadin solution was diked at 50-55' C and the Received 28.7. 1952.

Summary In 3 children suffering from chronic diarrhoea in which all normally occurring causes (including coeliac disease) were ruled out, the absence (or defective functioning) of invertase and/or maltase was proved to be the cause. The diarrhoea was arrested with a monosaccharide diet, and in the case of invertase deficiency also an invertase preparation helped. The observation of Holzel et al. that a chronic diarrhoea‐without excretion of lactose with the urine‐also can be caused by lactase deficiency could be confirmed in another child. The criteria were the severity of the diarrhoea, the pH of the faeces and the excretion in the stools of lactic acid and the volatile lower fatty acids, gas‐chro‐matographically differentiated into formic acid, acetic acid, propionic acid, (iso)‐butyric acid, (iso)valeric acid and caproic acid. It appeared that for the diagnosis of diarrhoeas caused by carbohydrate intolerance, the lactic acid content of the faeces is especially valuable. Differentiation of the faecal flora gives no help. In no case more than traces of sugar where excreted with the urine.