Coeliac Disease: An Investigation into the Injurious Constituents of Wheat in Connection with their Action on Patients with Coeliac Disease

Abstract

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.

The Place of Oats in the Coeliac Diet

“…Despite this variation, if maize prolamin is similar in structure and action to that of wheat, it is reasonable to suppose that maize would be detrimental to coeliac children. Hansted (1956b), without giving details, claims that maize, as such, is well tolerated, but in the majority of trials including those of van de Kamer et al (1953), Dicke et al (1953 and Hansted (1955), the only forms of corn (maize) investigated were cornstarch, or cornflour which consists almost exclusively of cornstarch (Ford, 1946). Thus although cornstarch like wheatstarch is harmless to the coeliac patient, the maize prolamin, zein, does not appear to have been tested and may, therefore, be injurious both by itself and in the form of the maize grain.…”

“…Continuous fat balance studies over relatively long periods were carried out, fat being estimated daily in the stools by the method of van de Kamer, Huinink and Weijers (1949). Any uneaten food was weighed, analysed for fat and its oat content calculated.…”

“…Previous workers on oats, Dicke, Weijers and van de Kamer (1953), and van de Kamer et al (1953), who fed the same child 140 g. oatmeal per day, and Hansted (1955), who gave one child 150 g. oatmeal per day, claim that such large intakes have some harmful effect. However, in another patient, 75 g. oatmeal per day produced only a slight increase in fat excretion (Hansted, 1955).…”

Quantitative Determination of the Saturated and Unsaturated Higher Fatty Acids in Fecal Fat

“…has not been taken into account. Moreover, in the case of healthy persons, as well as of patients suffering from steatorrhea, the excretion of unsaturated fatty acids is very small, as will be shown in subsequent articles (Weijers et al, 1953) so that the polyethenoid fatty a d s can be neglected. It appeared to us namely, through determination of the thiocyanogen and iodine value in the purified fatty acids from feces of seven different patients and from a number of mixed samples, that only 1&25 per cent of the unsaturated fatty acids consist of linoleic acid.…”

The Present Position in Cœliac Disease

“…The noxious effect of gluten, and especially after the ingestion of wheat and rye flour, was proven (Van de Kamer, Weijers and Dicke, 1953). The evidence indicates a specific sensitivity creating gluten enteropathy.…”