Celiac Sprue disease is an inherited human condition in which certain grains, when ingested, are known to cause lesions in mucosa of the small intestine, and affects the absorption of nutrients. Withdrawal of certain cereal grains from the diet improve the condition. Included in the section are issues concerning the types of grains that need to be avoided by people with Celiac Sprue.
Since you, Elaine Hartsook, Mary Alice Warren, Annette Bentley, and Elaine Monarch have all asked me from time-to-time about the safety for celiac patients of some particular foods, I thought I would just put together a general statement for you covering a number of the concerns. I am supplying copies to the other group chairpersons. These are my opinions based on quite a few years of research in the area of proteins as they relate to celiac disease, but, of course, do not necessarily represent those of the Agricultural Research Service,U. S. Department of Agriculture. You may use any of the information that seems of interest in your newsletters, but if you attribute it to me, it would be best to indicate that the opinions are mine as a researcher and are not intended to define USDA policy.
The only plants demonstrated to have proteins that damage the small intestines of people with celiac disease are those from wheat, rye, barley, and oats (and the man-made wheat-rye cross called triticale). [Note inserted on August 27, 1996: two recent studies indicate that oats are not harmful, but these findings have not been universally accepted by physicians.]These species are members of the grass family and are quite closely related to one another according to various schemes of plant classification (taxonomy). However, not all members of the grass family damage the intestines of celiac patients. Rice and corn, for example, are apparently harmless.
Many other grains have not been subjected to controlled testing or to the same scrutiny as wheat, rye, barley, oats, rice, and corn in relation to celiac disease. If we accept corn and rice as safe, then members of the grass family that are more closely reiated to these species (on the basis of taxonomy) than to wheat are likely to be safe. Such grasses include sorghum, millet, teff, ragi, and Job's tears, which appear to be reasonably closely related to corn. In some cases, there are protein studies in support of this conclusion, although the studies are not sufficiently complete to provide more than guidance. Scientifically controlled feeding studies with celiac patients would provide a better answer. However, such studies are not likely to be carried out in the next few years because of high costs and the difficulty of obtaining patient participation (such studies would likely involve intestinal biopsy). In lieu of feeding studies, further studies of protein (and DNA) would provide the next best way to evaluate my suggestion that millet, sorghum, teff, ragi, and Job's tears are not likely to be toxic in celiac disease.
The scientific name for bread wheat is Triticum aestivum--the first part of the name defines the genus (Triticum) and the second part, the species (aestivum). Species falling in the genus Triticum are almost certain to be harrnful to celiac patients. Grain proteins of these species include the various types characteristic of the gluten proteins found in bread wheats (including the alpha-gliadins) that cause damage to the small intestine in celiac disease. Some Triticum species of current concern include Triticum spelta (common names include spelt or spelta), Triticum polonicum (common names include Polish wheat, and, recently, Kawmut), and Triticum monococcum (common names include einkorn and small spelt). I recommend that celiac patients avoid grain from these species.
Rye (Secale cereale) and barley (Hordeum vulgare) are toxic in celiac disease even though these two species are less closely related to bread wheat than spelta and Kawmut. They belong to different genera, Secale and Hordeum, respectively, and lack alpha-gliadins, which may be an especially toxic fraction.
You have asked especially for my opinion regarding spelta and Kawmut. Evidently there have been anecdotal reports suggesting a lack of toxicity in celiac disease for spelta and Kawmut. Controlled tests would be necessary to draw a firm conclusion. I don't consider anecdotal reports as reliable for the following reasons.
The diagnosis, sometimes self-diagnosis, of celiac disease is occasionally made without benefit of reasonably rigorous medical or clinical tests, especially intestinal biopsy. Individuals who are "diagnosed" in this way without rigorous testing may not actually have celiac disease. Claims that particular foods cause this latter group no problems in relation to their celiac disease could cause confusion.
Furthermore, celiac patients who report no problems in the short run with spelta or Kawmut might experience relapse later. There is now adequate evidence that when celiac patients on a "gluten-free" diet (that is, a diet free of any proteins or peptides from wheat, rye, barley, and oats) have wheat reintroduced to their diets, times-to-relapse vary enormously among individuals, ranging from hours to months, or even years. And this is for wheat, presumably the most toxic of all cereal grains to celiac patients.
Additionally, the relapse may not be accompanied by obvious symptoms, but be recognized only by physicians through observation of characteristic changes in the small intestinal tissues obtained by biopsy. The reasons for the enormous variability of response times are not known. It may be speculated that they have something to do with the degree of recovery of the lining of the smail intestine on a gluten-free diet, the degree of stress that the patient had been experiencing (including infections), and individual genetic differences.
As I have indicated, all known grain species that cause problems for celiac patients are members of the grass family. In plant taxonomy, the grass family belongs to the Plant Kingdom Subclass known as monocotyledonous plants (monocots). The only other grouping at the Subclass level is that of dicotyledonous plants (dicots). Some other species about which celiac patients have questions actually are dicots, which places them in very distant relationship to the grass family. Such species include buckwheat, amaranth, quinoa, and rape. The seed of the last plant listed, rape, is not eaten, but an oil is pressed from the seeds that is becoming commonly used in cooking. This oil is being marketed as canola oil. Because of their very distant relationship to the grass family and to wheat, it is highly unlikely that these dicots will contain the same type of protein sequence found in wheat proteins that causes problems for celiac patients. Of course, some quirk of evolution couid have given rise in these dicots to proteins with the toxic amino acid sequence found in wheat proteins. But if such concerns were carried to a logical conclusion, celiac patients would have to exclude all plant foods from their diets. For example, buckwheat and rhubarb belong to the same plant family (Polygonaceae). If buckwheat were suspect for celiac patients, should not rhubarb, its close relation, be suspect as well?
It may be in order to caution celiac patients that they may have undesirable reactions to any of these foods--reactions that are not related to celiac disease. Allergic reactions may occur to almost any protein, but there is a great deal of individual variation in allergic reactions. Also, buckwheat, for example, has been claimed to contain a photosensitizing agent that will cause some people who have just eaten it to develop a skin rash when they are exposed to sunlight. Such reactions should be looked for, but for most people, buckwheat eaten in moderation apparently does not cause a problem. (Buckwheat is sometimes found in mixture with wheat, which of course would cause a problem for celiac patients.) It seems no more necessary for all people with celiac disease to exclude buckwheat from their diets because some celiac patients react to it than it would be for all celiac patients to exclude milk from their diets because some celiac patients have a problem with milk.
In conclusion, scientific knowledge of celiac disease, including knowledge of the proteins that cause the problem, and the grains that contain these proteins, is in a continuing state of development. There is much that remains to be done. Nevertheless, steady progress has been made over the years. As far as I know, the following statements are a valid description of the state of our knowledge:
I hope this information will be helpful. Please contact me if you need further details or clarifications.
Donald D. Kasarda
Crop Improvement and Utilization Research Unit
Elaine Hartsook, Gluten Intolerance Group, Seattle, WA
Mary Alice Warren, Gluten Intolerance Group of Florida, Cocoa Beach, FL
Annette Bentley, American Celiac Society, Dietary Support Coalition, West Orange, NJ
Elaine Monarch, Celiac Disease Foundation, Studio City, CA
Antoinette Betschart, Director, Western Regional Research Center, Albany, CA
Wilda Martinez, Associate Deputy Administrator, Agriproducts & Human
Nutrition Sciences, Agricultural Research Service, Beltsville, MD
From: "Karow, Russell S." KAROWR@css.orst.edu To: email@example.com Subject: Gliadins and spelt Date: Tue, 18 Feb 1997 15:04:44 -0800 Greetings: I've had a number of questions from people who want to raise spelt because it can be eaten by folks with gluten sensitivity. I've told them that as far as I know, spelts do contain glutens and that they may not be a total solution to their problem. As I understand it, celiac (gluten sensitivity) is actually caused by gliadins. Does anyone have information about gluten/gliadin levels in spelts? Information on wheat species in general that are less problematic for celiac sufferers? Russ Karow Oregon State Univ. Extension Cereals Specialist ----------------------------------------------------------------------------- Date: Wed, 19 Feb 97 12:08:59 EST From: "Dave Matthews" firstname.lastname@example.org To: email@example.com Subject: re: Gliadins and spelt Cc: firstname.lastname@example.org Hi Russ! I had a great time cruising the Web looking for answers to your question. My there's a lot of information out there now! I didn't end up finding any clear answers though. My inference from what I saw is that spelt is safe for some celiac sufferers but not others. Some details: "Celiac Disease and Gluten Sensitivity", http://cpmcnet.columbia.edu/dept/gi/celiac.html, is an excellent coverage of the problem from a medical standpoint. The only comment about different grains is that barley, rye and oat also cause the problem but rice is safe. "Small Grain Production, Ohio Agronomy Guide, Bulletin 472, http://www.ag.ohio-state.edu/~ohioline/b472/grain.html, says that spelt is safe for celiac victims. There is an archive of a newsgroup discussion on this topic at http://ekolserv.vo.slu.se/Docs/www/Subject/Crops/350-399/. The initiator of the discussion, Carol Miles of WSU Extension, concluded "... on spelt and the wheat allergy question ... the dozen or so responses I received have given me enough information to write a chapter on the topic :) In the process, I have learned that not all allergies are created equal. If anyone would like a copy of the responses, I would be happy to forward them on." cheers, - Dave ----------------------------------------------------------------------------- Date: Wed, 19 Feb 97 12:39:49 PST From: "Olin D. Anderson" email@example.com To: firstname.lastname@example.org Subject: Re: Gliadins and spelt ----- Begin Included Message ----- Date: Wed, 19 Feb 97 12:14:17 PST From: "Donald D. Kasarda" email@example.com To: "Karow, Russell S." KAROWR@css.orst.edu "Olin D. Anderson" firstname.lastname@example.org Subject: Re: Gliadins and spelt Russ, Spelt is simply Triticum aestivum with adherent glumes. I would say that it is unquestionably harmful to celiac patients. Many people have bought this line about spelt being some sort of miracle grain and become sick. The alpha-gliadins are the same, the gel electrophoretic patterns are the same (with minor variations typical of varietal differences) and I don't think there is any difference that is greater than you find among accepted wheat varieties. I also have some unpublished indications that it is harmful to allergic people as well as harmful to celiac patients. If you would like me to gather up references, I will do so, but will need some time to find them and put together a list for you. Don ----- End Included Message ----- ----------------------------------------------------------------------------- Date: Thu, 20 Feb 97 04:28:08 EST To: email@example.com From: Bob Graybosch firstname.lastname@example.org Subject: spelt Dear Dave, I read your response regarding spelt and celiac disease, and found it a bit disturbing. I spoke by phone this morning with the director of the Celiac and Sprue Association in Omaha. He cited at least 5 cases in Nebraska of severe reactions to spelt by celiac patients. Obviously, it is better to err on the side of caution, and if I were an extension educator, I would not recommend consumption of spelt by celiac patients. It is his opinion that consumption of spelt is not safe for anyone with celiac disease. Also, there is a web site (http://www.celiac.com) that contains a list of forbidden foods for celiac patients and spelt is included. Let's just think about this for a moment - if rye, a different species than wheat, is not safe, why should spelt, a group of landraces of the same species as bread wheat, be safe. Bob Graybosch Research Geneticist, USDA-ARS email@example.com 336 Keim Hall, University of Nebraska, East Campus Lincoln, NE, USA, 68583 402-472-1563 fax: 402-472-4020 ----------------------------------------------------------------------------- Date: Thu, 20 Feb 1997 08:22:37 -0600 (CST) From: Leonard R Joppa firstname.lastname@example.org Cc: email@example.com Subject: Re: Gliadins and spelt You probably have had enough replys to your question by now. I want to mention one other web site that seems to include a long list of references and sites dealing with every aspect of this problem. http://www.panix.com/%7Edonwiss/ We have also had this question from time to time and have seen no reason to believe that spelt can be eaten by celiac patients. Leonard Joppa ----------------------------------------------------------------------------- Date: Thu, 20 Feb 97 11:47:47 EST From: "Kim Garland Campbell" firstname.lastname@example.org To: email@example.com Subject: re: Gliadins and spelt Dave, and others. I wrote to Russ already basically echoing Bob and Olin's comments about Spelt. I didn't realize that the Ohio Agronomy guide stated that spelt was safe for Celiacs. It's incorrect. Hal Lafever indicated that 'some people who are allergic to wheat report that they can tolerate spelt '. (Knebusch, K.R. 1990. Dinkel, dinkel, little star. Ohio 21-Coll. Agric./OCES/OARDC/OSU 4:(2) 10-11) .This statement is true. Because of Hal's interest in Spelt, OSU extension and myself field several calls a month requesting information on spelt. People do say they can tolerate spelt although I don't think any of them have been diagnosed sufferers of celiac disease. Rather they have 'wheat allergies'., I've seen the literature from Purity foods and it's not bound in scientific fact. And, as I said to Russ, there is no genetic basis for any qualitative differences between wheat and spelt. Kim Kim Garland Campbell Small Grain Genetics Dept. of Horticulture and Crop Science The Ohio State University/OARDC 1680 Madison Ave. Wooster, OH 44691 (216)263-3886 (phone) (216)263-3887 (fax) ----------------------------------------------------------------------------- Date: Fri, 21 Feb 1997 09:24:00 -0800 (PST) From: "Padulosi, Stefano" S.PADULOSI@cgnet.com Subject: Gliadins and spelt To: firstname.lastname@example.org Cc: "Perrino Pietro" email@example.com Dear Dr Karow, Ms Rempel from Canada has forwarded this message to me and I believe that you may find useful to receive a copy of a recent IPGRI publication on hulled wheats which among various subjects addresses also the celiatic disease issue. You may also contact Prof. P. Perrino whose address I am herewith giving, as he is working on this aspect too. Prof. PERRINO Pietro Istituto del Germoplasma National Research Council Via Amendola 165,A 70126, Bari, ITALY Tel. (+39) 80- 5583400/ 5583463 Fax. (+39) 80- 5587566 email firstname.lastname@example.org Best Regards PADULOSI Stefano Coordinator, Underutilized Mediterranean Species IPGRI Via delle Sette Chiese, 142 00145, Rome ITALY Tel. (+39) 6- 51892243 Fax (+39) 6- 5750309 email email@example.com internet http://www.cgiar.org/ipgri/ -----------------------------------------------------------------------------Other links located at:
Celiac Support Page
Paul's Celiac Disease Page
The Gluten-Free Page
Celiac Disease, North American Society for Pediatric Gastroenterology and Nutrition (NASPGN)
Celiac Disease and Gluten Sensitivity, Columbia University Gastroenterology
Celiac Disease and Gluten Sensitivity, Columbia University Gastroenterology
Gluten Q&A, Ask the Dietitian
America's HouseCall Network
Health Information Resource Directory
Family Internet, Baby Care Corner
Nutritional Therapy, ACCM
Tissue Antigens (Abstr.)
spelt vs wheat allergies
Small Grain Production