Absent a Celiac Disease Vaccine, What Does a Perfect World Look Like for Celiacs?

Celiac.com 05/04/2020 - The demise of the Nexvax2 vaccine for celiac disease, coupled with more research that shows regular gluten ingestion for most people with celiac disease, points to a more prominent roll for enzymes, but absent a vaccine, what does a perfect world look like for people with celiac disease? Easy home celiac testing, regular gluten monitoring, and gluten-busting enzymes are three things that people with celiac disease would have in a perfect world.

Regular Gluten Exposure for Most Gluten-Free Celiacs

If you have celiac disease, you’re probably eating gluten more frequently than you realize, whether or not you have symptoms. Whether they know it or not, the vast majority of celiacs are eating gluten on a regular basis. In fact, one recent study showed that up to 90% people with celiac disease are being exposed to gluten when they eat outside their homes.

Celiac and Gluten Testing

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In a perfect world, people who suspected celiac disease would be able to do an easy, reliable test at home to determine if they had celiac disease, or if they needed further screened and assessment by a doctor. They would also be able to test regularly to see if they are getting exposed to gluten in their otherwise gluten-free diet. We've written about when to use home celiac test kits. We've reviewed the LetsGetChecked Home Celiac Disease Test Kit

Home celiac test kits are a popular topic on our celiac and gluten-free forum.

Gluten Monitoring in Celiac Patients

In a perfect word, people with celiac disease would be regularly monitored for gluten levels, much like diabetics are monitored for glucose levels. Currently, there are no home kits that monitor gluten without the user sending samples to a lab. However, there are a few good home test kits that use clinical labs to deliver accurate results fairly quickly. These tests are great for monitoring general gluten levels to spot check your diet.

Home Gluten Test Kits

Finger Prick Blood Test for Gluten

Microdrop Health, a Houston-based company today began offering its imaware™ celiac disease test to patients for monitoring, through use of anti-tissue transglutaminase (tTG) and deaminated gliadin peptide (DGP) blood test results.

Home Stool & Urine Testing for Gluten

Stool and urine testing is slowly moving mainstream. Gluten Detective claims to offer the only home test for gluten exposure. They also claim that stool testing can detect celiac disease before gut damage occurs, in many cases.

Enzymes to Break Down Gluten

For individual consumption - Oral are enzymes are enzymes that you take by mouth and which break down gluten. For oral enzymes to protect people with celiac disease, the enzymes need to break down the gluten proteins in the stomach, before they get to the small intestine, where they cause the gut damage typical of untreated celiac disease. That can be tricky for many reasons, including the amount of gluten consumes, individual gluten sensitivity levels, and level of gut healing, etc. 

AN PEP is one enzyme currently proven to break down gluten in the stomach before it gets to the gut, but it's only intended to protect against incidental gluten ingestion, and not meant to make gluten safe for people with celiac disease.

Currently, there are no oral enzymes on the market that can make gluten safe for people with celiac disease to consume. All enzymes, including AN PEP, are intended solely for episodes of minor and occasional gluten ingestion. Still, regular or strategic use of an oral AN PEP enzyme could provide some protection against the gluten ingestion that seems to be so common with celiacs. The anecdotal evidence is convincing, and stories like the one that found its way into a review of a particular brand of AN PEP formula, called GliadinX, are not uncommon. 

Dry Enzymes
For Manufacturing - Dry enzymes are enzymes that could be added to traditional gluten ingredients, such as flour, in bulk manufacturing, to break down the gluten and render the products safe for people with celiac disease.  

In a perfect world, food manufacturers could add a dry, temperature stable gluten-busting enzyme to traditional wheat ingredients to render foods safely gluten-free, or gluten-removed. Dry glutenase enzymes would work much the same way lactase works to make milk lactose free and safe for most people with milk intolerance. A team of researchers at Clemson University is currently pursuing a project to make dry enzymes heat stable for breaking down gluten in manufactured foods to create safe, gluten-removed foods for people with celiac disease or gluten sensitivity.

Why Digesting Gluten is Better than Dissolving Gluten
We see numerous comments in our forums where people seem to refer to the concept of "dissolving" gluten, instead of digesting or breaking down gluten. In healthy digestion, gluten gets broken down into tiny particles that the body can handle, without causing inflammation or adverse immune reactions. That's what most people mean when the refer to 'dissolving' gluten. Simply dissolving gluten wouldn't help people with celiac disease, because merely dissolving gluten wouldn't render it safely digestible. So, enzymes work by breaking down gluten gluten, not by dissolving gluten. The distinction is important. 

In a perfect world people with celiac disease would have access to easy, reliable home testing and gluten monitoring. They would also have access to effective enzymes to help prevent damage from the gluten exposure that is common in celiacs, even among those on a gluten-free diet.