Recommendations for accidental exposure to gliaden in the celiac or gluten-sensitive patient.

Dipeptidyl peptidase IV (DPP-IV)  Although not proven in human studies to help in celiac (which crazy celiac patient would volunteer for this study?), DPP-IV has been shown to help out of the body to degrade the antigenic portion of gluten.  Celiac patient have been shown in studies to have a decrease in DPP-IV activity. (1)

GI repair nutrients/herbs

N-acetyl glucosamine can prevent the immune reaction caused by antigenic protein.  Has been shown out of the body to protect intestinal cells.

DGL (deglycyrrhizinated licorice) increases the integrity of the mucosal cells, it increases the life span of the intestinal cells, improves the quality of the mucosa, and improves the blood supply of nutrients (3). Additionally, it has a high healing rate and significantly low relapse rate for ulcers (4).

Slippery elm provides a soothing, protective film on the gastrointestinal lining. Slippery elm calms the inflamed mucous membranes of the stomach 58). In addition to a soothing texture that coats the stomach lining, slippery elm contains the fiber-rich ingredient mucilage which stimulates mucus secretion (especially protective against ulcers).

Aloe Leaf Extract has been used for thousands of years to heal damaged skin, including the bowel lining. Despite the lack of scientific published studies there is anecdotal evidence to suggest that aloe vera helps inflammatory conditions of the gastrointestinal tract. In some individuals it may increase G.I. transit time, improve protein digestion and absorption, increase stool bulk and normalize stool bacteria where high levels of yeasts previously existed(6)

L-Glutamine is the most abundant amino acid in the body and is an energy source for  cells.  Intestinal cells prefer glutamine for energy and consume the majority of glutamine in the body. Glutamine is necessary for intestinal cell maintenance and healthy turnover.  (7,8)  In various experimental models, glutamine administration has been shown to reduce cell death and preserve or improve barrier function.  (9-11)  For instance, in an animal model of chemotherapy-induced intestinal damage, glutamine decreased the severity of intestinal injury. (12)

IgG (Immunoglobulin)  Immunoglobulins are antibodies.  They can bind and kill harmful microbes (bacteria, fungi, virus).  Supplementation has been shown to preserve the gut lining.*

Boring scientific jargon:  In vitro, DPP-IV efficiently degrades the immuno-dominant, proline-containing epitope of gliadin, the primary allergenic protein in gluten. DPP-IV has also been shown to markedly enhance the gluten- and casein degrading capacity of other proteolytic enzymes. In rats, functional expression of DPP-IV in intestinal and kidney cells is a requirement for proper digestion of gliadin and for renal filtration of the dairy exorphin beta-casomorphin. Research on the use of supplemental DPP-IV in humans is limited, but one clinical trial examined the effects of a multi-enzyme preparation with DPP-IV activity in a group of 22 children and young adults with ASD. In this open-label trial, 12 weeks of supplementation with the enzyme blend led to significant improvements in most of the clinical parameters measured including attention, comprehension, digestion, eye contact, hyperactivity, mood, sleep, socialization, and speech. A growing body of evidence thus suggests exogenous DPP-IV can be of substantial benefit for managing the digestive and neurobehavioral symptoms associated with reactivity to gluten, casein, and other allergenic and neuroactive dietary proteins.

Acetyl glucosamine, and its oligomers (N,N'-diacetylchitobiose and N,N',N"-triacetylchitotriose) were able to prevent and reverse cell agglutination induced by peptides from all the toxic cereals. Moreover, mannan and N,N',N"-triacetylchitotriose exhibited a protective effect on intestinal mucosa specimens of patients with active celiac disease cultured with wheat protein-derived peptides. These data are consistent with the hypothesis that the agglutinating and toxic peptides are bound by carbohydrates.  (2)

The basic functions of immunoglobulins are the neutralization and opsonization of harmful microbes. Unlike antibiotics, they allow the immune system to differentiate foreign microbes from the body’s normal microflora.  Many of the studies on immunoglobulins involving immune challenge have been animal rather than human studies because of the expense and difficulty using human subjects. Studies have shown oral immuno-protein supplementation restores appetite, (13) supports the body’s healthy response to inflammation (14-16) and promotes improved protein metabolism under immunological stress. (17,18)  Oral supplementation has been shown to preserve gut wall integrity and provide intestinal humoral immunity. (19)

1. Detel D, Persić M, Varljen J Serum and intestinal dipeptidyl peptidase IV (DPP IV/CD26) activity in children with celiac disease. J Pediatr Gastroenterol Nutr. 2007 Jul;45(1):65-70.

2. Auricchio S, De Ritis G, De Vincenzi M, Magazzù G, Maiuri L, Mancini E, Minetti M, Sapora O, Silano V Mannan and oligomers of N-acetylglucosamine protect intestinal mucosa of celiac patients with active disease from in vitro toxicity of gliadin peptides. Gastroenterology. 1990 Oct;99(4):973-8.

3. Glick L. Lancet ii:817, 1982

4. Kassir ZA Irish Med J 78:153-56, 1985; Irish Med J 1985;78:153-156

5. Balch JF Presc for Nutr Healing 1990, Garden City, NY

6. Davis K, et. al. Randomised double-blind placebo-controlled trial of aloe vera for irritable bowel syndrome. Int J Clin Pract. 2006 Sep;60(9):1080-6 [PMID: 16749917]

7. Oliveira GP, Dias CM, et al. Understanding the mechanisms of glutamine action in critically ill patients. An Acad Bras Cienc. 2010 Jun;82(2):417-30. [PMID: 20563423]

8. dos Santos RG, Viana ML, Generoso SV, et al. Glutamine supplementation decreases intestinal permeability and preserves gut mucosa integrity in an experimental mouse model. JPEN J Parenter Enteral Nutr. 2010 JulAug;34(4):408-13. [PMID: 20631386]

9. Tian J, Hao L, Chandra P, et al. Dietary glutamine and oral antibiotics each improve indexes of gut barrier function in rat short bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2009 Feb;296(2):G348-55. [PMID: 19095767]

10. Vicario M, Amat C, Rivero M, et al. Dietary glutamine affects mucosal functions in rats with mild DSS-induced colitis. J Nutr. 2007 Aug;137(8):1931-37. [PMID: 17634266]

11. Gulgun M, Karaoglu A, Kesik V, et al. Effect of proanthocyanidin, arginine and glutamine supplementation on methotrexate-induced gastrointestinal toxicity in rats. Methods Find Exp Clin Pharmacol. 2010 Nov;32(9):657-61. [PMID: 21225016]

12. Tazuke Y, Maeda K, Wasa M, et al. Protective mechanism of glutamine on the expression of proliferating cell nuclear antigen after cisplatin-induced intestinal mucosal injury. Pediatr Surg Int. 2011 Feb;27(2):151-58. [PMID: 21080177]

13. Kats LJ, Nelssen JL, Tokach MD, Goodband RD, Hansen JA, Laurin JL. The effect of spray-dried porcine plasma on growth performance in the early-weaned pig. J anim.Sci 1994;72:2075-81.

14. Tjellstrom B, Stenhannar L, Magnusson KE, Sundqvist T. Oral Immunoglobulin treatment in Chrohn’s Disease. Acta Pediatr 1997;86:221-3

15. Peirce, JL, et al. Spray dried plasma protein globulin for early weaned pigs. J animal Sci 74 (Supp 1):258

16. Wolf HM, Eibl MM. The anti-infl ammatory effect of an oral immunoglobulin (IgA-IgG) preparation and its possible relevance for the prevention of necrotizing entercolitis. Acta Pediatr Supple 1994:396:37-40

17. Thompson JE, et al. Effect pf spray-dried porcine plasma protein on feed intake, growth rate and effi ciency of gain in mice. J Anim Sci 1994;72:2960-5

18. Jiang R, Chang X, Stoll B, et al. Dietary plasma protein is used more effi ciently than extruded soy protein for lean tissue growth in early-weaned pigs. J Nutr 2000;130:2016-9

19. Dickinson EC, Gorga JC, Garrett M et al. Immunoglobulin A supplementation abrogates bacterial translocation and preserves the architecture of the intestinal epithelium. Surgery 1998;124;284-90