1. CME Evening – 15 August 2018

2. Gluten – the good, the bad, the ugly
Dr Adele Melton
MBChB, FRACP

4. Gluten Bloated Sick Constipated Pain Reflux Dry skin Unwell Poor concentration Touch of dysentery

5. Overview What is gluten? Food science Gluten-related disorders
Future developments

6. Wheat
Major food crop, cultivated, consumed

7. Gluten Latin = “glue” Main storage protein of wheat grains
Complex mixture of proteins
Gliadin + glutenin

8. Act as a binding and extending agent
Heat stable
Act as a binding and extending agent
Texture, moisture retention, flavour
Baked products Other sources
Bread - Processed meats
Pasta - Reconstituted seafood
Cakes - Seasoning, marinades
Biscuits - Confectionary

9. Gliadin contains peptide sequences
 resistant to gastric, pancreatic, intestinal proteolytic digestion in GI tract
many proteases are unable to cleave
high content of amino acids, proline
and glutamine

10. Dietary intake Western diet Major source – wheat-containing bread
5 – 20g / day
Major source – wheat-containing bread
Slice = 4g gluten

12. (1) Coeliac disease 1% Western population Genetic predisposition
Immune response  mucosal inflammation
Resultant complications
Malabsorption
IDA, Osteoporosis
Infertility
Strict lifelong GFD

14. Gluten-free labelling
FSANZ = “no detectable gluten”
CODEX = up to 20 ppm gluten
Future developments
Blood tests
Trials / Investigations
Therapeutic vaccinations

15. (2) Wheat allergy IgE-mediated reaction
Symptoms  minutes to hours after ingestion
Itching, swelling, skin rash, anaphylaxis
Baker’s asthma and rhinitis
Atopic dermatitis and urticaria

16. (3) Non-coeliac gluten sensitivity
NCGS or gluten-intolerance
Symptoms with gluten ingestion
Luminal and extra-luminal
Possible explanations
FODMAPs, changes in gut microbiota, altered serotonin
2 hit: gluten visceral sensitising, then poorly absorbing rapidly fermenting FODMAPs
Unanswered questions
All-or-none or dose-related phenomenon

17. Questions / Comments

18. Thank you