Gluten free diets have become increasingly popular in recent years, with more and more people adopting them for a variety of reasons. For those with celiac disease or gluten sensitivity, eating gluten free is a necessity, as gluten can damage the small intestine and cause digestive problems and other symptoms. But even for those without gluten issues, going gluten free has been trendy as people believe it can provide health benefits like weight loss, increased energy, and reduced inflammation.
However, following a strict gluten free diet can be challenging. Gluten is found in many common foods and ingredients like bread, pasta, baked goods, beer, and soy sauce. This means gluten free people have to be vigilant about reading labels and ensuring any foods they eat are certified gluten free. Eating out at restaurants and social gatherings with food can also be tricky to navigate. Furthermore, gluten free versions of foods often cost more than their traditional counterparts.
This leads to the question: is there a pill or supplement that can allow those on gluten free diets to occasionally consume some gluten without ill effects? Let’s dive into the research and science to find out.
What Exactly is Gluten?
Gluten is a general name for the proteins found in wheat, rye, and barley. It acts as a glue that helps dough keep its shape, gives bread its chewy texture, and provides structure to baked goods.
Gluten contains two main protein groups:
When flour and water are combined and kneaded, these proteins link together and form elastic strands called gluten.
For most people, gluten doesn’t cause any issues when consumed. But for those with certain conditions like celiac disease or non-celiac gluten sensitivity, it can trigger immune system responses and cause damage and inflammation in the body.
Celiac disease is an inherited autoimmune disorder that causes the body to be intolerant to gluten. When someone with celiac disease eats gluten, it triggers an immune response that attacks the small intestine. Over time, this reaction damages the intestine’s lining and prevents proper nutrient absorption.
Celiac disease affects around 1% of people worldwide. There is no cure, but total lifelong gluten avoidance is the only treatment.
Non-Celiac Gluten Sensitivity
Non-celiac gluten sensitivity (NCGS) is a condition involving gluten-related symptoms like diarrhea, bloating, and abdominal pain. But unlike celiac disease, it shows no damage to the small intestine. Those with NCGS may have a range of immune, digestive, and neurological responses to gluten without testing positive for celiac.
The prevalence of NCGS is debated and estimates range from 0.5% to 6% of the population. The only treatment is removing gluten from the diet.
Gluten ataxia is a condition characterized by damage to the cerebellum part of the brain that impacts muscle control and coordination. It is caused by an immune reaction to gluten that specifically targets the cerebellum region. It is considered an autoimmune disease and often occurs alongside celiac. The treatment is a strict gluten free diet.
While most gluten related conditions involve immune system reactions, wheat allergies are different. Wheat allergies trigger histamine release and IgE antibody responses. The body sees wheat proteins as a threat and responds like it would to other food allergies. Strict avoidance of wheat and related grains is necessary to manage a wheat allergy.
What Happens When Gluten Enters the Body?
Now that we understand what exactly gluten is, we can look at how it causes issues upon consumption. Here is an overview of the process:
- Gluten containing foods are consumed and enter the digestive tract.
- In individuals with conditions like celiac disease, the immune system identifies gluten proteins as a threat.
- The body mounts an immune response and starts attacking gluten proteins.
- This also causes inflammation and damage to the lining of the small intestines.
- The damaged intestinal villi are unable to properly absorb nutrients from food.
- A cascade of symptoms occurs including diarrhea, stomach pain, fatigue, skin rashes, joint pain, and more.
This immune reaction and inflammation continue each time gluten is consumed. Over time, the intestinal damage can become quite severe and lead to malnutrition, anemia, osteoporosis, infertility, neurological conditions, and other long term health consequences.
The only solution is strict adherence to a 100% gluten free diet, which allows the intestines to heal and prevents further reactions. This is quite burdensome and difficult for most people to maintain long term.
The Challenges of a Gluten Free Diet
Here are some of the key challenges faced by those adhering to gluten free diets:
Availability of Gluten Free Foods
Although gluten free foods are more available now than ever before, the options are still limited compared to traditional gluten-containing foods. Gluten free substitutes like bread, pasta, and baked goods are not always readily available, especially in rural areas and smaller grocery stores. This makes sticking to the diet consistently quite difficult.
Even if a food is labeled gluten free, cross-contamination is still a risk during processing and preparation. Traces of gluten could make their way into gluten free foods during manufacturing in facilities that also process wheat-based products. Restaurants may also use the same surfaces and utensils for gluten free and regular menu items. This makes people with celiac disease hesitant to eat anything they themselves did not prepare at home.
On average, gluten free alternatives cost at least twice as much as their traditional wheat-based counterparts. The extra steps required to ensure gluten free purity increases manufacturing costs that get passed onto consumers. The higher prices can make gluten free eating challenging to maintain for lower income individuals.
Since so many grains and starches contain gluten, eliminating them removes major carbohydrate sources and fiber from the diet. This can lead to reduced intake of B vitamins, iron, and fiber if gluten free alternatives are not enriched or fortified. Working closely with a dietitian helps prevent nutritional shortfalls.
Dining out, traveling, and attending social functions with food often revolve around gluten-containing foods like bread, desserts, and pasta. Having to avoid those items or bring your own gluten free dishes can feel socially limiting and lead to a sense of isolation. Being gluten free requires increased planning and precautions.
Mental and Emotional Toll
The social limitations and constant vigilance required to avoid gluten can take a toll mentally and emotionally. There is fear and anxiety about accidental exposure. People report grief over losing their favorite foods and resentment about having limitations. Ongoing hypervigilance and denial can also occur. Working with a therapist helps process the emotions.
The Quest for a Gluten Pill
With such burdens and health risks associated with ingesting gluten, researchers have been trying to develop a pill that could allow those with gluten issues to occasionally consume some gluten without consequences. This could provide a major improvement in quality of life. But is such a treatment scientifically plausible and how close are we?
How a Gluten Pill Could Work
Conceptually, a gluten pill would need to work via one of these mechanisms:
- Bind to gluten proteins and prevent absorption from the gut into the body
- Degrade gluten proteins into non-reactive fragments
- Suppress the immune system reactions to gluten
If gluten could be bound or broken down before passing too far into the small intestine, it may be able to avoid triggering the problematic immune responses that cause damage. Alternatively, temporarily suppressing the overactive immune reaction could also protect the body.
Challenges in Developing a Gluten Pill
However, developers face major scientific hurdles:
- Gluten proteins are highly resistant to degradation
- Binding or altering such large protein structures is extremely difficult
- Getting a compound to work uniformly across the highly variable human gut microbiome
- Precisely suppressing just the gluten immune response without wider immunosuppression
The biochemistry challenges are immense. Extensively altering gluten or gut immunity through a simple pill compound has proven elusive thus far.
Current Research on Gluten Pills
Despite the challenges, research is ongoing into compounds that could potentially enable gluten ingestion:
ALV003 is an experimental drug from pharmaceutical company Alvine Pharmaceuticals. It contains engineered gluten protease enzymes that are designed to rapidly break down gluten before it can trigger an immune reaction.
Phase 2 clinical trials showed ALV003 degraded most gluten within minutes under simulated gastric conditions. The fast action could prevent most gluten from reaching the small intestine intact.
However, the results have been inconsistent, with huge variability in efficacy across different study participants based on individual gut environments. Further trials are underway.
BL-7010 is a polymer compound developed by pharmaceutical company BiolineRx. It is designed to bind with gliadin in the gut, forming particles that are too large for the body to absorb. By preventing gliadin absorption, it may reduce immune activation.
A phase 2 trial found no difference in intestinal damage between placebo and BL-7010 groups after gluten ingestion. But there was slightly less gastrointestinal symptom severity in the BL-7010 group. The developers hypothesize higher polymer dosing may be more effective.
AN-PEP is an enzyme supplement derived from aspergillus niger mold. It aims to rapidly break down gluten in the stomach before it reaches the small intestines.
Studies have found AN-PEP does degrade gluten. But substantial variability is seen between individuals based on gastric pH levels and transit times. Its efficacy against inflammatory responses has not been analyzed yet in clinical settings.
Some researchers hypothesize short term immunosuppressant drugs like corticosteroids could temporarily dampen immune reactivity to gluten enough to prevent damage.
But immunosuppressants have major side effects with long term use, and their effectiveness against gluten immunity is theoretical. This approach has not undergone human clinical trials.
Rather than degrade gluten or suppress immunity, vaccines aim to induce gluten tolerance over time. Early research is looking at ways to reduce antibody reactions against gliadin.
But vaccines take time to induce tolerance – they would not enable immediate gluten consumption. And achieving specificity against just gliadin antibodies is highly complex biologically.
Are Any Gluten Pills Currently Available?
With research still in preliminary phases, no gluten pills are clinically proven or FDA approved yet. Nothing has consistently demonstrated the ability to sufficiently protect the body from gluten reactions.
Some supplements like gluten defense claim to have digestive enzymes that break down gluten. But their efficacy has not been confirmed through rigorous randomized controlled trials in humans. They should not be considered as substitutions for a gluten free diet.
While promising in concept, achieving a true “gluten pill” remains elusive for now. Leading experts urge caution against relying on any supplements currently marketed as allowing gluten consumption. Further research and trials will be needed before a proven gluten pill emerges.
The Future of Gluten Pills
While extremely challenging, developing medications or supplements that permit occasional gluten intake would be life changing for millions requiring strict gluten avoidance. What could the future hold in this area?
Rather than any single compound, researchers may eventually find success through a cocktail of gluten-targeting mechanisms. For example, combining a polymer that binds gluten, a protease that degrades it, and an immunosuppressant may provide sufficient protection in aggregate even if the individual components alone are insufficient.
The huge variability in individuals’ gastrointestinal environments is a major hurdle. Compounds that work more uniformly by colonizing the gut with custom probiotic bacteria engineered to process gluten may eventually be viable. Targeting the microbiome could make solutions more consistent.
Rather than pills taken right before gluten intake, future solutions may involve long-term use of devices that slowly release gluten-altering compounds directly into the gastrointestinal tract. This could enable them to be continuously present at effective concentrations.
Given the differences between people, the optimal solution may need to be tailored to individuals’ specific antibodies, intestinal pH, transit times, and microbiomes. As personalized medicine continues advancing, targeted gluten pills based on an individual’s unique profile could become possible.
A gluten pill that allows those with celiac disease or non-celiac gluten sensitivity to safely consume gluten remains elusive despite much research. While promising theoretically, developing a compound or device that prevents immune reactions to gluten without side effects has proven extremely challenging so far. With further research into combination approaches, microbiome targeting, slow-release devices, and personalized solutions, effective gluten pills may eventually be possible. But for now, individuals affected by gluten should not rely on any supplements and should maintain a strict gluten free diet. While difficult, total gluten avoidance remains the only way to manage gluten disorders safely at this time.
|Gluten Free Diet Challenges
|Limited availability of gluten free foods
|Improved food labeling and manufacturing processes
|High cost of gluten free foods
|Consumer advocacy and government subsidies
|Risk of cross-contamination
|Stricter regulation and quality control
|Increased awareness and accommodation by hosts
|Dietitian guidance and nutrient fortification