Are supplements to digest gluten safe and useful?
Dr. Burkhart examines whether products like GlutenEase are appropriate for those with celiac disease and gluten sensitivity
In the midst of the holidays, I often get questions regarding the use of enzymes marketed to digest gluten. People are worried about holiday events, cross contamination and whether there is any way for them to tolerate “just a little bit” of gluten.
Are the enzyme supplements safe? Do they work? Can we use them? Is there any risk? Gluten digestive aids on the market today include GlutenEase, Gluten Digest, Gluten Freeze and more. Many variations of these products are being offered, and people are buying them. However, we will examine how the power of marketing often overrides the conclusive scientific data – or lack thereof.
Are they clinically tested?
None of these products has undergone any sort of clinical trial or testing to assess efficacy and safety in people with celiac disease and non-celiac gluten sensitivity (NCGS). This statement alone may be enough for some readers to stop here. A closer look from a medical perspective might help you decide whether to take them if you are still unsure.
What do the experts say?
Top celiac experts agree that the enzyme supplements currently on the market can digest only a uselessly tiny number of gluten molecules, which makes them unsafe for people with celiac disease and non-celiac gluten sensitivity to rely upon.
Risky approach for celiac patients
I feel the biggest risk in using these products falls upon patients who have celiac disease. I have seen patients with celiac disease use these products as a ticket to consume gluten. Although many of the products state on the label that they are not for people with celiac disease, human nature often kicks in to ignore that disclaimer; as a result, some celiac patients rely on them for possible cross contamination or to have “just a taste” of something. This approach is more typically used by those who don’t experience severe symptoms with gluten ingestion. People with more blatant symptoms learn quickly that the products don’t work for them.
If you have celiac disease, damage from gluten ingestion can occur regardless of whether you are aware of any symptoms. These supplements are not tested for celiac patients and should be avoided by them no matter how mild or severe their symptoms.
Evidence also lacking for the gluten sensitive
But, are they safe for patients with non-celiac gluten sensitivity? The simple answer is, we just don’t know. We have so much to learn about gluten sensitivity. There are no studies looking at these products and their use in gluten-sensitive patients. Without scientific evidence, we cannot tell whether the products are safe or useful.
Anecdotal evidence and the placebo effect
As the Internet is now an important health resource for patients, I want to touch on a few points in the arena of effectiveness. As physicians we can say all we want about the lack of scientific data, but when you are sick and no one in the medical profession has given you answers, you look beyond the science. You read the anecdotal evidence you find online, and use information gleaned from conversations with family, friends and coworkers.
I would like to caution you that when you choose to use products that are not scientifically tested and validated, you may be influenced by online reviews written by patients (or presumed patients) experiencing a placebo effect or a benefit from some other component of the product. Is a product that only produces a placebo effect useful? In some health scenarios, placebos are useful. But, in this case, they could be harmful.
Additional ingredients may be source of perceived health benefits
Some of these formulations have probiotics, and others have vitamins and minerals in which gluten intolerant patients are often deficient: B vitamins, vitamin D and iron. Was it consuming one of these additional components that made the patients feel better, or was it the advertised enzyme component itself? If this was the reason for improvement, you would be better off being evaluated for vitamin and mineral deficiencies and treating them directly.
This holiday season and beyond
Until we see well-designed studies or clinical data with enough power to trust the conclusions, we cannot rely on these supplements to offer any protection from gluten consumption. For now, these products are not the miracle pill or panacea we all are hoping for. On the upside, there are other products in major clinical trials that look very promising as components of pharmaceutical treatments for celiac disease and gluten sensitivity. However, these products under development by Alvine Pharmaceuticals and Alba Therapeutics are still in testing. So for this holiday season, whether you are gluten sensitive or have celiac disease, careful attention to your diet in all settings is still one of the best things you can do for your health.
THIS ARTICLE IS COPYRIGHTED BY AMY BURKHART, MD, RD.