Enzyme Pill: A Game Changer for Gluten-Sensitive People?

A new enzyme pill could be a game changer for gluten-sensitive people, according to the authors of a new study.

The enzyme breaks down gluten in the stomach and prevents most of it from reaching the small intestine. So it could allow gluten-sensitive people to eat small amounts of the protein (found in wheat and other grains) without suffering consequences such as bloating, diarrhea, and abdominal pain.

For the study, the researchers tested the effects of an enzyme called aspergillus niger-derived prolyl endoprotease (AN-PEP) in 18 patients with gluten sensitivity. Each participant ate a serving of oatmeal with two gluten-containing wheat cookies along with either a high- or low-dose of AN-PEP or a placebo pill.

Researchers then measured gluten levels in the stomach and small intestine over a three-hour period.

In both the high- and low-dose AN-PEP groups, the researchers found that AN-PEP reduced levels of gluten in the stomach by 85 percent compared to placebo.

They also found that the enzyme reduced gluten levels in the duodenum (the first part of the small intestine) by 81 percent in the high-dose group and by 87 percent in the low-dose group.

The findings were presented at Digestive Disease Week 2017, the largest international gathering of experts from the fields of gastroenterology, endoscopy, hepatology, and gastrointestinal surgery.

“This substance allows gluten-sensitive patients to feel safer, for example, when they are out with friends at a restaurant and can’t be sure whether something is 100 percent gluten-free,” says Dr. Julia König, Ph.D., the study’s lead author and post-doctoral research fellow at the School of Medical Sciences at University of Örebro, Sweden.

“Since even small amounts of gluten can affect gluten-sensitive patients, this supplement can play an important role in addressing the residual gluten that is often the cause of uncomfortable symptoms.”

Previous research has demonstrated that AN-PEP can break down gluten when it is combined with a liquid meal and administered through a feeding tube. The new study is the first to study the effects of AN-PEP tablet in combination with a normal meal.

“Studies show that even when following a gluten-free diet, unintentional gluten intake can still occur, depending on how strict a gluten-free dieter is,” says König.

“Our results suggest that this enzyme can potentially reduce the side effects that occur when gluten-sensitive individuals accidentally eat a little gluten. We are not suggesting that AN-PEP will give these individuals the ability to eat pizza or pasta, sources of large amounts of gluten, but it might make them feel better if they mistakenly ingest gluten.”

Gluten is a protein found in grains such as wheat, rye, and barley, as well as medicines, vitamins, and supplements.

In addition to gastrointestinal problems, gluten sensitivity is associated with symptoms such as fatigue, muscle cramps, and leg numbness.

Despite some similarities, gluten sensitivity is different from celiac disease, a serious, inherited auto-immune disorder caused by gluten exposure. Unlike people with celiac disease, those with gluten sensitivity do not develop gluten antibodies and their immune systems do not mistakenly attack and damage their small intestines.

According to the National Foundation for Celiac Awareness, about 18 million Americans are affected by non-celiac gluten sensitivity, also known as gluten intolerance.

Gluten sensitivity is poorly understood. Because there are no specific tests to diagnose the condition, doctors must rule out other possible causes of a patient’s symptoms such as celiac disease and wheat allergy.

To confirm gluten sensitivity, doctors usually place patients on a diet that eliminates gluten to see if their symptoms improve. This is followed by an “open challenge” (a monitored reintroduction of gluten-containing foods) to see if their symptoms worsen.

König notes that her team did not test the enzyme on celiac disease patients, because even small amounts of gluten can cause long-term harm in these individuals.

Because of that, she does not recommend celiac patients view this enzyme as a way to start eating any gluten.