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Gluten formation: Its Sources, composition and health effects

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Chapter

GLUTEN FORMATION, ITS SOURCES, COMPOSITION

AND HEALTH EFFECTS

Leidi Daiana Preichardt1,* and Márcia Arocha Gularte2,†

1
Departamento de Alimentos, Instituto Federal Farroupilha, Rua Fábio João Andolhe,
Santo Augusto, RS, Brasil
2
Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal
de Pelotas, Pelotas, RS, Brasil

ABSTRACT
Wheat has a very important role in human feeding. Using wheat, we can make many
popular products such as cakes, bread, crackers, pasta, and many bakery products
consumed daily. In these products, especially bread, the formation of gluten is required,
obtained by mixing homogenized wheat flour with a liquid to form a viscoelastic batter
capable of retaining the gas produced during fermentation and at the early stages of bread
baking. Other cereals also have this ability, such as rye, barley, oats and triticale. Gluten
is produced due to its protein complex, mainly by disulfide bonds of the glutenin and
gliadin insoluble proteins. But some people have reactions to gluten, which provokes
intolerance or food allergy, also called celiac disease, which is considered an
autoimmunepathology. It is the result of the interaction of environmental factors, genetic
and immunological factors, causing bowel injury inflammation, with various reactions
such as diarrhea, malnutrition, weight loss, swelling, edema, anemia, muscular atrophy,
vomiting, pain and/or abdominal discomfort, constipation, short stature, dermatitis
herpetiformis, and various other symptoms. However, to avoid complications caused by
the disease, a strict gluten free diet is required. There are some negative characteristics
associated with this diet, because gluten-free food options are limited. It is a challenge
for researchers and industry to develop alternatives to gluten in bakery products,
replacing cereals that form gluten by others with different protein compositions.

*
Corresponding author. Eixo de Produção Alimentícia. Instituto Federal Farrroupilha, 98590-000, Santo Augusto –
RS, Brazil. Phone/Fax: +55 55 3781-3555; E-mail: [email protected].
†
E-mail: [email protected].
2 Leidi Daiana Preichardt and Márcia Arocha Gularte

1. INTRODUCTION
Wheat (Triticum vulgare) is the most important cereal used in baking. The proteins
present in the cereal prolamins can be classified into (ethanol soluble) and glutenin (ethanol
insoluble). These proteins when hydrated form a protein complex called gluten, responsible
for the viscoelastic properties of dough that are essential for the development of all kinds of
breads made from wheat flour. Importantly, in addition to wheat, gluten is present in barley,
rye and oats.
Some people have allergic reactions to gluten; these people develop celiac disease,
considered an autoimmune disease. This disease results from the interaction of environmental
factors, genetic and immunological, inflammatory lesions in the bowel and it triggers several
adverse reactions.
The treatment is done through a strict gluten free diet. Researchers have sought new
alternatives to facilitate diagnosis and contribute to improve the quality of life of celiac
patients. However, options for gluten free foods, especially in baking, are limited. Alternative
ingredients used to replace wheat flour or to simulate the effect of gluten in the dough have
been studied. Considering these facts, this first chapter will discuss the gluten network
formation, its sources, composition and effects on health.

2. GLUTEN
The cereals belonging to the Gramineae family can be divided into four subfamilies:
Bambusoidea, Pooideae, Panicoideae e Chloridiodeae. The subfamily Pooideae comprises
two subgroups: Triticeae containing most cereals: wheat (triticum) rye (secale), barley
(hordeum), and Aveneaepe containing oats (avena) (Sdepanian, Morais and Fagundes-Neto,
1999). The wheat (Triticum vulgare), together with rice and corn, is one of the most important
cereals, the flour obtained from the grain milling is intended, mainly, for the production of
bread, cakes and other bakery products (Quaglia, 1991; Hoseney, 1994).
Gluten is a complex protein composed of insoluble proteins, prolamins (soluble in
ethanol) and glutenin (insoluble in ethanol) formed during the preparation of dough, in other
words, during hydration, mainly by disulfide bonds of insoluble proteins in water and sodium
chloride 0.5 mol% (Hoseney, 1994; Sgarbieri, 1996; Cauvain and Young, 2009). These
proteins are found in cereals belonging to the Pooideae subfamily from the family Gramineae.
The gluten proteins present in the wheat seed endosperm, represents 85% of the protein flour
(Brammer, 2000). Gluten is mainly responsible for the preparation of various types of bread
made from wheat flour. Wheat is composed of approximately 50% prolamine, alcohol soluble
proteins, which have different designations according to their origin. In wheat, the alcohol
soluble fraction is called gliadin, the barley hordein, in rye secalina and, oats of the avenin.
Gluten is extremely important for the food industry because it gives quality
characteristics, especially in bakery products. In the case of wheat flour, gliadin is responsible
for the cohesiveness of the dough and glutenin is responsible for the resistance to the
extension of the dough (Hoseney, 1994). There is hydration of the gliadin proteins and
glutenin flour when wheat flour is mixed with water and homogenized mechanically for the
 Gluten: Composition and Nutritional Effects 3

production of bakery products, and these form a protein complex by association via hydrogen
bonds, Van der Waals bonds and disulfide bonds, forming gluten (Bobbio e Bobbio, 1992),
which gives the dough and single viscoelastic properties and the ability to retain gases
(Figures 1).

Source: Perten (2012).

Figure 1. Structure formation of gluten - gliadin and glutenin.

Glutinous wheat proteins are central in studies of proteins. These proteins are atypical in
their amino acid composition. Approximately 33% of the residues are glutamyl, which are
substantially all in the form of glutamine (amide grouping from the side chain carboxyl) a
non-ionizing group that forms hydrogen bonds with electron donors which can happen with
water molecules as with other amides. The basic amino acid residues are relatively small in
number, contributing to proteins low surface charge density, promoting the approach and
interaction in aqueous matrix mass. Another peculiarity is that gluten contains a higher
proportion of proline (about 14% of the residues) than does the usual protein; this factor may
contribute to the elastic properties of gluten (Cauvain and Young, 2009).
The gliadins forming the gluten prolamines are a mixture of monomeric, single chain,
which is extracted in a solution of 70% ethanol. Being also soluble in dilute solutions as 0.01
M acetic acid (Sgarbiere, 1996) it has low molecular weight. The average molecular weight of
40,000 Da, ranging from 30,000 to 100,000 Da, all occurring disulfide bonds are
intramolecular (Hoseney, 1994; Cauvain and Young, 2009). The gliadins can be divided into
four groups based on the mode in Acide-PAGE, α-(highest mobility), β-, γ-and ω-gliadins
(lower mobility). The molar mass ranging from 30,000 to 40,000 Da for the types α-, β-, γ-
gliadins and 60000-80000 Da for type ω-gliadins (Gianebelli et al., 2001). Many gliadins are
similar in their amino acid composition, with elevated levels of glutamine and lysine, low
prolamine and other sulfur amino acids. The γ-gliadins differ from α-and β-gliadins in the
amount of aspartic acid, prolamine, methionine, tyrosine, phenylalanine and tryptophan.
4 Leidi Daiana Preichardt and Márcia Arocha Gularte

Differently, the ω-gliadins differ from other types of gliadins for not presenting cysteine
(Tatham, Miflin, Sherwry, 1985; Pyler, 1988; Gianebelli et al., 2001; Santos, 2008).
These proteins are hydrophobic and, when hydrated, are responsible for the consistency,
viscosity and the extensibility of the dough. It has high tackiness, having little resistance to
extension. These proteins also have characteristic forms that are independent from the
genotype and growth conditions of the plant, being its analysis attractive to varietal
identification (Wrigley, 1976). According to Brammer (2000), the electrophoretic patterns
obtained with such proteins may relate to 69% of the variation in bread making quality in a
wheat genotype.
The glutenin, as well as gliadin is hydrophobic, since the amino acid composition is
similar to gliadin, but it has a very different molecular structure. It represents the least soluble
fraction of wheat proteins, being used for its solubilization, an acid or alkaline diluted
solution (Sgarbiere, 1996). The glutenin presents high molecular weight and can be
differentiated by the two high molecular weight and low molecular weight subunit groups.
The glutenin high molecular weight group (HMW-DS) are of the polymeric type, branched
chain, have molecular weights ranging from 95,000 to 136,000 Da, responsible for the
extensibility of the dough and are stabilized by disulfide bonds, resulting from the linking of
cysteine residues; are paramount in the baking process, because it is the main determinant of
gluten elasticity (Tatham, Miflin, Sherwry, 1985; Franceschi et al, 2008).
The GS-HMW subunits are coded by genes Glu-1 located on the long arm of the first
group homologous species (chromosomes 1A, 1B and 1D), which may encode one or two
kinds of polypeptides (Caldeira et al., 2000). The glutenin low molecular weight group
(LMW-DS), have molecular weights of 40000-50000 Da and are mapped in three-Glu locus
on the short arm of chromosomes 1A, 1B and 1D and near the locus Gli-1. The amino acid
composition, structure and molecular weight of glutenin low weight are considered similar to
the γ-gliadins, which makes the identification of LMW-GS unidimensional SDS-PAGE
difficult (Gianebelli et al., 2001).
The wide application of the wheat flour in the preparation of bakery products should be
precisely the characteristics of extensibility and viscoelasticity attributed to gluten proteins
that assist in the retention of the gas, enabling the development of an adequate volume of
products. It is these properties that provide flour baking characteristics, specific and suitable
texture to breads, cakes and pastries (Hoseney, 1994; Fenema, 1996).
The dough of gluten, rubberlike, able to deform, stretch, recovering the shape and entrap
gases is very important for the production of bread and all fermented products. Among all the
cereals, these properties are almost unique to wheat. However, it has been seen in some other
cereal flours such as those derived from barley and rye, that may produce gluten, but to a
lesser degree than the normally observed in wheat flour (Cauvain and Young, 2009).

3. CELIAC DISEASE
Celiac are people who have celiac disease. Celiac disease is a condition of the
gastrointestinal tract that results in the inability to properly digest the protein known as
gluten, it is a permanent intolerance to gluten, considered an autoimmune disease or gluten-
 Gluten: Composition and Nutritional Effects 5

sensitive enteropathy, as sprue and not tropical sprue (Mahan & Scott-Stump, 1998; Murray,
2002).
This disease is characterized by chronic malabsorption, a product of the interaction
between environmental factors, genetic and immunological factors, causing inflammatory
bowel injury, with various reactions (Baptista et al., 2005). The immune reaction to gluten
causes irritation and damage to the lining of the small intestine, making it unable to fully
absorb specific nutrients, which is a particular concern in children during growth. Celiac
disease is associated with maldigestion and malabsorption of nutrients, minerals and vitamins
in the gastrointestinal tract due to the toxicity of gluten, which damages the intestinal
villosities (Mahan & Scott-Stump, 1998).
The predominant toxic fraction of gluten for celiac patients are the prolamins, found in
wheat, barley, rye and oats. The high content of amino acids glutamine (> 30%) and proline
(> 15%) in these cereals provide a toxicity that is not observed with the prolamine cereal,
such as rice and corn, which predominates the alanine and leucine amino acids. There is
controversy about the toxicity of oats, as it has a small amount of avenin (4-14% of total
protein) in their grain, compared to approximately 40% of wheat gliadin. Another factor is the
composition of avenin; this presents an intermediate amount of glutamine and proline
aminiácidos therefore only an excessive intake of this cereal could cause problems (Mäki,
Collin, 1997; Dani, 2001).
The sensitivity caused by certain kinds of foods may occur due to food intolerance or
food allergy. Food intolerance is defined as any sensitivity to foods caused by non-
immunological mechanisms, including toxic reactions, pharmacological, metabolic or
idiosyncratic. Food allergy is an abnormal reaction of the immune system, but not infectious
to a food that causes damage to the body. It is also defined as hypersensitivity (Mahan &
Scott-Stump, 1998). In food allergy the immune response is directed to a specific protein in
the diet and, for celiac, gliadin is one of the gluten components. The symptoms of allergy and
food intolerance are often the same (Mahan & Scott-Stump, 1998). Because of this, confusion
often occurs between the terms used to define the cause of sensitivity. For immunological
mechanisms involved, celiac disease is considered a food allergy, although many authors use
the term food intolerance.
A deficiency of one specific peptidase mucosa in patients with celiac disease causes the
villosities of the intestinal mucosa to become flattened and smoothed in the presence of
gliadin. It is believed that a receptor on the cell surface allows the intestinal gliadin to join the
enterocyte and this complex gliadin/receiver, causes mucosal damages and antigenic
reactions, triggering antibody production and appearance of disease symptoms (Mahan &
Scott-Stump, 1998; Murray, 2002).
Celiac disease affects mainly individuals of European descendent. The prevalence in the
United Kingdom and Continental Europe is 1/100, whereas in North America this ratio is
1/300. Several authors suggest that the disease affects twice as many women as men, while
others maintain an equal distribution between the genders. The concordance between identical
twins is 70-100%. The probable prevalence among first-degree relatives is 10-15%. It is a
more common prevalent disease in patients with other autoimmune diseases such as type 1
diabetes mellitus and also thyroid disease (Ciclitira, 2003).
Symptoms of celiac disease can vary depending on the disease’s stage, but the most
common are bloating, irregular bouts of diarrhea, abdominal pain and dermatitis
herpetiformis. These symptoms mimic other diseases as parasitic infections, anemia, stomach
6 Leidi Daiana Preichardt and Márcia Arocha Gularte

ulcers and irritable bowel syndrome. Nonspecific symptoms may also occur, such as rash, dry
mouth, bone and dental problems, depression, irritability, stomach cramps and neuropathy
(tingling in legs and arms) (Mahan & Scott-Stump,1998; Ciclitira, 2003). The malabsorption
of nutrients due to celiac disease trigger various symptoms such as diarrhea, cramps, excess
gas, weakness, foul-smelling gray feces, growth failure, osteoporosis, and weight loss. Five
percent of patients initially diagnosed with irritable bowel syndrome actually have celiac
disease.
There is no cure for celiac disease but it can be controlled and intestinal damage
prevented through an appropriate diet. The most effective treatment to prevent complications
caused by celiac disease is not consuming foods containing gluten, which is paramount in the
performance of a gluten free diet in order to ensure development and pubertal height and
appropriate weight, bone mineral density, fertility, macro and micronutrients deficiency risk
reduction, as well as decrease the risk of onset of diseases of the digestive system (Sdepanian,
Morais and Fagundes-Neto, 1999).
Untreated celiac disease can lead to gastrointestinal adenocarcinoma and lymphoma of
the small intestine. What can prevent complications caused by the disease is a 100% gluten
free strict diet (Benahmed et al., 2003; Gallagher; Gormley; Arendt, 2003; Coultate, 2004).
To enable this, the charge of manufacturing industries gluten free products must have strict
control of processing to avoid cross-contamination with products that contain wheat, both in
the choice of raw materials as well as clean equipment. Public authorities should establish
laws to ensure the health of celiac patients, and the scientific community must promote the
standardization and validation of methods for the detection of gluten (Possik et. al., 2005).
The transgression of the diet may be voluntary or involuntary, and to follow the diet, it is
necessary for the patient to have knowledge about the disease and its treatment. Involuntarily,
consumption of gluten due to incorrect description of ingredients on food labels or gluten
contamination in manufactured products can occur. This type of accident can happen from the
harvest of raw material or even when marketing food.
Treatment is basically dietary and must exclude gluten from the diet throughout life, both
in individuals symptomatic as asymptomatic. The diet of celiac disease patients must meet the
nutritional needs, in accordance with age. After removal of gluten from the diet, the
symptomatic clinical response is rapid; resulting in the disappearance of gastrointestinal
symptoms within days or weeks, and a remarkable increase in growth rate after a short time
on the diet is noted. Histological changes in mucosal take longer. The reduction in
intraepithelial lymphocyte infiltration occurs within a few weeks; however, the recovery of
standard appearance villosities generally takes two to three months. Some patients never
recover completely, although they feel good (Sdepanian, Morais and Fagundes-Neto, 1999).
The complete healing of fingerlike villosities of the small intestine can take months. The
return of normal or nearly normal mucosa with strictly gluten free diets is possible; however,
changes are relapses after their reintroduction (Dani, 2001). The treatment aim is to improve
the quality of the patients’ life, reverse the changes of enteric mucosa, correct nutritional
deficiencies and reduce the risk of developing lymphomas on the small intestine.
The celiac must maintain a strong commitment to self-education about diet and food
ingredients. The staple foods in the diet are: fruits and vegetables, cereals, grains, tubers,
dairy, meats, since the labels of these processed foods are observed before purchase. And
foods that normally have gluten include: baked goods (breads, cakes, cookies, pasta), sauces,
and sausages.
 Gluten: Composition and Nutritional Effects 7

The starchy corn, rice, potato and cassava, as well as the oleaginous and/or protein such
as soybeans can be used in preparing foods for celiac patients to replace those that contain
gluten (Mahan & Scott-Stump, 1998). Gluten free foods are now widely available for sale and
each day disclosure grows as well as increased production of food for the celiac, as a niche
market. In this way, the use of proteinaceous and starchy flour to completely substitute for
wheat flour is being more intensively researched.

4. ALTERNATIVE INGREDIENTS FOR

GLUTEN FREE PRODUCTS
The proteinaceous flours such as soybean meal, sweet lupine and amaranth are of great
importance in increasing the amount of protein bread. On the other hand, starchy flours are
obtained from roots, tubers and some cereals, used for the production of pasta, cookies,
breads, pizzas and more.
Rice (Orysa sativa) occupies an important position in the global food system, and more
than half the population of this planet has corn as a staple food. Asian countries, where over
half the world's population, concentrate on production and consumption of rice. In these
countries the consumption reaches over 90% of world production (Ferreira; Villar, 2003).
Rice is a good source of food energy, since it is rich in starch and nutrients. The chemical
composition of rice can vary, depending on environmental factors. It presents a high
biological value when compared with other grains and it is easy digestible, having a great
importance in feeding (Quaglia, 1991). The rice protein fraction, although small, has an
excellent amino acid composition to the human body, generating less nitrogen waste when it
suffers metabolism, favoring renal function. Rice also contains fractions of thiamine,
riboflavin and niacin. This cereal is hypoallergenic, and contains no gluten, which enables its
use in celiac disease.
During the processing of rice, there is a high rate of broken grains formation, grits, and
other products with low commercial value. The industry and research institutions are seeking
better use of these products. According to Tedrus et al. (2001), the production of rice flour
would be an alternative to increment the value of this raw material, since it is a byproduct of
processing.
Rice flour has no competitive application with wheat and it has a weak volume of
production. Despite providing socioeconomic benefits and nutritional, rice flour supply
happens modestly; few supermarkets offer it to the consumer. Scientific studies using rice
flour through the total or partial replacement of wheat flour have been conducted, especially
for cookies, cakes, soups, snacks, bread and Sonhos (Sivaramkrishnan; Senge;
Chattopadhyay, 2004; Galera, 2006; Tubari; Sumnu; Sahin, 2008; Clerici; Ariroldi; El-Dash,
2009; Gularte, Gómez, Rosell, 2011; Gularte, et al., 2012).
The industrialization of products from rice flour is technologically difficult. This flour
has viscoelastic properties, characteristic of gluten proteins (Sivaramkrishnan; Senge;
Chattopadhyay, 2004), which impairs the quality, yielding products of lower specific volume,
are less soft and have a shorter shelf life.
Corn (Zea mays) is grown in many regions of the world. The chemical composition of
corn can vary, depending on environmental factors. In general, corn has approximately 10%
8 Leidi Daiana Preichardt and Márcia Arocha Gularte

protein, 4.5% fat, 75% carbohydrates, 1.3% mineral salts. Glicidios provide corn the
characteristic of a highly energetic food, represented by starch, sugars and cellulose. Starch is
essentially the endosperm, germ and the sugars in cellulose in external wrappers (Quaglia,
1991).
Corn flour is obtained after a process that involves cleaning, drying, grain removal of the
germ, grinding, particle size classification and packing (Abimilho, 2008). This promotes
naturally yellow flour products. Its flavor is distinctive and very well accepted, with several
applications. It has a low cost and is widely available in the market (Alvim; Sgarbieri; Chang,
2002).
As these flours do not contain the balance of proteins responsible for elasticity and dough
extensibility (gliadin and glutenin) various additives (individually or together) should be
added in the formulation in an attempt to improve the technological quality in products,
especially in bread, increasing the gas retention, and therefore, improving the volume. Flavor
and texture, crust, crumb and nutritional value of breads may also be improved depending on
what products they are added to.
An issue in the gluten free bread production has been the difficulty in establishing a
network identical to gluten, to make possible retention of gases produced during fermentation.
Taking into consideration that gluten has unique viscoelasticity and cohesion characteristics;
the production of gluten free breads with fully acceptable technological features has been a
major challenge for researchers. To achieve the same volume of a traditional bread, for
example, to maintain the crumb and gluten-free flavor characteristics in the bread, it is
necessary to use supplements with other sources of gas stabilizing ingredients, which may be
protein, carbohydrate or lipid based (Cauvain and Young, 2009).
The additives commonly used in the literature for the manufacture of gluten free bread
are: gums (guar, xanthan, locuste), emulsifiers (glyceryl monostearate, GMS;
polioxietilenoestearato, POES; mono and diglycerides, stearoyl lactates) and hydrocolloids
(methylcellulose, MC; carboxymethylcellulose, CMC, hydroxypropyl methylcellulose,
HPMC) as well as pentosan, modified starches, pregelatinized or extrudates, pectins, albumin
(egg white), milk powder and sodium bicarbonate, among others.
Xanthan gum is a microbial extracellular polysaccharide used in various applications in
various industries due to its excellent rheological properties. It is produced via fermentation
by bacteria of the genus Xanthomonas (Ross-Murphy; Morris; Morris, 1983). Regarding the
chemical composition, xanthan is a heteropolysaccharide (formed by more than one type of
monosaccharide) of high molecular weight. It consists of a linear cellulosic backbone
containing repeated penta saccharide D-glucose units joined together by β-1links, 4 with
alternating residues of D-mannose and D-glucuronic acid, and pyruvic acetyl groups and even
D-acetyl (Born; Langendorff; Boulenguer, 2002; Jansson; Kenne; Lindberg, 1975).
Xanthan gum has been applied in various types of foods because it presents important
properties of stabilization of emulsion, thermal stability, compatibility with various food
ingredients and pseudo plastic rheological properties (viscosity decreasing with increasing
shear rate). Xanthan gum is extremely soluble in both hot and cold water and this behavior is
related to the nature of their polyelectrolyte molecule. Xanthan solutions have high viscosity
and shear thinning, even at low concentrations of polymer, the high viscosity is responsible
for the ability of the xanthan thickener (García-Ochoa et al., 2000; Vuyst; Loo; Vermeire,
2002).
 Gluten: Composition and Nutritional Effects 9

The main effect of xanthan is produced by the amylose retro gradation delay. An increase
in starch viscosity solutions is observed by incorporating this hydrocolloid, which modifies
the rheological properties of the solution (Weber; Queiroz-Collares; Chang, 2008; Weber et
al., 2009). For this reason, xanthan gum has been used to improve the rheological
characteristics of dough products such as breads and cakes, increasing the specific volume,
the hardening delay, prolonging the shelf life and improving the overall quality of these
products.
Lazaridou et al. (2007), a study on the effect of hydrocolloids in the dough rheology and
bread quality parameters in formulations without gluten, rice flour used and hydrocolloids
(pectin, carboxymethylcellulose (CMC), agarose, xanthan gum and β-glucan) in
concentrations of 1% and 2% based on flour. In this study, the addition of xanthan provided
an increased elasticity of the dough as well as the deformation resistance. Weber et al. (2009)
studied the physicochemical interactions between corn starch and hydrocolloids (guar and
xanthan gums) and their effect on functional properties. The authors concluded that the
xanthan modifies the properties of the starch paste and thermal confers greater shear and
heating stability and it reduces starch retro gradation.
Xue and Ngadi (2009), a study on the effect of xanthan gum in thermal mass systems
formulated with different combinations of flour, observed that the addition of the
hydrocolloid gelling temperature increases, however, it lowers the glass transition
temperature. Higher temperatures and more energy would be required to develop the dough
structure, whereas lower temperatures are required to stabilize frozen dough.
Tubari, Sumnu and Sahin (2008) conducted a study on the rheological properties and
quality of rice cakes formulated with various gums (xanthan, guar, locust, k-carrageenan,
hydroxypropyl methylcellulose, mixture of xanthan and guar, xanthan gum-k-carrageenan)
and a mixture of emulsifiers. In this study the cake batter made with xanthan and xanthan-
guar blend the highest values of apparent viscosity. Compounds without the cake emulsifiers
produced xanthan obtained with high specific volume. These results demonstrate a stability of
dough and quality of the cake made with xanthan. Preichardt et al. (2011) have obtained
excellent results adding xanthan gum to gluten free cakes made with rice flour and maize
flour in concentrations of 0.3 and 0.4% xanthan gum.

5. DIAGNOSIS OF CELIAC DISEASE

The tests necessary to diagnose that a person has an allergy to gluten are blood tests with
tests of anti-tissue transglutaminase, anti-endomysium and anti-gliadin antibodies are proteins
in the immune system, it results in high levels of antibodies, indicates that the body is fighting
gluten. If confirmed, the antibody results changes in lining the villosities of the small intestine
wall (endoscopic biopsy) must be examined, in which a small portion of the intestine is
removed and examined under a microscope by a pathologist.
The toxic theory suggests that individuals with celiac disease lack the specific mucosa
peptidase enzyme, so that the gluten or like its biggest peptides containing gluten, are not
effectively hydrolyzed to minor peptides (amino acid or dipeptide) and consequently the toxic
peptides may accumulate in the mucosa, damaging it (Isselbacher & Fauci, 1995). The small
intestine is coated by the overlying mucosa convolutions, which are covered by projections,
10 Leidi Daiana Preichardt and Márcia Arocha Gularte

which are the villosities that are covered with microvilli, or brush borders, its function is to
absorb vitamins, minerals and nutrients from food intake.
The lining of the gluten intolerant small intestine begins to change, becoming flatter and
flatter, causing the expulsion of ingested nutrients, or food that should be digested in the
small intestine and absorbed into the bloodstream through the intestine pass unaltered,
causing the characteristic symptoms of the disease (Mahan & Scott-Stump, 1998). The
process of the gluten allergy intestinal mucosa deformation starts with light passing to the
medium and heavy aggression, as shown in, where villosities are deformed or destroyed.
The microscope is characterized by loss of villous architecture with villous atrophy, crypt
hyperplasia and infiltration of the own lamina by inflammatory cells. Thus, the absorption of
nutrients from food intake each day does not normally occur, being inefficient, causing
malnutrition and consequently several other health problems.
Morphological changes predominate in the proximal jejunum, and under histologically,
the wounds may range from the intraepithelial lymphocytic infiltrate to total mucosal atrophy
with complete loss of villosities and crypt hyperplasia. Celiac disease is a result of the
interaction between environmental, genetic and immunological factors.
Environmental factors refer to the ingestion of gluten; genetic factors refer to genetic
susceptibility and is suggested by the high association between celiac disease patients and
their families in relation to the presence and prevalence of histocompatibility antigen types,
known as system HLA whose coding is done by the action of genes located on chromosome 6
in their short arm and locus A, B, C and D are responsible for the regulation of the immune
response. Individuals with celiac disease have a greater amount of histocompatibility
antigens, particularly of the types HLA-DR3 and HLA-DW2. Phenotype HLA-DR3 is present
in 70 to 90% of celiac individuals, compared with 20 to 25% of normal individuals (Pizzinato
& Srbernich, 1992).
The disease is usually inherited; an individual has a higher than twenty percent chance of
having the disease too. The closer the relatives, the prevalence is higher: 70% in monozygotic
twins, 10% in first-degree relatives and 2.5% in the second degree, while in the general
population is about 1%. The prevalence in identical twins is 100%. However, studies suggest
that HLA genes are essential, but are not the only genes required for disease manifesting
(Pereira; Filho, 2012). The immunological factors relate to the abnormal immune response of
the peptides derived from gluten, which is a characteristic of celiac disease (Pereira; Filho,
2012; Sdepanian; Morais E Fagundes Neto, 1999). It has been found that the disease can
appear spontaneously after a major aggression on the body, such as a physical injury,
infection, pregnancy or any surgery.
Regarding clinical celiac disease, it presents four patterns of clinical presentation:
classical, non-classical, latent and asymptomatic. Celiac disease is the classical and most
frequent pattern, it manifests itself early in life, with clinical signs of chronic diarrhea,
vomiting, irritability, anorexia, weight loss, failure to thrive, abdominal pain and distension,
decreased subcutaneous tissue, commitment variable nutritional status, hypocalcemia,
paleness due to ferropriva anemia and atrophy of the gluteal muscles (Sdepanian, Morais and
Fagundes-Neto, 1999; Dani, 2001; Silva, 2003; Kotze, 2006; Pereir, Filho, 2012).
The non-classic pattern or atypical present later and gastrointestinal symptoms are absent,
or, when present are of little relevance. Individuals who suffer from atypical may present as
isolated manifestations: short stature, iron deficiency anemia refractory to oral iron therapy,
 Gluten: Composition and Nutritional Effects 11

arthralgia or arthritis, constipation, enamel hypoplasia, osteoporosis, infertility, depressive

syndrome, osteoporosis and polyneuropathies (Mahan & Scott Stump, 1998; Kotze 2006).
The silent or asymptomatic disease pattern is a condition in which patients have
histopathologic changes of the proximal small intestine but without symptoms. Since the
latent pattern is a condition in which patients present at a certain time, histopathological
characteristics normal jejunal consuming gluten, in another period of time, feature subtotal
atrophy villosities (Silva, 2003).
Other forms of celiac disease are already recognized: latent and potential. The latent form
is characterized by normal mucosa jejunal in individuals with few or no symptoms and who
maintain a diet containing gluten. This form may present two variants, firstly, the form in
which the disease was present in childhood (undiagnosed), in which there was a patient’s
recovery, remaining thereafter silent even with normal diet. Moreover, there is a form with
normal mucosa over a period early in life, with normal diet, but the disease is developed later
(Machado, et al., 2006).
A small percentage of individuals with celiac disease have a severely damaged gut that
does not recover with a gluten free diet. The treatment for this condition is to control
intestinal inflammation with the use of drugs to absolve nutrients.

6. OCCURRENCE OF CELIAC DISEASE

Gluten allergy was considered for many years, a pediatric disease. However, its diagnosis
in adults has been increasingly common, and currently it’s believed that it can occur at any
age. The prevalence is different according to the countries, ranging from 1:152 to 1:300.
In Brazil, the incidence of diagnosed patients is 1/300 inhabitants, being the ratio
between women and men 2:1. The question may be genetic determinant for the diagnosis, and
the first-degree relatives are the most vulnerable to introduce gluten allergy, then diabetics,
patients with autoimmune diseases and Down syndrome patients.
According to Peckenpaugh and Poleman (1997), celiac disease occurs more often among
British descendants than among other groups. However, it is extremely rare in blacks,
Chinese and Japanese, but it was already described in India. In Brazil, due to the high
miscegenation, it has been described in mulattos. In the south of the country, predominantly
colonized by Europeans, the ancestries were found, in order of frequency, German, Italian,
Portuguese, Polish, Ukrainian, Spanish, Russian, Swiss, Dutch, French, British, Indians and
blacks, with multiple ancestries in many cases (Dani, 2001).
According to Oliveira et al (2005), the prevalence of celiac disease in the city of São
Paulo is high in similarity with the countries of Europe and, possibly, this diagnosis has been
underestimated in Brazil. According to Shils et al. (1999), celiac disease in adults is more
common in women, having maximum prevalence during their reproductive age, between 35
and 44 years of age. But it has an increasingly common prevalence in children and
adolescents with autoimmune diseases, especially diabetes mellitus type 1.
In Brazil, there has been found a 4.8% celiac prevalence of 104 investigated patients with
diabetes mellitus type 1. This prevalence is comparable to studies conducted in Europe and
North America, which according to Baptista et al (2005), is considered a high prevalence,
requiring further study. In the same year, Mahmud et al (2005) in the state of Minnesota
12 Leidi Daiana Preichardt and Márcia Arocha Gularte

(USA) also identified the prevalence of celiac disease in patients with diabetes mellitus type
1, estimated in 7% and most of these patients did not have the typical form of the disease. The
fact that the symptoms are very variable, showing typical cases of malabsorption and
malnutrition are even milder and nonspecific (sometimes without any gastrointestinal
manifestation) and may understate their diagnosis.

7. PUBLIC POLICIES
In Brazil, the Federal Law No. 10674 of 16.5.2003 states that the labels of processed
foods should compulsorily submit entries: "contains gluten" or "does not contain gluten"
(Brasil, 2003).
According to Codex Alimentarius quantitative determination of gluten in foodstuffs and
ingredients should be based on immunological methods or another method that provides
equal sensitivity and specificity. The antibody used should react with protein fractions of the
cereal which are toxic to people who are intolerant to gluten, and should not react with other
cereal proteins or other constituents of food or ingredients. The limit of detection must be less
than 10 mg gluten/kg. The qualitative analysis that indicates the presence of gluten should be
based on relevant methods, the method of ELISA-R5 is widely used. Other methods used:
Western blot / SDS-PAGE, PCR ("Polymerase Chain Reaction"), mass spectrometry
(MALDI-TOF "Matrix Assisted Laser Desorption Ionization - Time of Flight), and immuno
chromatographic strips (Pité, 2008).

8. TECHNOLOGICAL ADVANCES
Advanced studies to decrease or eliminate the symptoms of allergic to gluten are
developed by producing monoclonal antibodies, DNA technology, cell cloning and still
engineered foods. In this sense, research for trial are being tested with oral supplements of
special enzymes, compounds that block in compliance area with other HLA molecule and
vaccine.

CONCLUSION
Celiac disease is caused by a permanent allergy to gluten. The diagnosis is made by
serology and biopsy of the small intestine and its treatment is the definitive exclusion of
gluten from the diet. Scientific researchers have shown that some ingredients and additives
can be used in gluten free product development in the field of bakery. The information on the
labels and knowledge about the sources of gluten contribute to improving the quality of life of
celiac patients.

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