In 2013, at the International Celiac Symposium hosted in Chicago, Illinois, I had the pleasure of hearing Professor Detlef Schuppan, MD, PhD from Germany, Director, Institute of Translational Immunology at University Medical Center of the Johannes Gutenberg University speak about a protein found in wheat, barley and rye, called Amylase Trypsin Inhibitors (ATIs). At that time, I had never heard about ATIs but now there is a growing number of articles linking ATIs to wheat intolerance and potential gut inflammation.
ATIs are present in many plants. They make up about 4% of the wheat protein, act as pest resistance molecules (they inhibit the enzymes of meal worms and bugs) and are a group of 17 proteins.
But…before you swear off wheat, please read on. And truthfully, it appears most people can eat wheat without issue. But there is a small subset of individuals that may benefit from a reduction in wheat or avoidance altogether.
This article below provides a great review.
As you may know, gluten sensitivity also known as non celiac gluten sensitivity (NCGS) or more recently called non celiac wheat sensitivity (NCWS) is a condition with both GI and non GI symptoms related to the intake of wheat that occurs without the presence of celiac disease. Celiac disease is an immune-mediated condition induced by dietary gluten in genetically susceptible individuals. There is no biomarker or diagnostic test for NCWS. Patients with NCGS/NCWS often have symptoms that mimic those present in IBS.
There is a growing body of science revealing a complex interaction between food, the gut microbiome and IBS. Of those foods commonly described as IBS triggers carbohydrates, gluten and wheat top the charts.
Wheat is a complex grain–made up numerous types of carbohydrates, proteins and fats. For most people, wheat is well tolerated in the diet and there is no reason to restrict eating it. But, for some individuals, eating wheat is associated with gastrointestinal (GI) and outside the GI tract symptoms, including: brain fog, headaches, anxiety, and more… and the ATI component of wheat may be part of this picture.
How do ATIs play a role in wheat intolerance?
ATIs proteins found in wheat (and also barley and rye) appear to cause symptoms directly by targeting certain pro-inflammatory receptors and indirectly by reducing the activity of digestive enzymes in the gut. Impaired digestive enzyme production allows accumulation of undigested protein with potential immune-activating properties. The ATIs in gluten containing grains (wheat, barley and rye) appear to be the primary ATIs to initiate immune activation. For this reason, a gluten free diet is basically ATI free.
ATIs activate both the intestinal and extra-intestinal innate immune system. The immune system is basically divided into 2 categories: the innate immune system and the adaptive immune system.
Innate vs. adaptive immunity: Let’s review the difference
Innate immunity involves your body’s first or early arriving defense mechanism that attacks an antigen (a foreign substance that induces an immune response) that appears in the body. The defense mechanisms include our skin, immune cells that attack foreign invaders, as well as chemicals in the blood.
The adaptive immune system acts in a more complicated and powerful manner. This immune system has to first recognize the foreign invader. Adaptive immunity adapts and remembers the foreign invader–so that subsequent exposures to the invader are more efficient.
The adaptive and innate immune system often act together, chemicals in the blood help them communicate with each other to coordinate there response to any ‘foreign’ substance.
Wheat Allergy vs. Wheat Sensitivity
In contrast to NCWS, wheat allergy presents typically with a quick onset of symptoms and can result in a life threatening event. Testing for wheat allergy is not perfect. The typical IgE testing can miss wheat allergy. In the research setting, wheat allergy can be assessed by placing wheat protein in the gut lining and monitoring the response with a specialized camera in a procedure called confocal endomicroscopy. This specialized allergy testing method is utilized primarily in the research setting and is not widely available.
Wheat allergy might affects up to ~2% of the population and risk of wheat allergy increases as we age.
Wheat Intolerance: Fructans, ATIs and Gluten
Let’s break down the components of wheat that might be associated with wheat intolerance. Wheat contains fructans. Those of you that follow the low FODMAP diet are well aware of these water-soluble fibers that are rapidly fermented by our gut bacteria. There are noted health benefits of fructans. Fructan intake has been associated with increasing probiotic microbes in our gut. But, also, as you well know, when fermented can induce painful gas for those with a sensitive gut.
Wheat also contains gluten, a protein that initiates an immune reaction in those with celiac disease, an immune driven disease. Celiac disease impacts about 1 in 133 Americans and it is increasing in prevalence. Wheat gluten may play a role in IBS symptoms as like ATIs, it is insufficiently broken down by our digestive enzymes and the intact gluten may initiate an innate immune reaction.
Wheat also contains wheat bran, an insoluble fiber that adds bulk to our stool. For those with IBS, wheat bran is commonly not well tolerated. This intolerance may be partly due to the fact it is indigestible and may mechanically stimulate and aggravate the gut lining.
Wheat germ agglutinin (WGA) is another plant protein found in wheat that may initiate an inflammatory immune reaction in the gut.
And as I have been discussing, wheat also contains amylase trypsin inhibitors. ATI content varies among modern gluten-containing grains. Determining ATI content in gluten containing grains is currently under investigation in the research setting. Some modern wheat has been shown to have levels of immune-activating ATIs that were as much as 100-fold higher than in gluten-free grains. Baking or processing does not lessen the ATI immune effects. Most older wheats such as Emmer or Einkorn have been shown to have less ATI immune activity.
Einkorn, pictured below, is an ancient wheat grain, and may contain less ATIs.
For Those with Pre-existing Autoimmune or other Inflammatory Diseases
The majority of individuals consuming wheat should not experience any symptoms. For those with autoimmune conditions or pre-existing inflammatory conditions, adding ATIs might aggravate these conditions. Unpublished animal studies show when chronic inflammation exists, exacerbation of disease occurs with modest ATI intake.
Potential Nutrient Deficiencies
Avoiding wheat products and going gluten free may reduce your intake of fiber, folate, niacin, vitamin B12, vitamin E, vitamin A, phosphorus, calcium, zinc, and selenium–most gluten free foods lack the enrichment of vitamins and minerals found in wheat based foods. Always consult with your health care provider before embarking on any nutritional change. I highly recommend working with a registered dietitian with digestive health expertise when experiencing food related symptoms to offer proper guidance.
Q and A with Dr. Detlef Schuppan
I asked some of my burning questions about ATIs to Dr. Detlef Schuppan. Here are a few of his quick answers to my questions:
Kate: Do you think ATIs may be more prevalent in the US based wheat products? So many of my clients can tolerate wheat products in Italy, for instance, but when they return to the States, can not tolerate them? Any thoughts on this discrepancy?
Dr. Schuppan: Could be – there is a wide variation of ATI content among different modern wheats – we are just investigating hundreds of wheat varieties.
Kate: In your expert opinion, who should avoid modern wheat products? Should this be a recommendation across the board? Or, simply for those with wheat intolerance or history of autoimmune conditions?
Dr. Schuppan: For now, only for the latter two.
Kate: What is your lab researching currently in this area?
Dr. Schuppan: We are investigating hundreds of wheat varieties and ATI content and performing more mouse and human clinical studies on NCWS (non celiac wheat sensitivity) and IgE negative food allergies.
Bottomline:
- Most people can enjoy wheat without health complications.
- Wheat contains prebiotic components shown to aid gut health.
- Wheat has numerous components (ATIs, gluten, fructans and more) that are linked with exacerbating GI symptoms in susceptible individuals.
- Many chronic diseases (including autoimmune diseases) are associated with systemic inflammation and may benefit from a reduction of wheat in the diet.
- Before changing your diet, always consult with a health professional.
References:
Schuppan, D et al Best Pract Res Clin Gastroenterol. 2015; Non-celiac wheat sensitivity: Differential diagnosis, triggers and implications.
Laury Hunt
Kate, on your recommendation, I’ve been avoiding gluten, when possible, for a few years now. Because I have been able to eat small amounts of it without serious repercussions, I’m not fanatical about it even though I find many gluten free breads and pasta lacking. Happily I have had success using the brands of sourdough bread (Iggy’s and Nashoba Brook) for french toast and an occasional sandwich. Would that indicate it’s more the reaction to yeast or what yeast does to products/gluten?
katescarlata
If you tolerate the sourdough bread that is great. The slow leavened sourdough breadmaking process reduces the fructans AND the gluten content–but the bread still has some gluten. I suspect in your case, that its about portion control. You can do diet challenges– adding back food that has gluten alone vs fructans if you wanted to test your tolerance to gluten.
Linda M.
Hi Kate,
Since I have been on a gluten free diet I have noticed a issue with my absorption of zinc, B12 etc. My doctor has prescribed zinc supplements several times, and as soon as I stop taking them my zinc level drops down, and my hair starts to fall out. I had a blood test for iron, and it was in the normal range, but low normal “40”, I asked my doctor if I should take an iron supplement but was told not to. I have been taking an enzyme hoping that would help with the absorption issue. I honestly do not know what to do, I work full time and take care of my little 92 year old Mom, and my husband has cancer. I am so tired all the time, and my memory is getting bad. Any suggestions would be appreciated!
katescarlata
Hi Linda, I am so sorry to hear that you are going through a difficult time right now. I hope you have supportive friends to give you some love and support. I think it would be best if you could get some nutrition guidance from a dietitian in your area–unfortunately, in a blog format it is not practical or appropriate for me to comment about personal medical issues without knowing your full history.
Linda M.
I am so sorry; I understand completely & appreciate the information that you provide to us. It is very frustrating for those of us who live in an area where there is not support, nor knowledge from the medical community regarding the Low Fodmap diet.
dkaj
Hi Kate,
Thanks again for all the wonderful up to date information you pass on to your readers. I am just curious if anyone discussed the topic of soaking the wheat flour to reduce the ATI’s and phytic acid at the conference. There is so much information on the benefits of soaking and sprouting for these reasons, that it makes me curious if any of the scientists are looking into this. I also wonder if ATI’s are reduced in traditional sourdough bread baking methods in addition to greatly reducing the gluten and fructans.
Thanks again.
katescarlata
Not sure if soaking will reduce the ATI content. Sprouting is an interesting concept–but I have not seen data on the effects of sprouting specifically on ATIs. Sprouting can reduce some of phytates and has many interesting potential health benefits. As for sourdough–it is possible the yeast and bacteria would feed off the protein in wheat (ATIs and Gluten)–sourdough processing reduced fructans–and gluten–so likely –though can’t say definitively, ATIs might reduce too.
Jennifer S
Hi Kate,
I have had constipation related IBS and finally tried the FODMAP diet. It has totally changed my life. I’m confused as I try to add back fructans, though. I was able to tolerate garlic and onion, but on two different attempts I cannot tolerate a full portion of bread (once tried a ciabatta roll and once a whole wheat english muffin). Does this mean I may be somewhat intolerant to all fractions, or just the wheat? Also, I accidentally had sun dried tomato in the elimination phase (not knowing it was a high FODMAP food) and I was in pain for 2 days. So, I suspect fructose as a problem too, but I’ve successfully tried lactose and sorbitol so far. Thanks for the help!
katescarlata
It is possible that you are reacting to another component of wheat. Wheat is a complex grain with multiple components that may trigger symptoms. Check out this post here: http://blog.katescarlata.com/2017/02/14/heard-amylase-trypsin-inhibitors/
~Kate
Jennifer S
That makes sense. So therefore I should be able to eat from the fructan category?
Gia Jelinek
On a previous thread that is closed to comments, you wrote: ‘wheat would be restricted because of the FODMAPs in it NOT the gluten.’
So the gluten free bread is not low fodmap because it is gluten free? If that is correct, what makes it low fodmap?
katescarlata
Hi Gia, the low FODMAP diet is a nutritional approach that focuses on carbohydrates in foods–specific ones that are commonly malabsorbed. Gluten is a protein NOT a carb. There is some overlap in gluten-free and low FODMAP foods–as both diets restrict wheat, barley and rye–the grains that contain gluten. But on the low FODMAP diet–small amounts of gluten are allowed such as in a handful of wheat based pretzels and regular soy sauce, for instance. We often recommend gluten free products on the low FODMAP diet–as this also reduces some FODMAP carbohydrates. But not all gluten free products are low in other FODMAP ingredients–for instance they may contain garlic, onion or apple juice –for instance. What makes a food low FODMAP -is that the food is devoid or has minimal FODMAPs in it. The Monash U low FODMAP app and my grocery list are good resources.
Gia Jelinek
Thank you! I downloaded the Monash app, and I think I understand the difference now. The 3 grains that contain gluten (wheat, barely, and rye) are high FODMAP. So avoiding gluten can help due to the elimination of the fodmaps…. not due to the elimination of the gluten. But gluten free products can contain other fodmaps such as garlic and onion. So much to learn!
katescarlata
You got it, Gia! It all gets easier in time. 🙂 Promise!
Kate