Is a gluten free diet forever?

A gluten free diet is currently the only treatment for celiac disease. A gluten free diet is exceptionally difficult to implement and maintain and is socially isolating. In this study, they look at the maximum threshold for gluten ingestion, latent or potential celiac disease, and if some with celiac may be able to return to a gluten containing diet.

Here’s the article.

Researchers here are defining a gluten free diet here not as a diet completely devoid of gluten, but an amount of gluten that is thought to be harmless. This is an interesting comment because I think this amount of gluten thought to be harmless is on a continuum. Some say they get symptoms from the slightest bit of cross contamination and others say they get little to no symptoms. On the whole, researchers found that a normal gluten free diet contains between 5mg and 50mg of gluten – just for reference a slice of bread contains between 2g and 4g of gluten.

The scientists found that children that had been on a gluten free diet for at least 3 months were given small amounts of gluten over the course of four weeks. Children who recieved 100mg of gluten showed minimal changes in their intestinal mucosa. Children who received 500mg of gluten started to show intestinal mucosal changes, celiac blood tests turning positive, and symptom relapse.

Another study showed that 50mg was the threshold for changes in the intestinal mucosa in adults.

The jury seems to still be out on exactly how much gluten someone with celiac can ingest without doing harm. Because we are already probably exposed to 50mg of gluten just through our normal day to day lives, the 100mg threshold doesn’t leave much room for error. So we still have to be vigilant about protecting ourselves.

There is something called the Gluten Contamination Elimination Diet or GCED. They have used this diet in helping those with unresponsive celiac disease. This diet focuses on naturally gluten free foods rather than depending on processed gluten free foods. After 3-6 months on the GCED, 82% of patients found symptom relief. There were only 17 patients involved in the study and the GCED is very restrictive. I think we should all focus on eating naturally gluten free products. I think it is just healthier and cheaper!

Here’s something controversial in this study, “All in all, current data allow for the assumption that the GFD has no definite role in the prevention of development of other autoimmune conditions.” So, diet has no impact on the development of other autoimmune disease. Also, those with celiac disease have a higher incidence of certain autoimmune diseases. The study indicates that it might be due to a common genetic root, rather than anything we can control.

Also, they cannot correlate adherence to a gluten free diet to the development of a malignant lymphoma. So, while, the general consensus is that a gluten free diet will prevent celiac cancer, the science isn’t so sure.

While we want to believe the science is all settled with celiac disease, I don’t think it is. Celiac is the only autoimmune disease we know what the trigger of the immune cascade is and what the ongoing damage is. What we don’t know are the long term effects of a gluten free diet, if and under what circumstances a gluten diet could be introduced, and what is a cure beyond a gluten free diet. Also the idea of latent or potential celiac and who may go on to develop celiac. So, there is some work to do on the celiac front and more that we need to understand. But this article sort of lets us know what we know and what we don’t know and what needs to be studied some more.


2 thoughts on “Is a gluten free diet forever?”

  1. What is celiac cancer that you referenced in the article? I have celiac disease but have never heard of celiac cancer. Have you done any research on it?

    1. It is enteropathy associated t cell lymphoma or EATL. It is extremely rare (when they were doing a clinical trial for a drug, they found fewer than 10 people with it) and the 5 year prognosis is poor. It is a direct result of untreated celiac as they typically find celiac and this cancer at the same time, typically in those over 50. It is unclear if the two are found together because of long term untreated celiac or if the celiac was already cancer prone in that individual. I guess I should post more info about celiac and cancer.

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