Celiac disease creates uncertainty—and a market for questionable tests, supplements and advice. Learn how to evaluate gluten enzymes, food-sensitivity tests, functional medicine claims and AI-generated information.
Celiac disease is hard. We have an autoimmune disease with a treatment we administer largely ourselves, often with far less medical follow-up than recommended.
The American College of Gastroenterology says treatment requires strict adherence to a gluten-free diet and lifelong medical follow-up. It also recognizes that symptoms, blood tests and intestinal healing do not always move together. Someone may have negative serology and no symptoms while the intestine has still failed to heal. [1]
There is also no simple, universally available way to know every time we have consumed gluten. Most of us rely heavily on symptoms, which are unreliable, and we know there may be long-term health consequences when celiac disease remains inadequately treated.
That uncertainty creates a market for questionable tests, supplements, practitioners and promises.
Some things may be useful. Others are expensive nonsense wrapped in scientific language.
Certified gluten-free products
Certified gluten-free products can be a useful and reputable way to obtain additional assurance about a packaged food.
Certification is voluntary and is performed by private third-party organizations, not the FDA. Different certifying organizations may use different testing, auditing and gluten limits.
Certification is also not the only way a food can safely be labeled gluten-free.
Under the FDA rule, any food carrying a gluten-free claim must meet the federal definition, regardless of whether it has been independently certified. Among other requirements, any unavoidable gluten present must remain below 20 parts per million. Manufacturers are responsible for compliance, although routine testing is not specifically required. [2]
A product may also be labeled gluten-free while carrying an advisory statement such as “made in a facility that also processes wheat.” The FDA says the gluten-free claim still must comply with the regulation. [2]
Processed wheat starch may be used in a food labeled gluten-free when it has been processed to remove gluten and its use does not result in the finished food containing 20 ppm or more gluten. [3]
That can make properly produced gluten-free wheat starch suitable for people with celiac disease. It does not necessarily make the product appropriate for someone with a wheat allergy, because wheat allergy involves wheat proteins other than—or in addition to—gluten.
Certification is useful. It is not magic, it does not mean literally zero gluten, and a lack of certification does not automatically make a gluten-free-labeled product unsafe.
Gluten-degrading enzymes
If commercially available gluten-degrading enzymes worked completely and reliably, they would represent a major treatment for celiac disease.
Researchers compared nine commercially available enzyme supplements in a laboratory study. They evaluated how quickly the products broke down several celiac-relevant gluten epitopes under simulated digestive conditions.
GluteGuard performed substantially better than the other products tested and reduced the measured epitopes below the detection limits of the assays more quickly. The authors also emphasized that the study was performed under laboratory conditions. It did not prove that these products prevent the autoimmune response or intestinal injury in people with celiac disease. [4]
That distinction matters.
Breaking down some gluten fragments in a test tube is not the same thing as demonstrating that a supplement protects the small intestine inside a person.
Coeliac Australia has also stated that gluten-degrading enzymes are not medicines designed to treat celiac disease. It notes that GluteGuard has limited clinical evidence suggesting it may reduce symptoms after small inadvertent exposures, but it should not be treated as permission to consume gluten or as a substitute for the gluten-free diet. [5]
Commercial enzymes do not make deliberately eating gluten safe.
Chiropractors and functional medicine practitioners promising to find the “root cause”
For many of us, the root cause of a lot of our health problems may already be celiac disease.
Celiac disease is a permanent immune-mediated response to gluten in genetically susceptible people. Its underlying disease process is not an unexplained mystery that can be resolved simply by correcting vague “toxins,” generalized inflammation or mitochondrial dysfunction. [1]
Recently, I saw a chiropractor advertising himself as a “Certified Gluten Practitioner.” He had completed a 100-hour course covering celiac disease, gluten sensitivity and root-cause health testing.
That is roughly two and a half weeks of full-time training.
Interesting? Maybe.
But it is not enough to make someone I would trust to medically manage my celiac disease.
I also once saw a functional medicine practitioner who ordered several expensive gut-health tests, explained the results and conveniently sold me supplements in her office.
I took them faithfully for six months.
When I returned and said I did not feel better, the answer was not that the approach might be wrong. The answer was that I had supposedly taken the wrong supplements and needed to buy different ones.
Thousands of dollars later, I realized I might not be in the right place.
Many people swear by functional medicine doctors. My experience was that I did not receive better answers. I received more time, more testing, more supplements and more guesses—paid for out of pocket.
For me, I need solutions, not guesses.
Time and attention have value. Feeling heard has value. Neither one proves that a test is valid or that a treatment works.
Food-sensitivity tests
I have taken one of those too.
It said I was sensitive to green beans.
I hate green beans, but not because they make me sick. I hate them because they taste like green beans unless they are covered in butter and garlic—and then they taste like butter and garlic.
Many commercial food-sensitivity tests measure food-specific IgG antibodies.
The American Academy of Allergy, Asthma & Immunology says these tests have not been scientifically proven to diagnose food sensitivities, allergies or intolerances. The presence of IgG may simply reflect normal exposure to a food, and higher IgG4 levels may even be associated with tolerance. The organization recommends against using IgG testing to diagnose food allergy or food intolerance. [6]
A long list of brightly colored “reactive” foods may look precise. That does not make the results clinically meaningful.
AI-generated medical content
Be careful with polished medical graphics circulating on social media.
AI can create something that looks professional and authoritative while mixing accurate information with exaggeration, missing context and false certainty.
For example, I recently saw an AI-generated celiac handout that said:
“20 PPM — safe threshold limit.”
Twenty parts per million is one criterion within the FDA’s legal definition for foods labeled gluten-free. The FDA selected that level partly because validated analytical methods could reliably measure gluten at that concentration when the rule was developed, and because available evidence suggested most people with celiac disease could tolerate variable trace amounts below that level without adverse effects. [2]
It is not a universal biological line below which every exposure is automatically harmless.
Parts per million measures concentration, not the total dose consumed. Ten grams of a food containing 20 ppm gluten and 500 grams of that food do not deliver the same total amount of gluten.
The same handout said:
“Progression halts completely once gluten is strictly eliminated.”
What does “gluten is strictly eliminated” actually mean?
Does it mean following a medically appropriate gluten-free diet?
Does it mean avoiding all processed gluten-free foods?
Does it mean trying to eliminate every theoretical possibility of cross-contact?
Those are very different things.
Most people have an excellent clinical response to a gluten-free diet, but recovery is not identical for everyone. Persistent or recurrent symptoms can occur despite following the diet and require evaluation for ongoing gluten exposure or other medical conditions. [1]
The ACG guideline also notes that intestinal healing may fail to occur despite negative celiac bloodwork and an absence of symptoms. It recommends considering intestinal healing—not symptoms or bloodwork alone—as a treatment goal. [1]
Refractory celiac disease is rare, but it exists. It involves persistent or recurrent celiac-related symptoms and intestinal damage despite a strict gluten-free diet after other causes have been investigated. [1]
Therefore, saying that disease progression “halts completely” is too absolute.
Words matter.
Context matters.
Something can be mostly accurate and still be misleading.
Celiac disease leaves us wanting certainty. That makes us vulnerable to anyone selling a test, supplement, course or treatment that promises to remove that uncertainty.
Ask who is making the claim and what evidence supports it.
Ask whether it was tested in people with celiac disease or only in a laboratory. Big difference.
Ask whether the results measured symptoms, bloodwork, gluten fragments or actual protection from intestinal injury. Those are not interchangeable outcomes.
And ask whether the person explaining the problem also happens to sell the solution.
That is the red flag: when someone convinces you that you have a problem—one that may not actually exist—it becomes much easier to sell you the solution.
Knowing what evidence supports a claim is important.
You should never have to trust someone simply because they sound confident.
Looking for evidence-based celiac information with the sources included? Visit the Fat Celiac resource library at fatceliac.net/resources.
Sources
1. American College of Gastroenterology: Clinical Guideline Update—Diagnosis and Management of Celiac Disease
https://socgastro.org.br/novo/wp-content/uploads/2023/01/American_College_of_Gastroenterology_Guidelines.17.pdf
2. U.S. Food and Drug Administration: Questions and Answers on the Gluten-Free Food Labeling Final Rule
https://www.fda.gov/food/nutrition-food-labeling-and-critical-foods/questions-and-answers-gluten-free-food-labeling-final-rule
3. U.S. Food and Drug Administration: Gluten and Food Labeling
https://www.fda.gov/food/nutrition-education-resources-materials/gluten-and-food-labeling
4. Tanner et al.: Relative Rates of Gluten Digestion by Nine Commercial Dietary Supplements
https://pmc.ncbi.nlm.nih.gov/articles/PMC8688929/
5. Coeliac Australia: Advice in Relation to the Use of the Enzyme Supplement GluteGuard
https://coeliac.org.au/news/important-advice-in-relation-to-the-use-of-enzyme-supplement-gluteguard/
6. American Academy of Allergy, Asthma & Immunology: The Myth of IgG Food Panel Testing
https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/igg-food-test
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