How Safe is Occasional Ingestion of Gluten for People with Celiac Disease?

Celiac.com 04/13/2023 - Contrary to popular medical wisdom, a recent study suggests that some celiac disease patients who occasionally ingest gluten may not experience significant clinical symptoms or small bowel damage. 

A gluten-free diet is currently the only medically accepted treatment for celiac disease, but adherence can be challenging, and many patients report occasional voluntary transgressions.

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Eating a gluten-free diet lowers the quality of life for most celiac disease patients, many of whom frequently ask if it's okay to occasionally ingest gluten-containing food. 

To get a better idea of the issue, a research team evaluated celiac patients reporting voluntary and occasional transgressions to their gluten-free diet. 

The Research Team

The team included Luca Elli, Karla Bascuñán, Lorenzo di Lernia, Maria Teresa Bardella, Luisa Doneda, Laura Soldati, Stefania Orlando, Francesca Ferretti, Vincenza Lombardo, Giulio Barigelletti, Alice Scricciolo, Sabrina Fabiano, Maurizio Vecchi & Leda Roncoroni.

They are associated with the Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; the Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan; the Department of Health Sciences, University of Milan, Milan, Italy; and the Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

Celiacs Voluntarily Eat Gluten- The Study

Researchers prospectively enrolled 109 celiac patients who reported occasional and voluntary gluten ingestion and a group of patients on strict gluten-free diet as controls. 

The study involved clinical examination, blood tests, duodenal biopsy, capsule enteroscopy, and a validated food-frequency questionnaire to assess gluten intake. The results showed that 57% of noncompliant patients did not present any histological alteration, and 70% did not present any alteration at capsule enteroscopy. 

Furthermore, 75% of patients reported no gastrointestinal symptoms after gluten ingestion. The findings suggest that celiacs can achieve a degree of tolerance towards gluten consumption can be reached, and occasional gluten intake may not necessarily lead to significant clinical symptoms or small bowel damage. 

However, the researchers highlight that strict gluten-free diet adherence is still the best course of action to prevent long-term complications, and more research is needed to understand the mechanisms behind tolerance towards gluten ingestion in celiac patients.

Clearly this result runs counter to popular wisdom, and even to some science. The conclusion will likely cause a stir in the celiac and the medical and scientific communities. For people with celiac disease, it's crucial to have a clear picture of the proper parameters of treatment. With so much at stake, for both doctors and, especially patients, it's clear that more research is needed to get a truly clear picture of the effects of minor gluten-consumption on people with celiac disease.

Read more at BMC Medicine