Will a Small Amount of Gluten Be Harmful?

in Celiac, The Celiac Expert

Q. How closely do I need to follow the gluten-free diet? Will a small amount of gluten harm me?

Shelley Case, RD: The only current treatment for celiac disease is a strict gluten-free diet for life. Eliminating gluten will allow the villi in the small intestine to heal, resulting in improved absorption of nutrients. Over time, symptoms will resolve and you will begin to feel better.

Gluten avoidance is important for managing celiac disease. Damage to the small intestine can still occur if you eat gluten on a regular basis, even if you don’t feel symptoms. The risk of long-term complications, including cancer of the gastrointestinal tract, is greatly reduced if the diet is followed closely.

But the question is: how strict do you need to be? And will a small amount of gluten matter? The fact is that the response to gluten is highly variable among individuals with celiac disease. So it is difficult to establish a safe threshold level.

In a 2007 study, 49 adults with celiac disease following a strict gluten-free diet were challenged with 10 or 50 milligrams of gluten for three months. Those who were exposed to 50 mg of gluten a day had small but significant mucosal damage to the villi lining the small intestine. One patient who was challenged with 10 mg of gluten a day developed symptoms. To put this in perspective, one slice of bread with wheat flour contains over 2,500 mg of gluten.

Learning the Avoidance Drill

To help you limit your exposure to gluten:

  • Read food labels every time you shop. Manufacturers sometimes change product formulations and what had been gluten-free previously may now include gluten-containing ingredients.
  • Buy grains, flours and starches that are labeled “gluten-free” from companies that test their products for gluten.
  • Be diligent in preventing cross-contamination when eating at home. Read my tips for keeping your kitchen gluten-safe.
  • Be especially careful when eating out. Choose restaurants that have a gluten-free menu or are knowledgeable and willing to accommodate those with special dietary restrictions.
  • Consult a registered dietitian with expertise in celiac disease who can review your diet and provide comprehensive and practical information about how to follow a strict gluten-free diet.

Shelley Case is a consulting dietitian and author of Gluten-Free: The Definitive Resource Guide. She is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and Gluten Intolerance Group.