Is a diet free of gluten impossible to achieve?

Gluten free diets

People with coeliac disease are advised to entirely eliminate gluten from their diet to avoid intestinal inflammation and other chronic illnesses. However, a new study indicates that many people following a gluten free diet accidentally consume gluten at levels that could trigger symptoms and cause harm in those with coeliac disease.

The researchers performed a meta-analysis on data from two different clinical programs. Gluten consumption was estimated in different ways, including measuring the amount of indigestible gluten breakdown products in stool and urine samples. Gluten was also measured by looking at histological changes to the intestine that result from gluten digestion in those with, and without, coeliac disease.

Using these biomarkers, it was estimated those with coeliac disease consume up to 244 mg of gluten per day. The study estimated the average to be from 150–400 mg using the stool test and 300–400 mg using the urine test. Other studies have shown these levels will cause both intestinal damage and potential symptoms in many people with coeliac disease.

While there are limitations to retrospective analysis of data collected for other studies as well as the reliance on surrogate biomarkers of gluten consumption, these results indicate there is merit in further exploration to quantify the risk for those needing to completely avoid gluten. It also highlights the challenges for the food industry in preventing low levels of gluten accidentally entering the supply chain for foods marketed as gluten free.

Reference: Syage et al. 2018 The American Journal of Clinical Nutrition, Vol 107(2) Pp 201–207. DOI: 10.1093/ajcn/nqx049