In the not so distant past, one of the main ways to confirm your celiac diagnosis was to do a gluten challenge. In other words — after you’ve been gluten free for a while, go back on gluten to see what happens and whether your symptoms come back. While that’s not quite as common any more since the gold-standard biopsy is the way to go, but some people still do it.
The ones I know who may go back on gluten after being off, is someone who tried the gluten free diet BEFORE being screened for celiac. Most of these patients find out after being gluten free for a while that they’ll have to eat gluten again (over a period of time — not just once) to get an accurate celiac diagnosis.
In a new study reported recently in BMC Gastroenterology, researchers wanted to know how quickly your gut is damaged when reintroducing even the smallest amount of gluten, or as the research put it, they aimed to “gain a clearer conception of the gluten amount needed to cause some mucosal deterioration but without inducing excessive ill health with a resultant dropout of trial subjects.” Specifically they referenced this information would be good during current drug trials that need celiacs to do a gluten challenge. I think this information could be useful to anyone.
Gluten Challenge Research
Scientists gave 25 celiac patients who had been gluten free for many years a biscuit containing between 1.5 and 5 grams of gluten. The moderate gluten dose group got 3-5 grams and the low gluten dose group got 1.5–3 grams. Four patients from the moderate dose group ended up leaving the study because of abdominal pain, vomiting and diarrhea. No one from the low gluten group left early because of illness. There were 21 patients left in the study.
The research concluded 15 of those patients ( 71% ) had mild to moderate abdominal symptoms with the gluten challenge. Eight (including the four who withdrew early) were from that moderate dose group and 7 were from the low-dose group. No one developed severe symptoms.
87% of the group also had mucosal changes in their small intestine. But 22% of those cases that had small intestinal damage had no symptoms! Based on these results, researchers warned anyone conducting a gluten challenge by relying on symptoms only could be dangerous for the patient “such persistent small-intestinal villous atrophy in symptom-free patients clearly carries a risk of subsequent severe complications such as osteoporosis and malignancies.”
In conclusion, researchers believed 3 grams of gluten per day, while maintaining an otherwise gluten free diet is a good place to start for a gluten challenge during the current drug trials. And that they may consider the challenge being shorter than 12 weeks (a time line that was used in this study). They also reminded that asymptomatic celiac patients could still get damage to their small intestine causing other significant health issues.
What does this mean for you?
Can you put this highly medical-speak research into a practical use for people with celiac (after all not everyone will be involved in the aforementioned drug studies)? I think so.
Some people may want to do a gluten challenge (for whatever reason you have). Well I think this research helps you understand that you shouldn’t do anything without your gastroenterologist’s knowledge or involvement. Please make sure your doctor knows exactly what you’re doing.
I also think this study shows you don’t need to go hog-wild on gluten in order to see damage. One small item daily would do just fine. If you go by the 3 grams of gluten mentioned in this research, you wouldn’t need even a full piece of bread. According to celiac.com, an average slice of whole wheat bread “contains around 4.8 grams of gluten”.
There are a lot of people that I have come across where they have taken gluten out of their diets before getting tested for celiac disease. Heck, we even went gluten free after Emma’s blood work which tested positive, but before her biopsy about a month later. I am lucky it still showed damage. No one told us otherwise.
For people in that category who didn’t know they should be tested for celiac before going gluten free, this could be an option for you — but again you should only do it under the watchful eye of your doctor. Although many folks feel they don’t need to go back on gluten to get the official diagnosis either…the absence of symptoms is proof enough. The decision is up to you.