When following a gluten-free diet, some gluten may be inadvertently consumed, due to cross-contamination in one’s own kitchen, related to eating out in restaurants which are not adequately prepared to provide safe gluten-free menu items, or simply related to the many complexities and challenges involved in living gluten-free.
Is this a significant issue in the celiac disease population? If so, how much gluten might be ingested, even by those who state they are following a gluten-free diet? This recently published research aimed to address this question. These researchers analyzed data which had been collected in two previous studies: one in which quantities of gluten in urine and stool were used to work backwards to determine related ingested amounts of gluten; and second, data from a trial of latiglutenase (a substance in development phase, designed to break down gluten).* In this second case, amounts of gluten were determined by correlating modifications in gluten intake with changes seen in patients’ intestinal cell health.
According to the authors, their findings indicate that a reasonable fraction of the CD population has difficulty controlling their gluten-free diet: 3 – 19% of subjects were found to have consumed significantly more than what is considered the safe threshold of 10 mg of gluten per day.
However, it is important to keep in mind when considering these findings that subjects involved were CD patients who were “more symptomatic” and that these results are therefore not necessarily representative of all CD patients who are on a gluten-free diet.
This study does, nonetheless, highlight the fact that there is still more to be done in the areas of both patient education and physician follow-up.
*Latiglutenase is under development by the company ImmunogenX, a supporter of this study, and is not available to consumers at this time.
Syage JA, et al. “Determination of gluten consumption in celiac disease patients on a gluten-free diet” The American Journal of Clinical Nutrition, Volume 107, Issue 2, 1 February 2018, Pages 201–207, https://doi.org/10.1093/ajcn/nqx049