Keeping a strictly gluten-free diet may be too difficult

Despite supposedly adhering to a gluten-free diet (GFD), patients with coeliac disease often end up having detectable intake levels of gluten, a new study has found.

“Our novel findings support the general concern that a GFD may be more aspirational than achievable, even by highly committed and knowledgeable individuals,” researchers said. “This issue likely underlies persisting symptoms and incomplete mucosal recovery. Additional treatments are needed for this common condition.”

None of the eighteen participants (median age, 41 years; 12 females) had any intentional exposures to gluten during the observation period. All had coeliac disease but were generally asymptomatic. Scores in the Coeliac Symptom Index ranged from 19–40, and results of the Coeliac Diet Adherence Test were ≤14.

Moreover, over 24 months of follow-up, the median serum tissue transglutaminase-2 immunoglobulin A levels dropped from 9 to 0.6 multiples of the upper limit of normal, further showing that the cohort was highly adherent.

Despite good adherence, 77 percent of the participants noted that they had “rare accidental gluten exposure,” as self-reported on the Gluten-Free Eating Assessment Tool-short. More than half (56 percent) had persistent villous atrophy.

Notably, eight percent of the food samples collected from nine participants had detectable levels of gluten, with a median concentration of 11 ppm. Forty percent had >20 ppm and 20 percent had >200 ppm.