Doctors have always told patients that the only treatment for Celiac Disease is to the lifelong avoidance of ingesting gluten. But is this really true? We know that there is such a thing as gluten intolerance, and we know that some people are more sensitive to gluten than others.

Over at APhAnet they recently tackled the question, how much gluten is to much gluten?  A couple key points from this article:

Key point: There is insufficient evidence to suggest a definitive threshold of gluten intake for patients with celiac disease (CD); however, less than 10 mg of gluten daily is unlikely to cause significant mucosal abnormalities.

Finer points:A systematic review of 13 clinical trials evaluating CD patients and gluten intake tolerance revealed that patients who consume more than 200 mg of gluten daily for a minimum of 4 weeks are likely to develop intestinal changes. Only three randomized, controlled trials were identified in this review.

Overall, studies were conducted in four continents and assessed gluten intake ranging from 1 to 200 mg/day for periods of 1 week to 8 years. Endpoints varied and included quality of life, mucosal histology, and symptoms. Investigators were unable to conduct a meta-analysis because of the significant heterogeneity in study design, quantity of gluten ingested, length of gluten exposure, and assessment of gluten effects among the clinical trials.

And also:

What your patients need to know:Tell patients with CD to avoid gluten to minimize symptoms. Encourage these patients to consume products that are naturally gluten-free. Explain that even products labeled “gluten free” typically contain the protein, albeit in small amounts. No one knows for sure how much gluten is too much for CD patients, but less than 10 mg daily is generally well-tolerated. Tell patients to be aware of how much gluten their body can tolerate and adjust their consumption accordingly.

If there is one thing that I’ve learned from both my experiences and my exposure to others with this disease, it is that everyone has very different symptoms. This is what makes it so difficult for doctors to correctly diagnose people with Celiac Disease.

With that said, there are some common symptoms that people with Celiac Disease often have when not following a gluten free diet. Some common Celiac Disease symptoms include:

• Diarrhea
• Weight Loss (Stunted growth in children)
• Fatigue

Note: Although Celiac is a bowel disease, symptoms may not include bowel discomfort.