Cross-contamination at the root of persistent celiac disease

By Jason Clevenger

Summary: A group of researchers affiliated with Johns Hopkins University focused on cross-contamination of gluten-free products in a study of patients who have persistent symptoms of celiac disease despite following a gluten-free diet.

In the study, 17 patients who were well documented as strictly following a traditional gluten-free diet were put on a so-called Gluten Contamination Elimination diet for three to six months. The diet consisted predominantly of whole, unprocessed foods such as rice, fresh fruits, vegetables and nuts in their shells. Six of the patients had met the criteria for refractory celiac disease before the study. Refractory celiac disease is defined as persistent or recurrent malabsorptive symptoms despite strictly following a gluten-free diet for 6 to 12 months. At the study’s conclusion, only one was still considered to have refractory celiac disease. Fourteen of the patients responded positively to the elimination diet and had a normal biopsy after following it.

Conclusion: While the vast majority of celiac disease patients can safely consume up to approximately 10 milligrams of gluten daily, the authors note that for some people significant intestinal signs can develop at much lower daily gluten exposure. For these particularly sensitive patients, a diet that reduces risk of cross-contamination by largely prohibiting gluten-free processed food may help. In particular, it might prevent a misdiagnosis of refractory celiac disease, which usually includes a treatment with corticosteroids that have undesirable side effects over time.


[1] “Trace gluten contamination may play a role in mucosal and clinical recovery in a subgroup of diet-adherent non-responsive celiac disease patients”, Hollon JR, Cureton PA, Martin ML, Puppa EL, Fasano A., #BMC Gastroenterology# 2013 Feb 28;13:40.

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