A recent prospective observational study reinforces the idea that most people with celiac disease are unable to accomplish a strict gluten-free diet (GFD): JP Stefanolo et al. Clin Gastroenterol Hepatol 2021; 19: 484-491. Real-World Gluten Exposure in Patients With Celiac Disease on Gluten-Free Diets, Determined From Gliadin Immunogenic Peptides in Urine and Fecal Samples

The investigators enrolled 53 adults with celiac disease (CD) for at least two years and followed symptoms as well as stool/urine testing for gluten immunogenic peptide (GIP). “GIP in stool can detect gluten consumption of more than 40 mg/d and the urine tests are positive from 40 and 500 mg/d of gluten.”

Key findings:

• Over the 4-week study period, weekend samples (urine) identified 70% of patients excreted GIP at least once, compared with 62% during weekdays (stool).
• Patients had a median of 3 exposures during the 4 weeks.
• Also, the authors noted increases in GIP excretion towards the end of the study. “This suggests a potential Hawthorne effect that could be explained by a decrease in hypervigilance that often is seen in a context of research studies.”

The authors note that GIP “excretions of greater than 2 mcg/g in stool or greater than 12 ng/mL in urine can induce mucosal damage in almost 100% of patients.”

My take: This study adds to the body of literature emphasizing the high rate of inadvertent gluten exposure.

Related blog posts:

• Is A Gluten-Free Diet Possible? Doggie Bag Study
• #NASPGHAN19 Postgraduate Course (part 2)
• Celiac Disease: “”80 percent of success is just showing up”
• Improving Care Process in Celiac Disease
• Closer followup for Celiac disease & pediatric guidelines
• “Gluten-Related Disorders” (Part 1)
•  Celiac Disease: “Ten Things That Every Gastroenterologist Should Know” | gutsandgrowth
• Oats OK for Celiac Disease
• How Slow Do Objective Markers of Celiac Change After Treatment? | gutsandgrowth
• Northern Latitudes –Higher Prevalence of Celiac in U.S.
• Celiac Disease Epidemic (High rate of celiac disease reported in Denver children)

Before and After at Lake Michigan shoreline (1 month apart in Evanston, IL)