How Refining the Gluten Challenge May Help Improve Diagnostics for Celiac Disease

According to this recent research, updates to the gluten challenge are being implemented.

Recommended intake of gluten should be increased to 10 grams of gluten per day for at least two weeks. Or longer.

While three grams of gluten will begin the immune response, ten grams of gluten is needed to get antibody levels up to where they can be measured in antibody tests and changes can be seen in the small intestine.  

Keep in mind that there are different amounts of gluten in different kinds of bread and gluten containing foods.  Pizza crust and breads that are thick and chewy contain more gluten than things like cake and cookies.  

References:

https://www.beyondceliac.org/celiac-disease/the-gluten-challenge/

And...

Evaluating Responses to Gluten Challenge: A Randomized, Double-Blind, 2-Dose Gluten Challenge Trial

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878429/?report=reader

 "In our study, limited changes in Vh:celiac disease (villi height vs crypt depth - aka damage to the small intestine)  following 14-day challenge with 3 g of gluten were observed, in accordance with Sarna et al.  While the 3 g dose was sufficient to initiate an immune response, as detected by several biomarkers such as IL-2, the 10 g dose was required for enteropathy within the study time frame. Based on our data, we would suggest that gluten challenge should be conducted over longer durations and/or using doses of gluten of ≥ 3 g/day to ensure sufficient histological change can be induced."
Keep us posted on your progress!

1 hour ago, knitty kitty said:

According to this recent research, updates to the gluten challenge are being implemented.

Recommended intake of gluten should be increased to 10 grams of gluten per day for at least two weeks. Or longer.

While three grams of gluten will begin the immune response, ten grams of gluten is needed to get antibody levels up to where they can be measured in antibody tests and changes can be seen in the small intestine.  

Keep in mind that there are different amounts of gluten in different kinds of bread and gluten containing foods.  Pizza crust and breads that are thick and chewy contain more gluten than things like cake and cookies.  

References:

https://www.beyondceliac.org/celiac-disease/the-gluten-challenge/

And...

Evaluating Responses to Gluten Challenge: A Randomized, Double-Blind, 2-Dose Gluten Challenge Trial

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878429/?report=reader

 "In our study, limited changes in Vh:celiac disease (villi height vs crypt depth - aka damage to the small intestine)  following 14-day challenge with 3 g of gluten were observed, in accordance with Sarna et al.  While the 3 g dose was sufficient to initiate an immune response, as detected by several biomarkers such as IL-2, the 10 g dose was required for enteropathy within the study time frame. Based on our data, we would suggest that gluten challenge should be conducted over longer durations and/or using doses of gluten of ≥ 3 g/day to ensure sufficient histological change can be induced."
Keep us posted on your progress!

Is there a way to know how much gluten is in something specifically? 

Not that I know of, unfortunately.  

10 hours ago, knitty kitty said:

Not that I know of, unfortunately.  

So it only takes 3 grams to start an immune response- but no idea what 3 grams would be eating?

On average, a slice of bread contains about 2 grams of gluten.  Three grams of gluten is enough to make you feel unwell, but TEN grams of gluten gets the anti gluten antibodies into the bloodstream at a high enough level where they can be measured for blood tests for Celiac Disease and to produce noticeable damage in the small intestine.

Different breeds of wheat contain different amounts of gluten depending on breed and growing conditions.  Manufacturers blend different wheats together to get the amount of gluten required to make their products.  

The addition of vital wheat gluten to different types of bread also affects the total amount of gluten in a product.  

Can an Increase in Celiac Disease Be Attributed to an Increase in the Gluten Content of Wheat as a Consequence of Wheat Breeding?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573730/

On 4/12/2024 at 10:46 AM, knitty kitty said:

On average, a slice of bread contains about 2 grams of gluten.  Three grams of gluten is enough to make you feel unwell, but TEN grams of gluten gets the anti gluten antibodies into the bloodstream at a high enough level where they can be measured for blood tests for Celiac Disease and to produce noticeable damage in the small intestine.

Different breeds of wheat contain different amounts of gluten depending on breed and growing conditions.  Manufacturers blend different wheats together to get the amount of gluten required to make their products.  

The addition of vital wheat gluten to different types of bread also affects the total amount of gluten in a product.  

Can an Increase in Celiac Disease Be Attributed to an Increase in the Gluten Content of Wheat as a Consequence of Wheat Breeding?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573730/

Thank you for this great information! I appreciate it. Does gluten build up on a day to day basis? Like if a person consumes 1-2 grams of gluten today and then another 1-2 tomorrow, does that become more like 4 gm of gluten in your body? And so on? 

No, you can't add it up that way.  

Gluten stimulates anti gluten antibodies to be made.  Those antibodies are what become cumulative.  Ten grams a day for several weeks, gets those antibodies produced in the small intestine to a level where those antibodies get into the bloodstream in a high enough level that they are measurable in the bloodstream.  

Gluten itself mostly stays in the digestive tract and is removed with bowel movements.  However, if one has leaky gut syndrome, gluten can travel to other places.  For example, joint inflammation and pain can be caused by gluten congregating in joints.  That's why it's important to heal the digestive tract so it doesn't leak.  The AIP diet and Benfotiamine are beneficial in this respect.

6 minutes ago, knitty kitty said:

No, you can't add it up that way.  

Gluten stimulates anti gluten antibodies to be made.  Those antibodies are what become cumulative.  Ten grams a day for several weeks, gets those antibodies produced in the small intestine to a level where those antibodies get into the bloodstream in a high enough level that they are measurable in the bloodstream.  

Gluten itself mostly stays in the digestive tract and is removed with bowel movements.  However, if one has leaky gut syndrome, gluten can travel to other places.  For example, joint inflammation and pain can be caused by gluten congregating in joints.  That's why it's important to heal the digestive tract so it doesn't leak.  The AIP diet and Benfotiamine are beneficial in this respect.

 

And the antibodies are what cause the damage to the intestines correct? 

I don’t think I could back on gluten to do the challenge and have the biopsy. I can’t imagine eating that much gluten every day for weeks.

So if gluten doesn’t build up and is excreted out, I guess I don’t understand why sometimes gluten causes huge reactions and makes me really sick and other times it’s not near as bad. 

Yes, the antibodies cause damage to the intestines, and the brain, and every other organ and tissues in the body.  

Anti-transglutaminase antibodies (anti tTg IgA on blood tests) are antibodies that attack transglutaminase, a building component in the cell membranes of every cell in the body.  

The gluten may pass, but the antibodies are what can stay circulating for months.  

Some gluten containing products can contain more gluten that stimulates higher antibody production than other products.  Chewy breads with those big bubbles have more gluten than a cookie that's crumbly and not chewy like pizza dough.  Vital wheat gluten added to a product can provoke a more extreme antibody response than a product without.  

With the higher doses of gluten in the updated challenge guidelines, you don't have to stay on the gluten challenge for months.  Sufficient changes for antibodies were seen in TWO Weeks.  

13 hours ago, knitty kitty said:

Yes, the antibodies cause damage to the intestines, and the brain, and every other organ and tissues in the body.  

Anti-transglutaminase antibodies (anti tTg IgA on blood tests) are antibodies that attack transglutaminase, a building component in the cell membranes of every cell in the body.  

The gluten may pass, but the antibodies are what can stay circulating for months.  

Some gluten containing products can contain more gluten that stimulates higher antibody production than other products.  Chewy breads with those big bubbles have more gluten than a cookie that's crumbly and not chewy like pizza dough.  Vital wheat gluten added to a product can provoke a more extreme antibody response than a product without.  

With the higher doses of gluten in the updated challenge guidelines, you don't have to stay on the gluten challenge for months.  Sufficient changes for antibodies were seen in TWO Weeks.  

Thank you this is very helpful! 2 weeks is not near as long, but if it’s higher gluten intake - I feel like it’s sort of going to be the same as small amounts over a longer period of time. I just can’t stand the thought of being sick all the time. Gluten can really cause havoc all throughout my body and even land me in the ER if I have enough to trigger palpitations and tachycardia 

@Ginger38, 

Have you had a DNA test for Celiac genes?  You don't have to eat gluten with a DNA test.  

8 minutes ago, knitty kitty said:

@Ginger38, 

Have you had a DNA test for Celiac genes?  You don't have to eat gluten with a DNA test.  

For what genes specifically? And if it’s negative what does that mean?