Is There a Safe Threshold for Gluten Consumption in Patients with Celiac Disease?

All over the world, manufactures have standards that they follow regarding how much gluten can be in a product that carries a “gluten free” label. In some parts of Northern Europe products can have 200ppm (parts per million), a Finnish survey gave permission for 100ppm. Here in the U.S. of A. (and most of Southern Europe) we won’t go for anything more than 20ppm.

So, who has it right? How much gluten is too much for a person with Celiac Disease to eat before it starts messing up those all important intestines? Truth is, the jury is still out on the exact limits, but a study conducted by CFCR between 2001 and 2004 did establish that 50mg is too much.

The study was conducted using 49 adult patients who had been diagnosed with Celiac Disease by biopsy. They split the participants into three groups and had them follow a pretty strict regiment for three months. During the study, the participants were each given capsules to ingest daily. One third of the pills contained no gluten at all- they were the placebo. The other two thirds of the group were given pills containing either 10mg or 50mg of gluten.

I do feel I should point out here that all of the patients were volunteers and they were closely monitored for any signs of declining health. This was NOT a movie scenario of experimenting on innocent people :) Not every participant completed the study. Anyone who showed negative side effects or seemed to have problems were taken out of the study.

Before the participants began taking their pills, they were asked to keep a food diary for 30 days. This was done to establish a baseline for the study. (The baseline refers to how much gluten is consumed accidentally on a daily basis) Researchers compiled the food diaries and did gluten tests on a lot of the foods listed. By doing this, they established that the average person on a gluten free diet ingests anywhere from 5mg to 50mg. Too much? That’s what they needed to know :)

So, study they did. I’m going to skip over a lot of technical aspects here, not because they are not important, just because they are very long and technical. If you are interested in reading the full study report (which you just might be) you can find it here. (FYI this is a PDF download). For this article, I’m going to skip ahead to the results.

At the end of the study, the people who were getting the 50mg capsules were showing signs of damage in the intestines. The people in the 10mg group were not. Researchers could not continue the study past three months safely to determine whether 10mg would hurt in the long run, though there is some speculation to that effect. After all, the patient’s health was of primary concern :)

This brings us back to the question at hand- How much gluten is too much? Well, 200ppm was determined to be an unsafe level. This would put you over the threshold very quickly, even with only occasional use. 100mg is still considered moderately unsafe. It would put you over the threshold with anything more than “moderate use”. 20ppm is considered a safe level, as it keeps people on a gluten free diet below the threshold of 50mg. This, my friends, is the study that the FDA used when deciding what rules to make for manufacturers, which is why the current “safe” level is still at 20ppm.

Now, considering the wide variety of symptoms and reactions from Celiac patients, this study should not be considered the final word. Some patients have a “clinical reaction”, meaning they get sick, at much lower levels. As with anything, you should work with your doctor and trust your body to know how much is too much for you.

Also, on a personal note, I am going to be more aware from now on where in the world my food comes from. I don’t want to get caught with a “gluten free” product that measures 200ppm!