Gluten Contamination Eliminiation Diet

“Trace gluten contamination may play a role in mucosal and clinical recovery in a subgroup of diet-adherent non-responsive celiac disease patients”

BMC Gastroenterology 2013, 13:40 -

Researchers at Johns Hopkins and Center for Celiac Research at Massachusetts General looked at cross contamination of gluten-free products found in a traditional gluten-free diet. They studied 17 patients who had Non Responsive Celiac Disease (NRCD). 6 of these patients met the criteria for Refractory Celiac Disease (RCD).

NRCD is a general classification term for patients with persistent symptoms and/or intestinal damage despite following a gluten-free diet.

RCD is a subset of NRCD. RCD is found in adults; middle-aged to elderly. It's never seen in children. In most cases, failure to improve on a gluten-free diet is not RCD. RCD is also further broken down as RCD1 and RCD2. RCD2 has a higher risk of developing intestinal cancer and 5 year death rate of 50-60%.

Participants of this study were put on a Gluten Contamination Elimination Diet (GCED) for three to six months. This diet consists of whole, unprocessed foods. It was designed to eliminate exposure to any possibility of gluten cross contamination from packaged/processed foods – including those labeled gluten-free. Patients were given sample menus and were asked to keep a food record.
Foods used in the study
Allowed Not Allowed
Grains - Plain, unflavored, brown and white rice Grains - Millet, sorghum, buckwheat or other inherently gluten-free grains, seeds, or flours
Fruits/Vegetables - All fresh fruits & vegetables Fruits/Vegetables - Frozen canned or dried
Proteins - Fresh meats, Fresh fish, Eggs, Dried beans, Unseasoned nuts in the shell. Lunch meats, Ham, bacon, Other processed, self-basted or cured meat products
Dairy - Butter, yogurt (unflavored), milk (unflavored), aged cheeses Dairy - Seasoned or flavored dairy products, Processed cheeses
Condiments - Oils, vinegar, honey, salts Condiments - Flavored and malt vinegar
Beverages - 100% fruit/vegetable, Gluten-free supplemental formulas, Gatorade, milk, water  

The study revealed some interesting results.

  • 14 of the 17 patients experience resolution of their symptoms and normal blood/biopsy results on the GCED.

  • 11 of the 14 successfully returned to a traditional gluten-free diet without return of symptoms.

  • Of the 3 patients that could not return to traditional gluten-free diet - one had a return of symptoms each of the three times they tried to return.

  • 5 of the 6 patients with RCD has full resolution of their symptoms and no longer met the criteria for RCD

The important take away from this study has to do with ferreting out those that truly have Refractory Celiac Disease. Due to the seriousness of RCD, it is important accurately diagnose this condition.

The researchers found it interesting that 79% of the test subject were able to return to their traditional gluten-free diet.

“Interestingly, the fact that the majority of the patients in our study were subsequently able to return to their previous strict GFD suggests that there is a degree of recovery that, once established, shifts these patients back to a more typical threshold of gluten reactivity.”

While the researchers commented on the ability to return to a traditional gluten-free diet, they didn't really discuss this aspect. It certainly raises several questions.

1) Once healed, why where most patients able to resume the traditional GF diet?

Dr. Tom O'Bryan's mantra “Heal the gut, heal the gut, heal the gut” comes to mind.

2) Long-term will they be able to remain on a traditional GF diet without further complications?

3) Could those now successfully following a traditional GF diet benefit from the GCED?

Any reduction [or complete elimination] of processed/packaged foods is beneficial. It gives us the ability to go from gluten-free to gluen-zero.