For those who give this advice, I want to ask: What is the limit? We know it does harm. We know it can lead to fatal secondary conditions. So where do you draw the line? A pizza a month? A bagel a week? A cookie every few days? What amount has been established as safe?
Despite the careless advice often doled out. There is actually an established answer (depending on your interpretation of the results). Internationally, the most common standard for labeling something "gluten free" is less than 20ppm (though some people have a clinical relapse at smaller amounts). Essentially, they did some short-term studies that tested celiacs' responses to certain levels of gluten, and then set a standard based on the levels that most people did not react to in that period of time. In Europe, they lowered the standard from 200ppm because of these studies. (Having been to Europe before the new standard was in place, I can say I reacted noticeably to their "gluten-free" products.) So, if we've established that to be safe a product must have less than 20ppm — which is “…a fraction of a crumb. A teensy weensy fraction of a teensy weensy crumb” (Living Gluten-Free for Dummies
) — how much more unsafe is it if you intentionally eat an entire piece of pizza?
There are not many studies that measure the long-term affects of various levels of cheating, because in the research world, it's accepted that the only cure for celiac disease is a "strict gluten free diet" ... not a "mostly gluten free diet". Studies that examine the benefits of the diet long term exclude cheaters — and there's a reason for that.
Considering cheating?
Here are some statements and studies to consider:
"Children and adolescents on not strict GFD [gluten-free diet] are at increased risk for low BMD [bone mineral densite]" (http://www.gfdoctor.com/bone-
"SMR [standardised mortality ratio] increased with increasing delay in diagnosis and for patients with poor compliance with gluten-free diet" (http://www.thelancet.com/
"The results are suggestive of a protective role for a GFD against malignancy in coeliac disease and give further support for advising all patients to adhere to a strict GFD for life" (http://gut.bmj.com/content/30/
"Long-term treatment with gluten-free diet produces a significant improvement in bone density in coeliac patients. Remineralization was more pronounced in patients who better comply with gluten-free diet" (http://onlinelibrary.wiley.
"Strict adherence to the GFD seems to be the only possibility of preventing a subset of rare but very aggressive forms of cancer." (http://www.sciencedirect.com/
"The cumulative risk of subsequent autoimmune disease was lower in patients compliant to a gluten-free diet versus noncompliant patients" (http://www.sciencedirect.com/
"Persistent villous atrophy in adult coeliac disease, even in the absence of symptoms, carries a risk of subsequent severe complications. The follow-up biopsy is important in detecting these individuals." (http://onlinelibrary.wiley.
"Excess morbidity was also calculated and was clearly related to the amount of gluten ingested (Table 3). The decreasing trend in higher morbidity rates with increasing adherence to a gluten-free diet was significant (p < 0.01)" (http://journals.lww.com/jpgn/
"These results show that a strict gluten-free diet is protective towards the development of enteropathy-associated T-cell lymphoma" (http://www.springerlink.com/
Thanks for showing this to us for our docs. My doc says celiac disease patients have a SMR (standard mortality rate) 50% below average, because typically we cheat. HALF A LIFE? Who wants that?
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