With Celiac Disease, A Gluten-Free Diet Is Non-Negotiable

My husband, John, is visiting the blog today with an article about the effects of a gluten free diet for those with celiac disease. 

As I was enjoying a cup of green tea and a couple of Barbara’s new almond joy delights, I came across an interesting article on Celiac.com titled Two-Thirds of Celiac Patients Show Full Histological Recovery After 1-Year on Gluten-free Diet.

As someone who has non-celiac gluten sensitivity and is the father of two sons who also have it, I was very encouraged by the headline. Hey, I thought, the three of us have been gluten–free for a lot longer than that. We must be doing pretty good. However, as they say, the devil is in the details. There was some good news and some not so good news in the study.

The article referenced a study from Sapienza University in Rome on the correlation between a strict gluten-free diet and the histological recovery of intestinal villi. The villi are the structures that allow for the efficient absorption of nutrients by the intestine. It is believed that people with celiac disease are genetically predisposed to villi damage in the small intestines by the ingestion of gluten. It is believed that this villi damage leads to the poor absorption of nutrients, which causes the severe health issues associated with the disease. More information here.

The study, conducted between 2009 and 2012, evaluated 65 consecutive newly diagnosed adult patients (median age 38 years, 18-70). The study’s results concluded that,

…66% of adult celiac patients who successfully follow a gluten-free diet can make a complete histological recovery after 1-year. However, patients with severe histological damage at diagnosis who successfully follow a gluten-free diet remain at risk for incomplete histological recovery 1 year later. Lastly, patients who do not follow a gluten-free diet have no hope of making a full histological recovery.

The good news is that 2/3 of people diagnosed with celiac disease and who have not suffered severe villi damage can, after remaining on a gluten-free diet for one year, experience 100% histological repair of their intestinal villi. Hopefully, this will lead to greater absorption of nutrients and subsequently better health.

Normal Villi                            Total Villous Atrophy

This result of the study implies that early testing is crucial. The Celiac Disease Foundation recommends that all first-degree relatives (children, siblings) of a person with celiac disease be screened. More on diagnosing celiac disease here.

Unfortunately, there are so many people who are still unaware of the disease and its severity.  Another report recently released showed that many people are now being diagnosed with celiac disease who never experienced the classic symptoms (I’ll comment on that next week).

The not so good news was that the study also discovered that 1/3 of celiac disease sufferers, who remained on a gluten-free diet for at least a year, showed incomplete histological recovery. It seems that this group experienced a greater severity of villi damage than the first. The study states,

 “Multivariate analysis showed that, for ADA (adequate gluten-free diet adherence) patients with incomplete histological recovery, Marsh 3C was still a risk factor.”

Marsh 3 is a histological categorization of the status of the villi done after an intestinal biopsy. The significance of the Marsh 3C category can be found here.

The article concerning the report didn’t specify whether there was any improvement in those with more severe damage. Granted the study was only for one year, but it would have been nice to know if there was any improvement.

What the study does confirm is that the long-term success of a gluten-free diet still depends on the severity of the disease. (Click here and here to read two current articles on the long-term results of a gluten-free diet and celiac disease.)

The Sapienza University study does, however, confirm an extremely important fact. There was no hope of complete histological recovery for those who refrained from a gluten-free diet.

This study probably confirmed much of what we already knew. If a gluten-free diet is instituted before severe damage has taken place, complete repair of the villi may occur quickly. However, for those like myself who found out about the disease later in life, even when on a strict gluten-free diet, intestinal repair may take longer (See the above studies).

Nonetheless, for all those diagnosed with celiac disease, a gluten-free diet is non-negotiable. Repair of the intestinal villi is impossible without it. Since this is the case, let’s strive to live life to the fullest. This includes enjoying the most delicious and healthy gluten-free food possible. We hope this site helps you achieve this. I think I’ll have one more gluten-free almond joy.