Just one crumb of gluten may as well be an entire loaf of bread to someone with celiac disease.

Celiac patients can’t even have a tiny crumb; that’s all it takes to trigger their immune system into attack mode–on their own body!

Celiac disease is not like heart disease or diabetes, in which an offending agent (i.e., saturated fats, refined sugars) can occasionally be eaten without damage to the body.

In celiac disease, foods containing gluten must be eliminated 100 percent, down to the last crumb.

In fact, so strict must the elimination of gluten be, for people with celiac disease, that they should also avoid using cutting boards that gluten-containing bread was placed upon.

I wondered why those with celiac disease can’t occasionally eat something with gluten.

It’s as though the body can’t differentiate between an occasional pretzel and multiple daily servings of bread, cereal and pasta.

I was thinking of this as an “all or nothing” approach, which isn’t fair to people with celiac disease.

“Actually, it is all or nothing when it comes to eliminating gluten,” says Nicole Kuhl Visnic, CCN, a dietitian and nutritionist in Santa Monica, CA.

“When a person with celiac consumes gluten, there is an immune cascade that is occurring in the body, even if there are no obvious GI symptoms.”

In other words, the occasional pretzel may not cause any observable reactions in the celiac patient, such as diarrhea or upset stomach, but something unseen and unfelt gets triggered.

“For every patient with CD, there are eight patients with CD and no GI symptoms,” says Kuhl Visnic.

The immune response to this protein is so strong, that a person with celiac disease must avoid non-gluten foods that were prepared in the same facility as gluten foods are.

A pizza with a wheat flour crust, consumed after being gluten-free for 12 months, really will make a difference in the patient.

Kuhl Visnic explains, “The reason a little bit of gluten is harmful is because people with celiac disease have hypersensitivity to gluten. Kind of the way a light switch turns the light on or off, gluten turns the immune system on or off.”

In celiac disease, the body thinks that this protein is a foreign invader, and this faulty recognition triggers an immune attack on the protein molecules.

Eating gluten-containing foods means a chronic immune response that, over time, damages the inner lining of the small intestine, impairing its ability to absorb important nutrients.

This malabsorption leads to a litany of medical problems including brittle bones.

But can just one occasional pretzel in an otherwise gluten-free diet cause such damage?

Kuhl Visnic says, “Another way to think about it would be to consider the effects of adding a couple drops of cyanide to a glass of water. A couple of tablespoons would be more toxic than a couple drops, but a couple of drops is still toxic.”

The presence of the wheat protein in that tiny pretzel will activate “T cells,” which are the body’s defense against foreign invaders.

T cells then release certain chemicals that would be valuable in the event of a microbial attack.

But in the presence of gluten, T cells that are activated harm the intestinal cells that are responsible for nutrient absorption.

So if someone has celiac disease and you can’t understand why he or she thinks “one little bite” will indeed hurt, Kuhl Visnic explains, “The immune cells in someone with CD sit on the intestinal epithelial cells ready to pounce, as soon as gluten is recognized,” in any amount.

Nicole Kuhl Visnic specializes in custom-designed diets tailored to the individual and has worked with numerous celiac disease patients.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


Top image: Shutterstock/ Mia Stern