Systematic review: tolerable amount of gluten for people with coeliac disease
Article first published online: 29 FEB 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 27, Issue 11, pages 1044–1052, June 2008
How to Cite
AKOBENG, A. K. and THOMAS, A. G. (2008), Systematic review: tolerable amount of gluten for people with coeliac disease. Alimentary Pharmacology & Therapeutics, 27: 1044–1052. doi: 10.1111/j.1365-2036.2008.03669.x
- Issue published online: 29 FEB 2008
- Article first published online: 29 FEB 2008
- Publication data Submitted 6 November 2007 First decision 22 November 2007 Resubmitted 15 February 2008 Second decision 17 February 2008 Resubmitted 19 February 2008 Third decision 19 February 2008 Resubmitted 26 February 2008 Accepted 26 February 2008 Epub OnlineAccepted 29 February 2008
Background The threshold amount of gluten in ‘gluten-free’ products that can be tolerated by people with coeliac disease is unclear.
Aim To investigate the threshold amount of gluten and the threshold concentration of gluten in food products that can be tolerated by people with coeliac disease.
Design Systematic review of studies published between 1966 and May 2007.
Methods The data sources used were MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and reference lists of retrieved articles. We included studies that evaluated the amount of dietary gluten or the concentrations of gluten in food products that can be tolerated by people with coeliac disease whatever their design, method or language of publication.
Results Thirteen studies (three randomized controlled, one cohort, two crossover, and seven cross-sectional) met the inclusion criteria. The daily amount of tolerable gluten varied widely between studies. Whilst some patients tolerated an average of 34–36 mg of gluten per day, other patients who consumed about 10 mg of gluten per day developed mucosal abnormalities. The effect of the consumption of ‘gluten-free’ products with different degrees of gluten contamination was also inconsistent.
Conclusions The amount of tolerable gluten varies among people with coeliac disease. Although there is no evidence to suggest a single definitive threshold, a daily gluten intake of <10 mg is unlikely to cause significant histological abnormalities.