The short answer is that we don’t really know. There is a distinct lack of high-quality studies that clearly define a ‘safe’ level of gluten intake for people with coeliac disease. Regulatory bodies such as Food Standards Australia New Zealand the Food and Drug Administration in the US, the Food Standards Agency in the UK and European Food Safety Authority have reviewed the same literature, but have arrived at different standards, perhaps because research findings to inform decision-makers are limited, and the quality of available studies is not consistent.
While medical evidence may not currently exist to support a defined threshold, this does not mean a safe threshold does not exist – it simply means the necessary definitive studies to establish one have not occurred yet.
Finding Answers
Recent advancements in research have introduced a promising tool: the blood-based immune marker Interleukin-2 (IL-2). This development is pivotal because it allows researchers to accurately detect when the immune system of someone with coeliac disease reacts adversely to gluten. Traditionally, determining the harmful effects of gluten involved patients consuming gluten daily for months, followed by invasive biopsies of the small bowel both before and after the gluten challenge.
The innovative IL-2 method simplifies this process significantly. It requires only a single gluten challenge and a subsequent blood test to assess immune response. This method not only reduces the burden on patients but is also a more sensitive marker of immune activity. With funding from Coeliac Australia, researchers at Wesley Medical Research are utilising IL-2 to pinpoint the smallest amount of gluten that can trigger an immune response and cause symptoms in people with coeliac disease.
This research is expected to yield crucial data that will aid in identifying a potential ‘safe’ gluten threshold for coeliac sufferers. By methodically increasing or decreasing the gluten dose and monitoring immune activation, researchers aim to define whether a precise point of tolerance exists and then, potentially in future studies, how much that point of tolerance differs between individuals. It will also be important to establish the clinical relevance of these gluten doses. Stay tuned for further updates on this groundbreaking work!
Meet the Researcher – Anuj Sehgal
Dr. Anuj Sehgal, a Senior Research Officer at the Wesley Research Institute in Brisbane, brings a unique blend of personal motivation and scientific curiosity to the field of coeliac disease research. His journey into the world of gastroenterology research was inspired by a childhood filled with visits to the Singapore Science Centre and an early fascination with the human body’s ability to recover
from illness. This curiosity evolved into a passion for understanding autoimmune diseases, particularly coeliac disease, driven by the desire to improve patient quality of life and explore the disease’s complex genetic and environmental triggers.
Dr. Sehgal’s approach to research is deeply rooted in his personal experiences and scientific inquisitiveness. From an early age, he was captivated by the idea that “all disease begins in the gut,” a concept introduced to him through a book he found at age six. This quote from Hippocrates has guided his focus towards gastroenterology, aiming to uncover how diseases like coeliac disease develop and how they can be better managed or even prevented.
Today, Dr. Sehgal is not only committed to advancing scientific understanding of the condition but also to practical outcomes that enhance the lives of those with coeliac disease. His work includes developing innovative diagnostic tools and therapeutic strategies that promise to transform the landscape of coeliac disease management.
By integrating patient feedback into his research, Dr. Sehgal ensures that his work remains relevant and patient-focused. His vision is to establish an Australian cross-institute centre for research excellence, providing tailored care and support for patients living with coeliac disease, as well as conducting innovative and progressive research to increase our understanding of the disease.
