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Defining Tolerable Amount of Gluten for People With Celiac Disease

Celiac disease is an autoimmune disorder. The lining of the intestine becomes inflammed when foods with gluten are consumed. The damage can interfere with the ability of the intestine to absorb important nutrients from food. As a result people with untreated celiac can become malnourished. A gluten-free diet can halt the damage. Gluten is mainly found in wheat, rye, and barley, but can also be found in some prepared products, flavored coffee, and beer. This can make it difficult to make a diet completely gluten-free.

Booth Hall Children’s Hospital in England reviewed several past studies to determine if there was a particular gluten level that was tolerable for people with celiac disease. The review, published in Aliment Pharmacology Therapy , found that the tolerable levels of gluten can vary greatly between individuals.

About the Study

Researchers conducted a systematic review of 13 previous studies. The studies had all tested the response to varying levels of gluten. The studies examined the level of mucosal abnormalities or clinical symptoms after ingesting gluten. The review found a wide range of gluten tolerance such as:

  • Amount of daily gluten to cause intestine abnormalities ranged from 10 mg-36 mg (milligram).
  • In one trial, no symptoms were present with 200 mg/day but three patients had loose stools with 1 gram/day.
  • In one trial, symptoms were not induced by 36 mg/day.
  • In a separate trial symptoms, were induced by 1.5 mg/day.

How Does This Affect You?

It is very important to manage celiac disease to prevent long-term damage and secondary illnesses. There may be varying degrees of reliability between the studies reviewed here. However, it does appear that gluten tolerance may vary greatly between individuals.

Work closely with your doctor to find the right balance for you. Once you know your gluten goals, work with a dietitian to develop a varied nutrition plan. Look for gluten-free foods as a substitute for foods that are traditionally high in gluten.




  • Akobeng AK, Thomas AG. Systematic review: tolerable amount of gluten for people with coeliac disease. Aliment Pharma Th . 2008 Jun 1;27(11):1044-52. Epub 2008 Feb 29.

Last reviewed March 2009 by Larissa J. Lucas, MD

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