Theoretically, yes! However, even a gluten-free diet has very tiny amounts of gluten and probably these small amounts are not overtly harmful in most patients. A few patients might be very sensitive
Yes, even small amounts of gluten can be harmful to a patient with coeliac disease.
There seems to be no clear consensus on the safe
amount of daily gluten intake. This may be related to
differences between individuals, method of gluten
intake assessment, and differences in methodology
between the different studies. Total daily gluten consumption
that seems to be safe for most CD patients
is
Even small gluten is harmful for established celiac disease. Many so called gluten free products contain small amount of gluten (nebulous gluten free) so disease does not respond. However absolute gluten free diet is costly and lacks taste which is unacceptable in children who are unfortunately the prime targets of the disease. Recent approches to treatment include
[1] Decreasing the immunogenic content of gluten (genetically modified wheat, gluten digestion in gut by glutenases, gluten pretreatment using endopeptidases.
[2] Sequestering gluten in gut lumen before it is digested into immunogenic peptides using binders.
[3] Preventing uptake of digested gluten through intestinal epithelial tight junctions.
[4] Tissue transglutaminase (tTG) inhibitors.
[5] Prevent downstream immune activation after uptake of gluten immunogenic
peptides through the intestinal mucosal epithelial layer. Examples include HLA-DQ2 blockers, cathepsin inhibitors, corticosteroids, anti TNF.
The trouble is related to the immune system because Coeliac disease is an immunologically-mediated disease. The trigger for activating the immune system can be small amounts of gluten.
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