<<Disclaimer:  Verify this information before applying it to your situation.>>

I asked the following three questions of Dr. Joe Murray for the benefit of the
whole Celiac list, and his replies follow -- Bill Elkus

> question..
> 1)  My son's gastroenterologist said that when he does a follow-up biopsy on
> a confirmed Celiac on a gluten free diet, he always sees residual damage to
> the intestine.  His personal feeling is that the intestines should completely
> heal on a truly gluten free diet, and that this residual damage is due to the
> fact that it is almost impossible to be truly gluten free ---  in modern
> society, there are so many opportunities for gluten to sneak into food, or be
> accidentally introduced due to cross contamination that no one is 100%
> gluten free.

answer..
I believe that a Celiac intestine can heal  completely and I usually
aim for just that in the follow-up biopsy.  The  length of time it
takes to heal seems to be longer in older individuals than in younger
people. The earlier one rebiopsies the less likely there  will have
been time for the gut to heal.

question
> 2)  How much gluten can be tolerated with de minimus damage?  It is said that
> the intestines can be damaged even when the patient feels fine after eating a
> small amount of gluten.  The mechanics of damage to the villi seem to imply
> that very small amounts of gluten are sufficient to bind to ALL the villi
> cells, so that once this initial quanta of gluten has been ingested, all the
> damage is already done, and additional amounts of gluten do no further
> damage.....unlike a dieter cheating on his diet for a CD patient the damage
> is not proportional to the amount of cheating.  Is this true?

answer...
Can gluten occupy all the receptors in the villi thereby blocking the
subsequent effect of further doses of gluten ?  This is unlikely as I
see a cumulative effect of continued exposure to gluten over the long
term.

question...
> 3)  By now you have seen a number of posts on he issue of gluten and casein
> intolerance and the possible link to autism. From what you know of the
> mechanics of gluten damage, does it make sense that casein  (or even
> other proteins) could cause analogous damage to the villi --- or instead
> is a totally different mechanism in place, a mechanism which coincidentally
> involves gluten but is not itself classic Celiac disease?  From what I have
> read, I would have thought it is the latter, but my son was biopsy confirmed
> Celiac.

answer...
Related to casein and whether it can cause a similar lesion in the
intestine as gluten does in Celiac disease.  Yes, in young children,
there can be a patchy enteropathy that is thought to be milk protein
allergy.

These are short answers to what are rather involved questions but I don't
type very fast.  Joe Murray