A "celiac challenge" is necessary when a person who is already living gluten free needs to confirm that he or she actually has celiac disease. This iknvolves reintroducing gluten into the diet and then testing to see if this has caused actual damage to the digestive system. Is the diagnosis worth all the hassles involved in adding gluten to the diet of a person who is currently experiencing good results from the gluten free, I wrote about this issue in December and receive a number interesting responses:

"So we tried it (the gluten free diet). I sometimes cry when I see the difference in him (the writer’s husband) now after six months on the diet! He is happier than I have seen him in 16 years I have known him….his head is clear, he is happy and content, and has so much energy I can hardly keep up with him." Is this man a candidate for a gluten free challenge?

"I think we should look at the quality of life….If gluten makes them sick, they shouldn’t be eating gluten." What more needs to be said?

"I see no need…to go through the expensive and invasive procedure when the diet is so obviously working.".

"Perhaps some may feel a diagnosis is necessary, but if that means continuing to consume things that consistently make us ill that perspective seems rather counterproductive to me."

"A clinical diagnosis would be helpful, so that doctors would be more understanding and take us more seriously. But I can not say that I would go on a gluten challenge for that label."

"…for the last few years I have been without insurance and I’m not able to afford the biopsy tests. But I have been on the diet for almost a year and I am well, as long as I don’t accidently ingest gluten. Make myself sick for more test results????….I wish doctors would look at the whole picture and not just test results."

I received no comments from anyone who had undergone a "gluten free challenge". Of course, the number of replies is too small to draw any conclusions. But the ideas expressed above are certainly worth considering. Ideally, of course, people are tested for celiac disease before they begin the gluten free diet, but what do we do when that has not happened? I think that the last sentence in the final response summarizes the problem beautifully: "I wish doctors would look at the whole picture and not just at test results."

Published 1/11/09