u/ComputerDear1153

Hi guys, I occasionally check the celiac cruise website. I haven't been on one yet but I'm tempted. I just noticed they have a cruise to the British Isles (12 days) where the entire 1,200 person ship will be celiac safe. 11 restaurants, whole ship.

It's a more expensive cruise line (Oceania) than the normal celiac cruises, so for 2 people it's like 15K for the cheapest room, not including the flights to London where it departs. The cruise line seems to be geared toward an older crowd with a focus on dining, spa, relaxation rather than kids stuff.

Just curious if anyone here is going?! How are they going to find 1,200 celiacs willing to pay 15K for a cruise?

https://celiaccruise.com/oceania-vista-2028/

Disclaimer: I am not a scientist. I am just a person with celiac disease trying to stay updated on current research. Please correct me if you believe I have misinterpreted the research or have other insights.

Link here: https://www.gastrojournal.org/article/S0016-5085(26)00264-7/fulltext

This study was released in Gastroenterology in March. It is a randomized controlled, double-blind study whose purpose was to find the lowest level of gluten that triggers a measurable IL2 (immune) response and accompanying symptoms in treated celiac patients.

Elevation of serum IL2 is the most sensitive blood test for gluten exposure in celiacs. It peaks ~4 hours after gluten ingestion.

There has only been one previous randomized controlled double-blind study that tried to establish a safe gluten threshold in celiac disease. Rather than looking at immediate immune response, the previous study looked at mucosal injury on endoscopy after 3 months of consuming a daily capsule of a fixed amount of gluten (This was Catassi et al., 2007). Link here: https://celiac.org/wp-content/uploads/2009/12/catassi-study-on-gluten-tolerance.pdf

The 2007 study concluded: "It appears that 50 mg gluten/[day] is the minimum dose required to produce measurable damage to the small-intestinal mucosa in CD patients."

If you assume most people eat 1-2 kg/day of food, you would consume around 50 mg/day by eating a diet in which all food had ~25-50 ppm of gluten.

In my opinion, there were two major limitations of the 2007 study:

• (1) it looked only at a 3 month period, and it is reasonable to suspect damage from much smaller gluten doses could accumulate over a longer period of time; and
• (2) it looked only at mucosal damage caused by sustained autoimmune response, not actually what triggers each autoimmune reponse.

My key takeaways from the 2026 study:

(1) There was significant variation in the quantity of gluten that caused an immune response in different individuals.

• In 50% of those with celiac disease, the minimum single dose of gluten required to trigger an immune response was 111 mg (about 1/50th a slice of bread).
• In the 25% most sensitive celiacs, this minimum dose was 14.9 mg. (It was 2.4 mg in the 10% most sensitive celiacs and 0.8 mg in the 5% most sensitive celiacs).

(2) Cross contamination does not cause reliable symptoms beyond the placebo effect.

• Almost all patients in the study, including those in the placebo group, reported symptoms after the gluten challenge.
• Compared with placebo, no association was found between any gluten dose and symptom severity.
• Doses went as high as 1,000 mg (about 1/4 slice of bread). This means the study found that any reported feeling of "I got glutened" from cross contamination is placebo effect. Obviously this is just one study but it demonstrates how powerful the placebo effect can be in risky situations (e.g. eating at a restaurant, consuming a potentially contaminated product, or participating in a study where you might be fed gluten.)

(3) Stool and urinary GIP tests are questionable at best.

• These tests are available through the company GlutenDetect for home use. I've actually purchased them in the past and I will not be buying more after reading the study. They failed to detect GIPs after the gluten challenge of > 50 mg.

(4) Many questions are still unanswered.

• Does triggering a low-level immune response (IL2 activation) significantly below the 50 mg threshold found in the 2007 study lead to mucosal injury or other meaningful health damange over a longer period of time (> 3 months)?
• Is there a way to use IL2 to determine one's personal sensitivity to small amounts of gluten? In other words, am I in the 50% of people that don't get an immune response from even 100 mg or gluten, or am the a highly sensitive group that reacts to even 1 mg? This knowledge might inform my on the margin decisions, like whether I buy food labeled "gluten free" (< 20 ppm) foods or whether I look for brands tested to be at lower levels.
• The study did not include homozygous carriers of HLA-DQ2.5 (about 25% of celiacs, including myself). People have speculated homozygous individuals may have a stronger immune response to gluten. I would be interested to see more research on this topic.

It's an annual tax. For instance, if you make 100K and agree to 10%, you pay 10K per year. Once you lock in the % it's locked in for life. You can't later decide you'd rather have celiac and not pay.

Edit: I'd personally do like 20-25%.