Alyssa Ramuscak, RD. Celiac Canada Scientific & Research Analyst, December 16, 2025
Dr. Amélie Therrien, a clinician scientist at the Celiac Center at Beth Israel Deaconess Medical Center and an Assistant Professor of Medicine at Harvard Medical School, offered an in-depth summary at where research stands today, highlighting both progress and persistent challenges in non-biopsy diagnosis, digestive enzymes in the management of celiac disease, literacy and patient education, risks factors of persistent symptoms, and non-celiac gluten sensitivity.
If you have been tested for or diagnosed with celiac disease, you are likely familiar with the key diagnostic tool, a tissue transglutaminase (TTG) blood test, that checks for antibodies the body makes when it mistakenly attacks gluten in the small intestine. Dr. Therrien emphasized that while blood tests like TTG are useful, no antibody level alone is accurate enough to diagnose celiac disease without considering biopsies and expert guidance, especially since some people may improve or fluctuate without ever developing full celiac disease.
Trials of digestive enzymes, once considered promising for preventing accidental gluten exposure, have so far shown inconsistent results. Dr. Therrien highlighted the scientific and regulatory challenges of developing digestive enzymes as an adjunct therapy for celiac disease, noting that gluten is an unusually resilient protein that human enzymes cannot fully break down, making it difficult to create an enzyme capable of neutralizing the harmful gluten fragments. Since these digestive enzyme products are regulated as a drug rather than supplements, they must also undergo extensive clinical testing. As a result, the research to date has produced mixed findings: one study in patients with persistent symptoms showed no improvement in digestive symptoms and even had a slight reduction in villi height, while another trial in individuals with celiac disease in remission found that taking an enzyme alongside daily gluten exposure prevented symptoms from worsening and maintained small intestine villi structure. A third study ended early due to funding limitations. Overall, Dr. Therrien emphasized that while enzyme therapy may be a promising concept, the evidence is still inconsistent, and more rigorous research is needed before such treatments can be recommended.
Education is the cornerstone of effective celiac disease management, yet many resources available to patients often fall short of being clear, practical, and easy to read. As Dr. Therrien highlighted, health resources should ideally be written at an eighth grade reading level or lower to ensure accessibility. However, research from Columbia University showed that most of the 199 online resources they analyzed were written well above this grade level. This gap can make it harder for patients and families to navigate their gluten-free diet, recognize symptoms, and manage their condition confidently, highlighting the need for educational materials that are not only evidence-based but also accessible.
Dr. Therrien also addressed the increasingly recognized issue of persistent symptoms in celiac disease, noting that while most people improve on a gluten-free diet, a substantial number continue to struggle with ongoing discomforts. In a study from Germany of over 2,000 individuals, it was found that although 93% reported feeling better after diagnosis, 86% still experienced symptoms such as abdominal pain, bloating, diarrhea, and fatigue. Risk factors for continued symptoms included being female, having these symptoms before diagnosis, feeling inadequately informed about celiac disease, and being diagnosed at an older age. These results are like those of Celiac Canada’s own State of Celiac Disease study of 7500 Canadians. Dr. Therrien emphasized that persistent symptoms are often caused by factors other than gluten exposure, such as acid reflux, food intolerances, small intestine bacterial overgrowth (SIBO), pancreatic insufficiency, constipation, or irritable bowel syndrome. Because inflammation in the small intestine can temporarily reduce brush-border enzymes and disrupt the gut microbiome, many individuals may develop lactose or other food intolerances during healing. For these reasons, Dr. Therrien stressed the importance of regular medical follow-up to receive thorough on-going dietary counseling and assessment for other co-occurring conditions.
In Dr. Therrien’s final topic of her session, she discussed the most recently published meta-analysis and systematic review that looked at the prevalence of non-celiac gluten sensitivity among the general population. In this Lancet published report, it was noted that 10% of the population self-report sensitivity to gluten or wheat, with the most common symptoms being bloating, abdominal discomfort, and fatigue. While the prevalence of non-celiac gluten sensitivity appears to be growing, the question remains whether gluten is the true culprit. From the studies examined, Dr. Therrien highlighted that other factors such as FODMAPs (poorly digested carbohydrates), expectancy of receiving gluten, and overlapping diagnoses like irritable bowel syndrome symptoms may be at play. Although the underlining causes of non-celiac gluten sensitivity remains unknown, Dr. Therrien emphasized the importance of seeking out medical evaluations before following a strict gluten-free diet and receiving dietary counselling from a registered dietitian to ensure a nutritionally balanced diet.
Dr. Mark Wulczynski, a postdoctoral fellow at McMaster University’s Farncombe Institute Nutrition Initiative, highlighted how gut microbes, and dietary fibre could become powerful tools for improving health in people with celiac disease. His research, sponsored by a Celiac Canada Young Investigator grant, shows that different fibres don’t act the same: inulin, for example, dramatically accelerated small-intestinal healing in a gluten-sensitive mouse model from 10 weeks to 6 weeks by boosting beneficial short-chain fatty acids produced by gut bacteria. But when Wulczynski examined human patients, he found a challenge; many people with celiac disease have fewer fibre-degrading bacteria to begin with, meaning they may be unable to fully benefit from added fibre alone. His work suggests that future therapies may need to pair the right type of fibre with strategies to restore key microbes such as Prevotella or other fibre-degrading bacteria, unlocking better healing and gut resilience. Ultimately, Wulczynski envisions a personalized approach to the gluten-free diet, one where microbiome profiles help determine which fibres and microbial supports are most effective for each individual.
Dr. Diana Mager, registered dietitian and Professor from the University of Alberta, provided helpful insight into the importance and challenges of helping children and teens with celiac disease eat a nutritionally complete gluten-free diet. She explained that many gluten-free products lack key nutrients like folate, iron, fibre, vitamin D, and calcium, and are often more expensive, highly processed, and harder for families to access. In response, her team from the University of Alberta created a kid-friendly, evidence-based Gluten-Free Food Guide, which was developed with input from parents, youth, dietitians, physicians, and Celiac Canada. The Guide offers clear visuals, simple handouts, and practical tools for label reading, balanced meals, budgeting, and everyday eating. Early research shows the Gluten-Free Food Guide helps boost protein and fortified milk intake, although fruit and vegetable intake remains an area for improvement. Dr. Mager’s presentation also highlighted the alarming rates of gluten-free food insecurity in Canada. Nearly half of families struggle to afford safe gluten-free foods, with challenges particularly pronounced among those living in northern, rural, and high-cost housing regions. As Dr. Mager concluded, she emphasized the need for policy change, better support for food banks, and sustained community-driven solutions. Celiac Canada was proud to support Dr. Mager’s work with a James A. Campbell Research grant.
Dr. Jason Tye-Din, a gastroenterologist and researcher at the Walter and Eliza Hall Institute and Royal Melbourne Hospital (Australia), shared exciting progress toward a future where diagnosing celiac disease is easier, faster, and doesn’t require eating gluten. After outlining the many flaws of today’s testing such as missed cases, the need for gluten consumption, imperfect biopsies, and widespread underdiagnosis, he introduced a breakthrough interleukin-2 blood test that detects gluten-specific immune cells with remarkable accuracy, even in people already on a gluten-free diet. By mixing a patient’s blood with gluten in a test tube and measuring tiny bursts of interleukin-2, his team can identify celiac disease without triggering symptoms and even predict who is most sensitive to gluten exposure. Early research also shows promise for a simple saliva-based screening tool, which could make mass screening far more accessible, ultimately reducing the potential delay to a celiac disease diagnosis. Together, these innovations point toward a new era of immune-based testing that may replace invasive procedures, such as endoscopies and intestinal biopsies, to close the gap on the many people living with undiagnosed celiac disease.
Celiac Canada’s annual conference showcased both the exciting scientific progress being made in celiac disease research and the ongoing real-world challenges faced by patients and families. Advances in immune-based diagnostics, microbiome-informed nutrition, and evidence-based dietary guidance signal a promising future for more personalized and accessible care. Despite these advances, the conference also reinforced the need for continued investment in patient education, equitable access to safe gluten-free foods, and multidisciplinary collaboration to translate emerging research into meaningful improvements to the lives of those living with celiac disease.
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