"Dr. Johnson, I'm mostly gluten free, isn't that OK?"
This is a question I receive fairly often from patients who just can't seem to bring themselves to a totally gluten free exisitence. My first response is, "Mrs. Jones (or Mr. Jones), you know it's not possible to be just a little pregnant, correct?", to which I usually get a chuckle. Then the serious discussion begins.
Most of these same patients originally came to me for care for a chronic condition (fibromyalgia, chronic low thyroid symptoms despite being on thyroid medications, lupus, vertigo or other balance disorder, even chronic migraines). A majority have also been to a multitude of doctors for help and have had little to no reduction in their symptoms. Many are on several medications but still, only the edge is taken off their main complaints. Persisting symptoms usually are; brain fog, depression, fatigue, joint aches and pain, body swelling, and being overweight.
Other patients are in pretty good health, but have a persistant symptom or two, with the most common being some type of chronic joint pain, stubborn back pain or neck pain and being overweight.
Thorough testing is completed on all patients, with lab testing for those with a chronic condition to find out root causes for their various symptoms. Symptoms are like the oil light on your car, only coming on when there is low oil pressure or a faulty sensor. Just putting black tape over the oil light is not the best idea due to the fact that you would only be covering up the messenger. Using the concepts of functional medicine, my approach is to discover the underlying reason for the symptom (why the oil light is on) and correct the underlying reason. I use a combination of diet changes, specific individualized nutritional supplements and lifestyle changes along with chiropractic care for better nervous system function and perhaps other drug-free means based on the complexities of the case. For a helpful document that details what functional medicine is all about, click here.
Now back to the original question, I get from some patients (and probably all are thinking about); How much gluten can I eat and not have any ill effects? The answer to this question is based on what your testing shows. If you have testing that shows you have a genetic predisposition to gluten intolerance (like me) AND you have testing that shows your immune system looks at gluten as a foreign substance AND you have any autoimmune attack as shown in your testing (like me)....then NO AMOUNT OF GLUTEN IS SAFE FOR YOU (or me)!  Sorry to yell (that's what all caps means when one is texting), but if you want your body to heal, you have to continue avoiding gluten, period.
Even a very small exposure to gluten has been shown to activate the immune system making it go on the attack for several weeks to a few months, thwarting the healing progress.
Going back to my analogy of "you can't be just a little pregnant", if you are gluten intolerant, you just can't eat a little gluten and expect it not to have a negative effect on your health. So that one bite of pizza or a few crackers or a piece of cake on your birthday or family holiday IS going to cause trouble for you. At a recent speaking engagement, Dr. Tom O'Bryan, explained that even a small, seemly insignificant, amount of gluten (1/50th of a communion wafer) can set off a cascade type immune response in the body that “takes on a life of its own.” The only way to heal the gut and then the body is to be “gluten zero.” The Lancet (vol 358, August 4, 2001) reported that, “Death was most significantly affected by diagnostic delay, pattern of presentation, and adherence to the GFD (gluten-free diet)…Non-adherence to the GFD, defined as eating gluten once-per month, increased the relative risk of death 6-fold.” A “little bit” of gluten has proven to be way too much.
In my case, with autoimmune conditions on both sides of my family, (mother who had Hashimoto's and rheumatoid arthritis, dad, grandpa and grandma had Parkinson's disease) there is no way I will knowingly eat gluten. I avoid it like the plague. I look at it as poison for my body. Why would I want to potentially flare up my immune system to push it into attack mode?
You have to come up with a reason big enough to continue your health supporting lifestyle of being gluten free...and perhaps casein free and soy free so that you would never want to cheat on your diet.
It really is easy to stay gluten free, casein free and soy free on a day to day basis, even when eating outside the home. You first have to keep in mind your reason for eating in this heatlh supporting manner, and then make good choices by being informed as to what ingredients in food have the things you are avoiding. I have a good document that can help you identify the various ingredients you don't want in your diet. You can download it here.
Another good article entitled, "11 Ways Gluten And Wheat Can Damage Your Health" is worth the read. and Sébastien Noël has a lot of paleo recipes and a paleo recipe book you can purchase. 
The best strategy to help heal the damage is to combine gluten avoidance, cross reaction food avoidance WITH gluten and casein digestion enzymes (DPP IV enzymes) along with other individualized specific nutritional support that “puts out the fire of inflammation” in the gut.
My motivation in writing this article, and the others I have posted, is to help make a difference for my patients. I truly love to help people regain their health. My best patient is an informed one. This blog is part of my overal strategy to educate my patients and those who potentially will find their way into my office...or who I will never meet, but will make a difference for them by my writing.
If you found value in this article, please use the social sharing icons at the top of this post and please share with those you know who are still suffering with low thyroid symptoms or other chronic health challenges, despite receiving medical managment. Help me reach more people so they may regain their zest for living! Thank you!
All the best – Dr. Karl R.O.S. Johnson, DC – Digging Deeper To Find Solutions
 http://www.ncbi.nlm.nih.gov/pubmed/15497770 (PDF available above)