How Long Does it Take the Gut to Repair after Gluten Exposure?

September 27, 2012 in Categories: , by

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This is a very relevant question for those who are just embarking on their gluten-free journey.  But, it’s also extremely important for anyone who has been following a paleo/primal/gluten-free diet for a while, but has been inadvertently exposed to gluten.  It sometimes feels as though the longer we avoid gluten, the more sick we feel after accidentally eating some.  This is in large part because the body stops protecting itself from gluten (for example, there may be less mucus in the gut) so when we do consume some, we are defenseless.  It may also be because we forget how we used to feel and are so used to feeling so much healthier.  Whether you are new to paleo or have been eating this way for a while, a common question is:  how long does it take the gut to heal after gluten exposure? 

I have talked about the irritation, inflammation and damage to the lining of the small intestine that can be caused gluten (I promise I will go back and add references to this post soon) and I have mentioned that it can take up to 6 months for the body to fully heal after a single gluten exposure.  After delving into the research more thoroughly, I have discovered that this statement is simultaneously a gross understatement and an overstatement.  Just like the extent of damage that gluten causes varies from individual to individual (see this post for a little bit more on variability in tolerance), so does the length of time it takes to recover.  And it’s not as simple as the more damage you have, the longer it takes to recover.  There are factors that control how sensitive you are (genetics, overall health, diet, stress, nutritional-deficiencies, gut microflora) and there are factors that affect how quickly you heal (okay, it’s the same list of factors, but it’s more complicated than A+B=C).

The cells that line the gut, called enterocytes or gut epithelial cells are organized into hills and valleys (to help maximize the surface area of the gut), forming finger-like columns of cells called villi separated by valleys called crypts.  The enterocytes are constantly regenerating themselves (a pool or resident stem cells supplies the new enterocytes).  As the cells age, they migrate higher up the villi and are eventually shed into the gut to be redigested (yes, we are constantly cannibalizing ourselves).  This is called the “turnover” of the gut epithelium.  In the normal healthy gut, the enterocytes migrate to the top of the villi in in 1-4 days, meaning that all of the villi cells are replaced with new cells every 3-5 days (this gets slower as we age) 1,2,3.  The cells that migrate toward the bottom of the crypts have a longer lifespan of 2-3 weeks.  What does this mean?  A healthy person has an entirely new intestinal lining every 2-3 weeks.

Repairing the intestine following injury (whether that is caused by ingested toxins, infection, or some other injury) is a more involved and complex process that is tightly regulated and controlled by the body (for a detailed understanding of this process, see reference 4).  The healing time varies depending on the extent of injury and studies trying to understand the role of the resident stem cells of the gut show that repair of the crypt and villi structure of the intestinal wall after injury can take anywhere from 2 to 12 weeks (depending on whether the stem cells themselves are injured) in the absence of confounding factors 4,5.

What does this mean?  For healthy individuals without celiac disease or gluten sensitivity (where their bodies are producing antibodies against gluten), the damage to individual cells and the junctions between them that can be caused by gluten is relatively fast to heal, anywhere from a few days to 3 weeks.  For these healthy individuals, most of this time is likely asymptomatic.  Many people report symptoms that only last from a couple of hours to a couple of days after gluten exposure.  This also means that healthy individuals should be able to heal their guts completely after following a 30-day paleo challenge such as a Whole30.

For those with confounding factors, healing is slower. Confounding factors are numerous and include gluten sensitivity (where the body is producing antibodies against gluten which increases inflammation and slows healing), celiac disease (an autoimmune condition), uncontrolled inflammation in the gut (which could be caused by food allergies, food sensitivities or diseases such as Inflammatory Bowel Disease), nutritional deficiencies (which can be caused by having a very inflamed and damaged gut, but slows healing because not all of the raw materials needed to repair are available), gut dysbiosis (the wrong type, amount and/or location of microorganisms in the gut), infections, stress, body-wide inflammation, and chronically elevated insulin.

How much do these confounding factors slow healing?  The extreme end of the spectrum is those with Celiac Disease, an autoimmune condition triggered by gluten exposure.  One hallmark of Celiac Disease is a shortening or blunting of the intestinal villi which is observed by performing a biopsy of the small intestine (they are typically 3-5 times longer in healthy individuals than those with Celiac Disease).  For those with celiac disease, one study showed that only 66% of patients had a normal intestinal biopsy after 5 years on a gluten-free diet 6.  This means that even after 5 years, 34% of Celiac Disease sufferers had not recovered.  There are no good similar studies evaluating intestinal repair in people with non-celiac gluten-sensitivity, but medical professionals who specialize in treating gluten-sensitivity report time frames of approximately 1½-2 years 7.

It’s probably worth mentioning here that current reports suggest that both Celiac Disease and gluten-sensitivity are ridiculously underdiagnosed.  It is estimated that 1 in every 100 Americans suffer from Celiac Disease but only 5% are ever diagnosed 8.  This means that there is something like 2.5-3 million Americans with celiac disease that have no idea that they have it (when you extrapolate this statistic globally, it’s even scarier!).  Gluten intolerance is estimated to affect 15-20% of the population 9.  The take home message here?  Even if you have never been diagnosed with celiac disease or gluten intolerance, you may have one of these conditions which could be contributing to slowed intestinal repair after switching to a paleo diet or after accidental gluten exposure.

How much gluten can cause a problem?  This is highly individual.  For those with Celiac disease (whether confirmed or undiagnosed), even a minute amount of gluten can cause significant damage to the small intestine in the majority of sufferers 10.  Interestingly, a not unsubstantial percentage of these people (22%) will have significant damage to their small intestine but not suffer any gastrointestinal symptoms.  For healthy individuals, the threshold amount to suffer symptoms is highly variable.  Unfortunately, you don’t know until you test it on yourself.

So, how long does it take the gut to repair after gluten exposure?  Once again, like so many topics I cover on this blog, the answer is “it depends”.  For healthy individuals, healing likely takes only a couple of weeks.  For those with celiac disease (and perhaps autoimmune diseases in general), fully healing the lining of the small intestine may take years.  The rest of us can be anywhere in between.

1 Creamer B et al. “The turnover and shedding of epithelial cells–Part I The turnover in the gastro-intestinal tract”. Gut 1961 2: 110-116

2 Lipkin M et al. “Cell Proliferation Kinetics In The Gastrointestinal Tract Of Man. I. Cell Renewal In Colon And Rectum” J Clin Invest. 1963 June; 42(6): 767–776.

3 Godlewski MM et al “Into the Unknown–The Death Pathways in the Neonatal Gut Epithelium”  Current Pediatric Reviews. 2011. 7(4):337-345

4 Blikslager AT et al. “Restoration of Barrier Function in Injured Intestinal Mucosa” Physiol Rev 87:545-564, 2007.

5 Booth C and Potten CS “Gut instincts: thoughts on intestinal epithelial stem cells” J Clin Invest. 2000;105(11):1493–1499.

6 Rubio-Tapia A “Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet.” Am J Gastroenterol. 2010 Jun;105(6):1412-20.


8 Lohi S et al. “Increasing prevalence of coeliac disease over time.” Aliment Pharmacol Ther. 2007 Nov 1;26(9):1217-25.


10 Lähdeaho ML et al. “Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease.” BMC Gastroenterol. 2011 Nov 24;11:129.


You can heal 100% trust me kill all bacteria parasites fungus in the gut…….. Gluten is just one of many things that damage the lining of your gut of course stop eating gluten, dairy sugar but also remember infections in a big deal…….

Excellent post. I’d been looking for something like this as I kept reading anything from 1 month to 6 months. I’ve got a gluten intolerant son (who had skin and behavioral issues) and the changes in him after 8 months gluten free (about 4-5 months Paleo) have been amazing. But there are some lingering issues and I’m almost glad to hear that we may not see full benefits for another year.

Thank you! Almost all of my posts are topics that I research for my own interest (I’m usually interested because it impacts my own health or my family’s) and it always amazes me when that information is so hard to find (which this was).

Thank you for this very interesting post. I have celiac disease and even a minute amount can leave me physically sick for days…I didn’t realise how long it was really taking my body to heal. I have been following the Paleo Autoimmune protocol for about a month and feel better than I have in years. My next challenge will be to spend five weeks travelling in the USA and eating Paleo(we live in Australia).

Oh lordy, that could be a real challenge depending on where you’ll be! You could try locating farmers markets (food and culture in one!) – perhaps the city council would be able to give you dates and locations. Or there’s Eat (I think?)
I live in Europe now but whenever I go home to Canada I’m hit again with how hard it is to find real food there, and what a challenge my family is up against to just find yogurt that’s JUST YOGURT. No wonder American real foodies come off as kooks who make their own everything – you can’t buy it so you HAVE to make it if you want to eat it. And that’s just speaking of groceries. God forbid you want to eat out!
Sorry; end of rant. Have a great trip!

Where in Canada are you visiting? I live in the west and also have friends on the coast. We have no trouble at all finding good paleo food. Perhaps they don’t know where to shop?

Thank you for the post. I am in the category of what you refer to above as a healthy individual. However, I have MS and have removed gluten and most other grains and dairy (still working on the entire conversion as I was just dx and am totally overwhelmed!), so I do not consider myself “healthy”. I have been struggling to find a dietitian or ND that has any idea of how to answer these questions. I am asymptomatic when gluten gets into my system, but I continue to research the effect of gluten on autoimmunity as a whole and there does seem to be connections between gluten and MS. There just seems to be no one out there researching it to any extent. In any case, I am rambling, and I just wanted to say thank you for giving me an idea of how long the gluten will stay in my system if I am contaminated.

Great post. I’ve had a strange relationship with gluten over the last ten years. I slowly developed gluten intolerance. I had multiple blood tests for celiac which all came back negative. It was a nutritionist that finally told me to just leave gluten out of my diet for two weeks and see if I felt better. (I was really sick at the time.) This confirmed a fairly severe intolerance to anything gluten: brain fog, severe stomach/intestinal cramps, severe exhaustion. I would have symptoms almost immediately after eating anything containing gluten. I went GF for six years. When I first went GF there weren’t any products on the market and if I wanted anything I had to make it from scratch. As GF products came on the market I started finding substitutes for granola, cereals, breads, muffins and various other baked goods. However, I still had some GI symptoms and I finally realized that a lot of the newer GF treats were neither organic nor GMO free. So last fall I did the Paleo Whole 30 (but kept in milk since I had tested fine for dairy). Now I seem to be able to eat small amounts of regular wheat products with little ill effect. However if I have a pasta dinner I do get some GI distress so I know I’m not completely healed yet. For the past year I’ve combined the ideas of Paleo, Primal and GAPS (a gut healing protocol) and seem to be doing quite well on it. I think just going GF isn’t enough. The GF bakery treats contain nasty ingredients and are not a good substitute for real food and a Primal/Paleo diet.

I agree. Even some of the new paleo baking include ingredients which are gut irritants. You have to have encyclopedic knowledge of all of these things to be able to avoid them. Unfortunately, it’s still best to make your own.

I just want to know how long it takes for the lining of my gut to heal from celiac disease. I have been very strict Paleo since my diagnosis, over a yr ago! They say it takes 10 years to heal. But come on now, I eat so healthy, it can’t be nearly that long. Just wish they had a study out there so I’d know for sure! Well the long term complications I have are low blood sugar, and allergies. But thats it, thankfully.

It can take 5-10 years to heal completely (some think that the gut never fully heals in celiacs), but that doesn’t mean that you can’t get it healed to the point of being completely asymptomatic much, much faster than that (like in a few months)

I have been gluten free/Paleo since August 4. During that time I have had gluten only twice. Each time I have burning and pain in my stomach EVERY time I eat something (even if it’s perfect Paleo) beginning a day or two after the gluten exposure and lasting for 2-3 days. Does this sound like irritation to the stomach lining or something else? I am convinced it’s related to the gluten, but it seems like most people have reactions quickly instead of a day or two later so I’m confused… Help?

Actually, the reactions to gluten can be highly variable, immediate or delayed (or both), and some people don’t even get any GI symptoms. It really depends on how you are sensitive, what health issues you have etc. from what you are describing, my guess is that you have some gall bladder inflammation (possibly liver or pancreas too, but I think gall gladder is ore likely) induced by gluten (known to be very common in celiac disease, no one has studied it in non-celiac gluten intolerance). The burning sensation would be from the irritation to the gall bladder when it empties when you eat (location wise, it would feel very similar). Another possibility is a peptic ulcer (which they now know can be caused by gluten intolerance too). So yes, even thought your symptoms aren’t what many people report, it totally sounds like its explainable by gluten exposure.

Thank you for the post! I am curious if you feel that there are useful ways to heal after an exposure? I am not diagnosed officially with celiac or gluten sensitivity, but after 15 years of awful constipation decided to go gluten free, I have had great success for about six months. I also went paleo a few months ago as I have RA and want to do what I can to fight it naturally. Inadvertently I ate some gluten a few weeks ago, which backed me up for a week, and included intense colon pain for the last five days of that week. What’s left behind, it feels like, is a wound in my colon. I had already been taking probiotics but I got a more complete one, and am watching what I eat very carefully. The pain continues a few hours before I go, though its no where near as bad as it was that week. Do you feel that any supplements can speed up the healing process?

Sounds like you are doing everything right by keeping your diet super clean. Broth or a collagen supplement might help speed healing. And sleep–as much as you possibly can.

Thank you for these suggestions. I haven’t been using either up to this point so its definitely worth a try. 🙂

I get the same burning sensation, but it is no where near my stomach. It feels like it is in the small intestine. I have been G-F since late Feb 2015. The burning has lessened, but it continues to happen each time I eat unless I have a very small amount of food. Gall bladder was removed several years ago, but was still getting aching (and sometimes sharp) pain in that area until a couple weeks after diligently eliminating gluten. Accidentally had a gluten exposure the other day and all the pain came back and the burning, which hadn’t completely disappeared, is now a little more intense.

I am assuming the pain is because the cells of the small intestine that are most affected are on the right side of my abdomen, which is where the ache occurs, and that the burning is also an effect of years of gluten damage. Thank you.

I would love to know your thoughts on a supplement called zinc L-carnosine with regard to helping heal the GI tract. It thickens the mucosal barrier and helps to heal hPylori infections. Has anyone tried this? There is a good amount of literature available regarding zinc L-carnosine on We tried it, along with probiotics and inulin fiber, for my son after he had months of non-stop gut pain which was idiopathic. Within about two weeks, he was healed. Not sure which of the things we tried were responsible for the “cure”, but I have to think the zinc supplement was a major part of it.

Zinc supplementation is definitely valuable for people with unresolved inflammation and autoimmune disease. I’m not familiar with that particular supplement so I can’t really comment on it in particular.

Thank you for this valuable information. I’ve been hypothyroid for about 8 years and last summer was diagnosed with Hashimoto’s Disease (both thyroid antibody tests were off the chart!). I also had a food sensitivity test done which showed very high antibodies to wheat and gluten, among six other things. Admittedly, I occasionally cheat and feel the affects anywhere from immediately to days (foggy, digestion issues, great fatigue, nausea). I totally lost control and went on a gluten “free-for-all” at a get-together with friends yesterday. I was up all night with diarrhea and feel absolutely awful today!! I MUST come to terms with my auto-immune disease and stop killing my poor body!! So, I was wondering how much damage I may have been doing and how long it might take to recover. I usually start feeling better in a few days but obviously repeated assaults like this just continue to damage my cells. I realize everyone is different but this gives me a great perspective on just how long it takes to heal…and I realize my cheating hasn’t allowed my body to heal probably at all. This is my wake-up call. Thank you!

When you first start the AI protocol and remove everything including the nsaids will your body take time to understand you are doing this for the better ? I have RA and only use aleeve OTC and I am now removing all the nasty list from my diet but im finding Im just abit stiffer and a bit achey (no nsaids) I really want to keep going!! You inspire me!!!

There can be a bit of a delay. Specifically for RA, try a collagen supplement (I like Great Lakes collagen) and eat a ton of fish or add a fish oil supplement (fresh fish would be better). Hang in there!

Sue, I have also found a supplement called Zyflammend very helpful. It is combination of several herbs with anti-inflammatory properties. With that, and with paleo, I have been off all RA meds for about five months. Still a tiny bit of inflammation but no more than I ever had while taking the meds. I am going to look into the collagen too!

Thanks Sarah! I actually picked up a bottle of that last week. And I just ordered the collagen. I have never taken meds and I hope I never have to. Im glad you are off your meds. I have been eating this way or somewhat because I fall off the wagon alot when I feel to deprived or when I feel it makes no difference. But I did the 30 days no sugar now I will do the AI protocol and see if I can hopefully add eggs (since I just got chickens!) and nuts back into my diet!

Dear Paleo Mom,
Wanting to heal from gluten, and severe candida overgrowth. I was a human ginnie pig for my doctors for 30 years, abusing antibiotics. I had no idea that it would be so abusive to myself. Assuming that western medicine had all the answers. Now I know better and have worked with nutritionist to basically be paleo for several years. I find the sweets creep in and I binge probably because the candida. I have IBS and progressed to IC which is to my understanding, could all be related to the severe gut irritation for such a prolonged period. GI doctors gave me psylliac daily which just about killed me. I had so many problems from antibiotics, I developed C-difficile which doctors fought with stronger and longer antibiotics! At this point, after years of eating well, I have come to a good place although still have to fine tune. It has been suggested to my that Nystatin (anti-fungal) be used to help get off the Elmiron for IC. I also read from another post here on your sight, Zyflamend might be helpful as an anti-inflammatory. I take good doses of vitamins which are very helpful, Magnesium, Calcium, multi, fish oil, D, Bcomplex, and of course my probiotic (which I alternate often).

I think you would like John B. Symes site, He is a vet who has celiacs, and has some interesting observations on it. (He also treats animals by removing gluten/casein from their diets, with dramatic results.)

One study he cites says that only 16% of people with celiac’s disease have fully-recovered villi two years after they are diagnosed and go “gluten free”.

He himself was 100% healed within 3 months.

The difference is that he also eliminated all corn, soy, and dairy in addition to gluten grains, and the key here is “ALL”. Even trace amounts will prevent healing.

This also matches the experience of studies on autistic kids, where about three-quarters of them show dramatic improvement on gluten-free/casein-free diets, but the rest need a celiac-like/autoimmune protocol to show improvement. Karen DeFelice, in her book about using digestive enzymes to treat autism, found the same thing: about 80% of autistic kids show significant improvement on a standard-american-diet plus digestive enzymes, but the remaining 20% need an AIP diet (presumably because even the trace amounts of trigger proteins after the enzymes cause massive gut inflammation). I suspect that some autistic kids are also sensitive to environmental triggers, especially mold/mycotoxins (but of course your AIP eliminates the commonly-contaminated foods).

Has anyone had Multiple allergies developed because of the damage to the gut with celiac and gluten. For me it was going GF but then fixing the infections, yeast, bacteria in the gut , then healing the gut.. and now working on the multiple allergies that has developed.
Do you find many of these fix themselves over time. Its been 3 yrs I have been strict GF… and still dealing with Multiple allergies. My dr. says maybe about another yr. I am doing Allergy Immune drops.
I just wonder if many people may be not recovering because of their diet but also Multiple other allergies they are not aware of, because of gut damage? Also wondering if anyone else went through this and how long it took to get past this?

To heal, you need to stop eating anything you are sensitive to, and Sarah’s autoimmune protocol on this site is a good place to start. You also need to eliminate mold from your environment, as many people with autoimmune/gut issues are also mold/mycotoxin sensitive. For mold, critical to keep relative humidity between 45-50 to keep mold from growing (get dehumidifiers), clean all visible mold with vinegar mixed with a few drops of tea tree oil, and spray your bath/shower with the same after each use. If no vent in the bathroom, then put a dehumidifier in there.

Tim, Thank you for the advice, and I will look at starting Sarah’s autoimmune protocol. Yes I do have a Mold allergy also, as I was tested for this with my inhaled allergy test. I tested positive for everything they tested me for in foods and inhaled allergies. I have an Austin air cleaner and after about 4 months doing the allergy drop treatment I am noticing a turn around finally. 🙂 Wish more Dr.s knew to look at Multiple allergies after gluten damage. Seems the body just does not want to stop reacting to everything and its a long road to health again.
Thank you for the advice with Vinegar and tea tree oil, I didn’t know that. I know I was told to use Borax ..

There is also a lot of good stuff on mold allergies on Dave Asprey’s Bulletproof site, he is extremely sensitive. When we drink his coffee, we’re always fine; when we drink other people’s coffee, we more often than not have a reaction and feel bad for days. One of the interesting things about Sarah’s autoimmune protocol is that it eliminates the food most likely to have mycotoxin contamination…

Borax works as well for mold, but we like the vinegar/tea-tree because is easier to use, especially in the bath/shower. We just keep a spray bottle on the counter, spray the shower/bath after we get out.

I think for mold that relative humidity, and fixing any water leaks, is more important than an air filter — it cuts off the source of any mold spores, while the air filter just reduces the concentration. Mold can’t grow without water, but it can get water from the air when relative humidity is 60% or higher.

Sounds like you are figuring this out!

Thank you for Dave Asprey’s Bulletproof site. I was reading on there they show beans to the further left, I was wondering if you knew why? Also Rice was shown before Quinoa? Also I saw it showed ” cooked Spinach”? Do you know why, I make green drinks with raw Spinach.
I found adding coconut oil to my green drinks helps my stomach more 🙂
Any suggestions also for Freezer storage, with left overs, and seasonal fruits and veggies from my garden?
I hope next year I will be much better and I can “learn how to can”, but I was told Zip lock baggies were BPA free, then I was just told ANY soft plastic can off gas, including the baggies. With the inhaled allergies, I also have an allergy to plastic.
I looked on line and found glass Pyrex as an option, and some seem to use Canning jars with BPA free lids to freeze in. I will miss the ease of zip locks along with the Space you can get in using those in your freezer over glass. BUT I have found every step helps.

Thanks for your help and advice.

Beans have fairly high levels of toxins, primarily lectins, and also have high levels of phytates, which reduce nutrient absorption. So if you have food sensitivities, they aren’t recommended (and aren’t on Sarah’s autoimmune protocol).

White rice has the lowest levels of toxins of any of the grains, and tends to have less mycotoxin contamination, so imo is the safest grain, better than brown rice. Rice in general is less cross-reactive than other grains, so brown rice is the safest whole grain. Quinoa and oats often cross-react if you have gluten sensitivity, and both of them can have mycotoxin contamination.

Cooked spinach is more nutritious than raw, it increases the nutrient content and makes them more bioavailable, also lowers oxalates slightly.

Coconut oil is good, get a brand without mycotoxins. We use Wilderness Family Naturals or Artisana, both seem to be fine.

For freezer, would definitely go with glass over baggies…

And you’re right — every step helps. If you read Sarah’s story, she didn’t heal until she eliminated everything she was sensitive to. We’ve had the same experience.

Using probiotics and prebiotics can really help too, as long as you don’t have SIBO. Ideal level is about 30-40g/day of prebiotics. We use 2tsp of inulin plus 1tsp of potato starch, take that 3x per day, which puts you right in the middle of the range. (Start slow and ramp up…) Probiotics we like are Natren Trinity or Renew Life Ultimate Flora. Soil bacteria like Prescript Assist can also help, we use that 1x per week. The probiotics directly help calm down your immune system, and getting your colon to be healthy helps in a number of ways.

Thanks for so much information.
No, I have not read the perfect health diet book. It may be something for me to look at.
With beans I thought it was just an issue of making sure they are cooked well?
I had no idea Quinoa could be cross contaminated like oats. For me I showed on my tests I was allergic to rice and potatoes, tomatoes, etc. Everything on the food test I reacted to and inhaled. So I’ve been eating meats and quinoa and beans, and rotating my foods.
I have been eating the Eden foods quinoa and they do complete cleaning of machinery and are very careful of gluten. Is the cross contamination you mentioned from the plants they are made at, or in shipping and storing?
What are your thoughts on allergy drops, Immunotherapy?

The Jaminet’s idea is to eat about 400 cal/day of starchy carb like sweet potato, about 15% of calories as protein, lots of veggies and some high-fructose veggies like beets/carrots/squash, the balance as fat. So it is not super-low-carb, which I don’t think is healthy, nor super-high-carb, also unhealthy. It hits a sweet spot, where you get enough glucose from the starchy carbs to keep your gut/brain/immune system working well, but not a lot more (to minimize chronic long-term inflammation).

So on a rotation diet, you need 4 starchy carbs that you aren’t sensitive to. Can you eat sweet potato? It is very different from potato, most people can eat it. Then you need to find 3 more. If quinoa is ok for you, you could use it in your rotation till you heal and can eat more foods. So you need to find two more. Some possibilities are taro, yucca, parsnip and turnip, green plantains (Sarah has some great recipies)…

The grain cross-reactivity issue isn’t from contamination, it is because the proteins in the various grains are similar enough that once your body reacts to something in wheat/gluten, it then also reacts to similar proteins in other grains. A lot of people with celiac don’t heal until they cut out ALL grains, dairy, and soy, and don’t eat even trace amounts.

Beans also trigger a response in a lot of people with multiple food sensitivities, which is why they aren’t recommended.

When you eat something you are sensitive to, even in trace amounts (“just a sip” or “just a little taste”), it causes your immune system to flare up and the flare can last for a couple of weeks. If your body starts cranking out IgG in response to a food, the peak production is 3-4 days after the trigger, because it takes that long to grow the particular immune system cells that produce it. Then it takes a while for the IgG to get removed and you to get back to normal.

If you can eliminate all triggers, you will feel really good pretty much as soon as any outstanding IgG antibodies die down, typically in 1-2 weeks, and you will feel good as long as you don’t encounter a trigger.

Some people find that allergy drops and Immunotherapy help. My sense is that healing your gut and getting good, healthy gut bacteria in place is faster and more reliable. My wife had good results from NAET, as long as you make sure to heal your gut and not rely on it as a permanent fix it can help you get there. Fortunately, you can do all of these at the same time, if you want 🙂

Thank you for all of this information. Do you feel Acorn Squash and sweet potatoes would be on the same level, or are those OK to rotate with? I try to have like , Lamb or Bison and acorn squash one day, quinoa 2nd day & beef and sweet potato 3rd day and then rotate that.
Its hard when you are allergic to so much and I do feel doing the Allergy drops has helped, but it goes hand in hand with Elimination and Rotation too. As I am doing both.
I think a lot of people think if they just keep eating GF and some eat a lot of processed GF products, that “in time” they will just “self adjust” and stop reacting to things. But that doesn’t seem to happen once the gut is damaged badly enough where your body reacts to so much.
We sure need more Dr.s on top of understanding this!
I appreciate you going over this in detail.

Since you have mold allergies, it would be better to wait on mushrooms and try them after you have been feeling good for a while.

Acorn squash would be OK for a rotation, sure. It is lower carb than the sweet potato or quinoa, so either eat a little more of it, or a little more carbs on the other days. Cooked squash is very good for gut issues.

One other thing is to get 100% grass-fed meat; beef raised on a feedlot isn’t healthy, and some people find that just switching to 100% grass-fed resolves a lot of gut/inflammation issues.

The best combination is to use Paul Jaminet’s Perfect Health Diet for amounts, meal timing, and excellent nutrition and lifestyle help; Sarah’s auto-immune protocol for what specifically to eat or not eat, and Dave Asprey’s blog for info on mycotoxins.

Hi , I had caster oil for say 2 months as a result of piles . The doc said that Caster oil would makes things normal fast. As a result of my anxity to get better soon i had excess and did strugle with multiple problems like non formed stools, loose stools, excess gas which did not pass out etc. I dis a colonoscopy in August and the doc said everything was fine and i have Post infection IBS . I was on probiotics and Antibiotics called RC fact. I am now better in November with no constipation and over all health. The main issue i have is

1. The have internal Gas which at times gives me a growling intestine and rumbling
2. I hit the loo twice and the second time i just get gas
3. At times i get air bubles in my stools

The docter says the Caster Oil has caused damage to the lining in the small intestine and it could take a while till in fully recover.

My question is
1. how long does it take to fully recover?
2. Once recovered will the rumbling fully stop, or would i still have occational flare ups?
3. What probiotic should i take for excess gas, doc recommened a new probiotic called
Enterogermina. for intestinal lining and gas

I have no other issue like Pain, some times rarely get loose stools. My constipation is now fully recovred.

Recovery time varies depending on extent of damage, how much nutrition you’re getting, how well your sleeping etc. but think anywhere from 3 weeks to 6 months or much longer if root problems haven’t been addressed. Gas is a sign of hindered digestion and imbalances in gut bacteria (which very likely resulted from the protocol you were on if they weren’t preexisting). I would suggest a very nutrient-dense diet with lots of seafood and vegetables and glycine-rich foods like broth as well as digestive support supplements. I am not familiar with enterogermina. You’ll get much more diversity in probiotics out of unpasteurized fermented vegetables (like homemade sauerkraut).

Tks a ton really useful information . Now I know i need to wait patiently for upto 6 months. The gowling and movements are ocational rumbling from my anus is all because of Gas? or is it because of spastic Colon ? From what i have been hearing is if it wa spastic Colon it would have pain and in my case there is none . Also i did hear that if the lining in the small intestine is damaged it loses the power to absord the gas and pass it into the blood stream which comes out through the breath.

So in all these cases beleive time is the only answer. Pls let me know if the rumbling and movements in my stomach and in my anus is because of Gas or Spastic Colon?

Interesting post. I have followed a gluten free diet for 3 weeks as part of a challenge, and I would not say I have noticed a huge change over the time. I noticed a change around 5 days in, but since then it has been pretty much the same. I am an elite athlete, and my nutrition is very good, I think that may be why I recovered so fast, and why I have not noticed too many differences as I am so in tune with my body anyway. Very interesting read. Thanks for sharing!

Thank you so much for this post. I ordered your book and can’t wait for it to arrive. I’m currently trying to heal my leaky gut. I had a flare-up of digestive issues, joint pain, and brain fog, following the birth of my daughter 9 weeks ago. I had a few of these flare-ups last year and then was relatively symptom-free during my pregnancy. I’m wondering what role hormones play in leaky gut? I definitely still feel as though my hormones are out of whack and am trying to find out how this may impact my healing.

I am glad you included the disclaimers about other confounding factors. I have Celiac disease and developed gastroparesis, and my GI told me it could take 3 years for my intestine to heal after exposure to gluten. I felt significantly better after strict AIP for 30 days, but I wouldn’t want anyone to be discouraged if they weren’t “healed” by that time.

[…] Another article says “For healthy individuals without celiac disease or gluten sensitivity (where their bodies are producing antibodies against gluten), the damage to individual cells and the junctions between them that can be caused by gluten is relatively fast to heal, anywhere from a few days to 3 weeks. . . . For those with celiac disease, one study showed that only 66% of patients had a normal intestinal biopsy after 5 years on a gluten-free diet 6. This means that even after 5 years, 34% of Celiac Disease sufferers had not recovered.” How Long Does it Take the Gut to Repair after Gluten Exposure? […]

I have had RA for 26 years, have been gluten-free for 1 1/2 years, and Paleo for 4 months. I’ve read The Paleo Approach and am preparing to start the Paleo Approach/AIP (just got the cookbook last week!). Although my RA is currently well controlled by the biologic medication, Enbrel, I worry about potential side-effects and would love to get off of this drug or at least reduce how much of it I am taking. I know that it may be harder since I have had RA for so long, but your story and the story of other bloggers who have had great results with the AIP has inspired me to give it a try. I have a question that is sort of the flip side of the question of how long it takes to heal: if you are feeling good after a few months on the AIP and then start slowly reintroducing foods, how long might it take before the body signals that a certain reintroduced food is problematic? I suspect my RA was caused by leaky gut, which I’m guessing didn’t develop overnight but rather over a long period of time of eating offending foods (and not getting enough sleep or managing stress effectively). So, for example, if I reintroduce a food and feel o.k. for a month afterwards, is it safe to assume that that food will not contribute to a return of leaky gut and RA symptoms, or could it take longer than a month for the food to cause problems again? I guess I’m thinking ahead and wondering how long I will need to wait in between reintroducing foods so that I don’t confuse symptoms from the second reintroduced food with a cumulative/delayed reaction to the first reintroduced food. Thanks for any guidance, and thanks so much for your books, blog, and all you do to help those of us with autoimmune disease.

I have celiac disease and follow a gluten-free diet, however, once or twice a year, I get diarrhea that lasts for 4-6 weeks, so I know I have had inadvertent exposure to gluten. What shou Id I avoid eating or drinking during these bouts? Is there any point in taking vitamins/supplements since everything is going right through me without being digested? Is there anything I can take to heal faster, or that will be absorbed so that I don’t become completely depleted/malnourished? Which foods are best at this time? Thank you

Elizabeth, I’d love to have answers to these questions as well. I am an incredibly sensitive celiac and feel like I’m constantly fighting cross-contamination. When I get sick, it’s so hard to know what to do. If you figure anything out, please share. 🙂 kara.snoke at

Thank you for this!

I have celiac disease, and the last time I accidentally ingested a substantial amount of gluten (2 pieces of wheat bread, pre-autoimmune-protocol days), it took 2 or 3 months before daily GI symptoms subsided. I love learning the details of why, so thank you for sharing. Finding this kind of information can be very difficult!

Thanks for this Sarah. Very timely for me. I recently unknowingly ate something w/ bread crumbs (egg salad from Safeway, where I NEVER shop….REALLY???, Bread crumbs in egg salad???? The next night I was really sick, after 7 years gf. It took about a month, slightly more on my fairly strict Paleo lifestyle to get completely better. WOW!!

Thank you for explaining this. I have a few extenuating circumstances like UC followed by jpouch surgery many years ago. I gained weight at first but something happened and I dropped to about 10 pounds below my ideal weight and have stayed there. This year I started working with a nutritionist, had hair analysis in lieu of blood tests since I’m living abroad, and am in supplements. I was having a hard time complying with modified AIP but my research has shown me that people like me who are living healthy are eating paleo and most definitely gluten free. The last frontier for weight gain is to assume gluten intolerance–never tested for celiac and not planning to–and be serious about complying. Coconut aminos are my friend.

I am the ‘ lucky’ one suffering from what is called microscopic colitis or colagenous colitis! No cause no real solution! I am on GF diet and altho the bloating has relieved a bit it remains the same. ( i also watch out for sugar) Do you or anyone knows about this kind of colitis? Thanks for reading my comment!

So I’ve been on AIP for Hashimotos for 5 weeks. I was doing so well. Had a bad morning at work and…I had a small cookie. I feel like such a failure. 🙁 is there any chance that I haven’t just screwed myself?

Sarah, thank you so much for all your articles and your latest book is my bible! I truly believe that minerals are deficient for leaky gut to happen and that they are so essential for the healing and protection of the digestive tract plus being essential for functioning enzymes. My son had an extremely damaged gut, poor blood sugar control and adrenal fatigue but has made a full recovery. On the very rare occasion he has accidentally eaten something he takes Silicogel and he is recovers in a few hours. I am sure that this is because he is now well mineralised from taking daily Sizzling Minerals and L-glutamine. A healthy gut should be able to recover in a few hours.

Not sure if you monitor these comments or have the time to respond, but I have been told that I need to do the celiac endoscopy and a colonoscopy because my doctor is (mildly) concerned about colon cancer. The colonoscopy is a priority so they want to do that sooner rather than later, but they figured they’d do celiac when they are in there.

I am mostly gluten-free, but certainly not strict about it. I never worry about cross-contamination, and I sometimes have bites of bread, or a cookie, etc. – I haven’t had much for the last 2 months or so, but certainly had a little. Do you know whether that limited amount of gluten is sufficient to make any damage show up, or do I need to do the full 8 week gluten-loading? (When I have completely eliminated it for ~30 days I have never had a problem re-introducing if that makes a difference)



Does anybody have problems with bowel/stomach noises, gurgles, popping sounds when exposed to gluten? I have had this for years while eating gluten and while off it. The noises are MUCH louder when I have been exposed to gluten but they are constantly there even off it.

What I a great post – I just had my second gluten exposure since gving it up 10 months ago.
The first one lasted ten days – this one is just horrible – I am feeling worse.
I have several autoimmune conditions including Hashimotos, CFS, and Fibromyalgia
Wish you included some supplements for healing it quicker – but from my research – it’s just time.

Thanks so much for this….it is awesome

I was inadvertently exposed to gluten at Thanksgiving. I have been diagnosed via bloodwork only with Celiac.Although our whole family is very careful and watches ingredients, something slipped past. It so happened that a week or so later, my doctor requested that I take a test that is supposed to detect early bowel cancer. Just before Christmas, they called me to say that they now want to do a full colonoscopy because there were “microtraces” of blood in the sample. I asked that they hold off on that, because I am convinced the blood is actually from the destroyed villi the gluten killed. I am going to print this out and show it to my doctor at my next visit.

Thank you for this post. I had a blood test for coeliac disease which came back positive 9 months ago. The doctor advised a gastroscopy with biopsy for a definitive diagnosis. However it took me 7 months to get an appointment with the specialist, during which time I strictly followed the AIP. I was told I would have to eat gluten for six weeks prior to the gastroscopy, and I have put it off as I find it very difficult to willingly eat what I know will make my life very difficult (gastric distress and joint pain being my main symptoms). I have improved enormously on the AIP. My question is, how important is a definitive diagnosis in your opinion? If exposure to trace amounts of gluten can cause months of damage to the gut, is it worth eating gluten for six weeks just for a diagnosis? Thank you so much.

Hello Tanya,

I don’t know if you already went to get the biopsy or not, but this is what I can advise. I’m not sure where you live, but I’m from Canada and here, if you want to get some money back for the very expensive gluten-free diet, you need to have a letter from a specialist that says that it was confirmed by biopsy that one has a celiac disease. So that’s the only reason in my opinion for the gastroscopy. You can check regarding this where you live and make a decision based on that. I wish you all the best.

I am confirmed coeliac after biopsy. After adhering to gluten free diet for one year, and having a further biopsy, I have been told my gut villi are normal. Just for your info. Your 5 year potential prognosis to heal after an accidental injestion of gluten is quite scary, as inevitably this will happen from time to time.

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