A non-responsive celiac diet is also known as the Fasano diet. It’s a diet used for those who aren’t responding to a typical celiac-safe diet. Additionally, it is extremely restrictive. It’s designed to give the body a chance to heal by eliminating high cross-contact foods.
High cross-contact foods eliminated include most foods with a food-label. Meaning there is a huge focus on only eating fresh food.
Before we dive into the Fasano diet, we need to understand what this diet is used to treat. To put it simply, non-responsive celiac disease is when your body is not responding to normal gluten-free precautions. It’s defined as having persistent symptoms, elevated celiac blood test results, and intestinal damage despite 6-12 months of following a verified strict gluten-free diet. Essentially, it’s when the body does not respond to a typical celiac-safe diet.
A 2020 study on non-responsive celiac disease estimates that up to 30% of celiacs will continue to experience inflammation in their gut or have symptoms. Causes include frequent accidental gluten exposure, slow healing, refractory celiac, or another condition.
Non-responsive celiac is often diagnosed after ruling out any potential gluten exposures or causes of lingering symptoms. The key here is, you’re staying generally celiac-safe but your celiac follow-up testing is not improving and you’re still not feeling better.
This is where making sure patients have a solid background in celiac safety knowledge and skill is essential. If this is your missing link, check out the Celiac Crash Course, where I cover all of the basics of how to avoid gluten for celiac. If you do have a solid background in celiac safety and you’re still not improving, your doctor may start to consider non-responsive celiac.
The Fasano Diet or the Non-Responsive Celiac Diet was developed by Dr. Alessio Fasano. It’s for people who are not improving on a strict gluten-free diet.
This diet removes trace amount of gluten. This is because a small portion of the celiac population need to remove trace amounts of gluten in our food system to heal. As a result, the Fasano diet is used to help these people heal and identify their triggers.
This diet is extremely restrictive. It involves focusing on fresh food and eliminating most foods with a food label. It also involves avoiding eating out.
This diet is so restrictive that it’s only used temporarily. The goal is to assess for what foods at high-risk for cross-contact may be triggering continued symptoms.
A celiac dietitian will guide you through the steps of this diet. It’s never to be followed long-term. And following this diet without proper guidance and protocols can do more harm than good. So be sure to work with a specialized dietitian if you need to follow this diet.
And again, it is critical that you have the basic celiac safety skills and knowledge before starting this diet. Something I teach in the Celiac Crash Course if you need it, but something your celiac dietitian should be able to educate you on over the course of several sessions too.
A normal celiac diet is one that minimizes cross-contact risk and gluten exposure to <20ppm. This is generally enough to help most celiacs heal, but some things may delay healing and require a stricter intervention.
For a normal celiac diet, products with food labels are generally allowed and enjoyed as long as they are gluten-free. For a fasano diet, these products are generally off limits.
We do not start people off on a non-responsive celiac diet immediately after diagnosis because in most cases it’s not necessary. And it’s is highly restrictive, reducing the quality of life of celiacs to an all time low. And can quickly lead to eating disorders with celiac disease if not done correctly. One of the top most deadly mental health conditions.
So who is Dr. Alessio Fasano? Dr. Alessio Fasano is a world-renowned pediatric gastroenterologist, research scientist and entrepreneur. He directs the Center for Celiac Research. He specializes in the treatment of patients of all ages with gluten-related disorders.
Dr. Fasano is a celiac-specialist dedicating his work to helping the celiac disease community. Part of his work has been to research and develop the Non-Responsive Celiac Diet, which has been dubbed the Fasano diet.
Depending on the phase of the Fasano diet you’re in determines what foods are allowed. Additionally, your dietitian may make modifications to the diet as necessary. In general, all fresh foods are allowed. You might even call this diet, the celiac fresh food diet. Here’s a more complete list of Fasano diet foods to include:
A special note on dairy and the Fasano diet: Milk should be avoided for the first 4 weeks. After 4 weeks, reintroduce unflavored milk, yogurt, aged cheeses and butter. This is to help assess for lactose intolerance in celiac disease.
In general, avoid foods with a food label on the Fasano diet. This includes avoiding spices, canned foods, nuts, and more. However, this again is all subject to the work you do with your celiac dietitian.
General foods to avoid on the Fasano diet:
This list of foods to avoid is long. It might seem like you need to avoid almost the entire grocery store. This is where the term “shop the outside of the store” really applies. And not to sound like a broken record but working with a dietitian specializing in celiac can help this protocol not feel as hard.
The Non-Responsive Celiac Diet, or the Fasano Diet, is extremely restrictive. Thus, it is dangerous for those with a history of eating disorders, disordered eating, or malnutrition. Before starting this diet, make sure you are seeking the guidance of a celiac-specialized dietitian to make sure it is appropriate for you.
Because this diet is so restrictive, it can feel impossible to follow. Some tips to survive include:
Above all, remember that this diet is temporary. You do not have to eat this way for the rest of your life. You only have to eat this way for a short-while while we encourage your body to heal and figure out your tolerance.
Below is an example non-responsive celiac diet meal-plan. Please note, the below meal-plan is not to take the place of a dietitian’s guidance. This meal-plan is for educational purposes only. Do not attempt to follow this diet alone. Doing this diet wrong can cause a lot of harm.
Breakfast: Homemade Rice Porridge with Fruit.
Lunch: A garden salad dressed with olive oil, vinegar, and salt. Topped with grilled chicken breast and served with a side of brown rice and fresh fruit.
Snack: Sesame-Free Fresh Hummus with fresh vegetables.
Dinner: Slow cooker pork chops & white beans with kale (avoid ground cumin, ground coriander, bay leaves, dried ancho chile, avoid the white beans if still in phase 1).
Breakfast: Savory Rice Porridge with fresh fruit and a hard-boiled egg.
Lunch: Stuffed baked sweet potato with diced chicken, fresh salsa, cilantro, and avocado. Serve with a side salad dressed with olive oil, salt, and vinegar.
Snack: Fasano Friendly Guacamole with vegetables.
Dinner: Salmon broiled with olive oil, lemon, and fresh dill. Serve with a side of steamed brown rice and roasted vegetables.
Breakfast: Scrambled eggs, fried rice, and fresh berries.
Lunch: Avocado egg salad with a side of steamed white rice, fresh vegetables, and an orange.
Snack: Fresh fruit with homemade nut butter
Dinner: Taco bowl with ground sirloin, pinto beans (avoid if in phase 1), brown rice, cilantro, avocado, and fresh salsa. Serve with a side of sautéed zucchini & squash.
Only follow a non-responsive celiac diet if it’s prescribed to you by your healthcare team. You must do this diet correctly for safe results. Additionally, you need the help of a celiac dietitian to do it correctly.
The Non-Responsive Celiac Diet is also known as the Fasano diet. This diet involves avoiding most foods with a food label. This limits any cross-contact that may be triggering your celiac to be unresponsive.
In most cases, celiac disease does not require a Fasano diet. A generally safe celiac diet is usually enough for most celiacs. If you need help with nailing down the basics of general celiac safety, I give you the simple strategies you need to start avoiding gluten in the Celiac Crash Course.
Talk to your healthcare provider if you are still struggling with lingering symptoms. They will be able to tell you what the next steps to feeling better will be.