How rigorous do i have to be in avoiding gluten if you suffer from celiac disease?

Very careful: If you truly have celiac disease then very small amounts of gluten will trigger increase in zonulin in the gut which causes increased intestinal permeability and inflammation. Studies show that even very small amounts will trigger this inflammation and that it takes days for the response to calm down. First make sure you really have celiac, but if you do, you must be very careful to avoid gluten.