# The Body Underneath: Bloodwork, Healing, and the Real Goal By Gregory Wilson · Excerpt from Chapter 8 of *Celiac vs Me* In May of 2024, the number on the screen was 1021. In February of 2025, the number on the screen was 101.4. Same test. Same patient. Nine months apart. The reference range printed underneath, both times, said normal was below 20. I want to start with those two numbers because they are, in a real sense, the only feedback my body has ever given me that I could rely on. Everything else — how I felt that morning, whether my stomach was settled — turned out to be unreliable in ways I did not see coming. ## What the disease is actually doing The lining of your small intestine is covered in tiny finger-shaped projections called villi. They are how you absorb nutrients. If you have celiac disease, your immune system mistakes a fragment of the gluten protein for an enemy invader and attacks it. The collateral damage is that it also attacks the villi. The fingers get worn down to stumps. The technical name is **villous atrophy**. When I had my endoscopy in May 2024, the biopsy came back as Marsh 3B villous atrophy. My fingers were almost gone. When you stop eating gluten, the immune system stops attacking. The villi grow back, in months and years rather than days and weeks. The lining repairs itself. ## The most important sentence in the book **The goal is not to avoid symptoms. The goal is to never let my immune system damage my intestines again.** These sound like the same thing. They are not. If your goal is to avoid symptoms, you spend your celiac life trying to map every bad afternoon back to whatever you ate three hours ago. I did it for the first six months. The ledger did not converge. Celiac can damage your intestine without making you feel anything. **Silent celiac** is a real category — people go years with active villous atrophy and zero symptoms. And on the other side, plenty of celiacs feel sick from things that did not, in fact, contain gluten. The damage and the symptoms are two different things, and they don't always travel together. If you reframe the goal — from *avoid symptoms* to *don't let it damage the lining again* — a lot of confusing things get clearer. ## Bloodwork is the scoreboard If your gut is not going to tell you whether you're doing this right, what does? The bloodwork. Mostly the bloodwork. The same tTG-IgA test that diagnosed you is the test your GI will run again, periodically. If you stay strict, the number comes down over months. The number is not perfect — it lags reality by weeks. But compared to *how did I feel last Tuesday*, it is a Hubble Space Telescope. The other long-term measure is a follow-up endoscopy a year or two after diagnosis, to look at the villi directly. My own scoreboard: 1021 to 101.4 in nine months. The trajectory is correct. The next number is the one I'm waiting on. ## Don't promote "I felt fine" into permission So why be so careful, if the body isn't a reliable referee? Because the damage happens whether or not you feel it. If you tie your discipline to whether you feel sick, you will gradually relax it on the meals where you don't feel sick, which is a lot of them, which is a slow leak in the levee. If you tie your discipline to *don't let the lining get hit again*, the discipline holds whether you feel anything or not. The question every celiac eventually gets from a well-meaning friend: *do you really have to be that careful, when one bite probably won't even bother you?* The honest answer: a bite that doesn't bother me can still let the immune system pick up where it left off. The bother is not the disease. The disease is the damage. I am not optimizing for the bother. I am optimizing for the damage. --- This is an excerpt from Chapter 8, the final chapter of Celiac vs Me. The full chapter also covers two common celiac companions I was diagnosed with along the way — lymphocytic colitis (caught on the same biopsy as the celiac) and bile acid malabsorption (spotted a few months later) — and how they make symptom-reading even harder, why no NSAIDs ever again if you have lymphocytic colitis, the principle of signal not gospel applied inward to your own body's reports, and the state of celiac research as of 2026 — the therapies in trials that may, for the first time in the history of the disease, give us something to do other than avoid gluten for the rest of our lives. - [Paperback](https://a.co/d/0ci9KEzr) - [Kindle Edition](https://a.co/d/0dqv86CH) ## Related chapters - [The Day You Get the Celiac Diagnosis](https://celiacvsme.com/the-diagnosis/) - [The First Weeks of Celiac Life: Rebuilding Your Kitchen](https://celiacvsme.com/the-first-weeks/) - [Telling People About Your Celiac Diagnosis](https://celiacvsme.com/telling-people/) - [Reading Gluten-Free Labels: Certifications, Ingredients, and Hidden Gluten](https://celiacvsme.com/the-aisles/) - [Eating Out with Celiac: Trust Signals, Dignity Signals, and the Bridgeport Ribeye](https://celiacvsme.com/the-table/) - [Celiac Travel: Road Trips, Hotels, and the Parking Lot Moment](https://celiacvsme.com/the-road/) - [The Holiday Calendar with Celiac: Thanksgiving, Birthdays, and the People Who Love You](https://celiacvsme.com/the-calendar/)