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  • Wendy Cohan, RN
    Wendy Cohan, RN

    When Mistakes Happen, Focus on Comfort (How Celiacs can More Quickly Recover from Gluten Exposure)

    Celiac.com 09/25/2008 - Even after identifying yourself as having a wheat or gluten allergy and asking for a specially prepared meal, it is a common mistake to have a server deliver soup with crackers, or the entree with a side of Texas toast.   I get frustrated just thinking about the number of times my salad has arrived with croutons.  However, getting upset, or pointedly reminding the server can ruin the ambiance of the meal, as well as leave a bad impression with your dinner companions. It is helpful to remember that you are in the very small minority of their customers, and simply consider it an honest mistake.  Do not remove the croutons, crackers, cheese, etc. and eat your contaminated food—SEND IT BACK TO THE KITCHEN—politely, please.  State that you cannot eat what they have brought you, and repeat that you are allergic to the offending food.  Use the opportunity to gently remind your server and educate them about gluten.  Hopefully the next time they will be more conscientious.

    If you are wheat or gluten intolerant, and have the genetic component that leads to celiac disease, there is no going back to gluten.  As your body heals, you may think that you will be able to cheat once in a while, and that your sensitivity to gluten will decrease once you are not getting "too much".  In fact, the opposite seems to be true.  Once the body begins to get rid of its toxic load, heal damaged tissues, and regain health, it becomes more sensitive to gluten.  I see this over and over again in the clients I counsel, and in my cooking class students.  You will know right away if you cheat, or if you are accidentally "glutened".  Your body, fortunately or unfortunately, will tell you.  It is important to learn techniques to sooth your symptoms as much as possible until recovery takes place.

    Symptoms of gluten exposure in a gluten-intolerant person can vary widely, but some commonly reported ones are abdominal discomfort, bloating, pain, swelling (sometimes extreme) and cramping, followed by diarrhea, or loose stools.  For those with Dermatitis Herpetiformis (DH), even very minor exposure can provoke itching and a return of a healed or nearly healed rash.  Others report headaches, or experience a sudden decrease in alertness and clarity of thought.

    Short-term treatment strategies for gluten exposure include taking an over-the-counter anti-histamine (check with your pharmacist for gluten ingredients), drinking nettle leaf tea (a natural anti-histamine), and using a warm castor oil pack over your upper or lower abdomen, wherever the pain and cramping are centered.

    Longer-term strategies include rebuilding your intestinal health through following an anti-inflammatory diet, taking supplements like L-Glutamine, coconut oil, fat-soluble vitamins A, E, D, and K, Calcium, Magnesium, B-Vitamins, Essential Fatty Acids (EFA's), and probiotics.  Dr. Thomas O'Bryan, a nationally recognized speaker on celiac disease and gluten sensitivity, also recommends Carnitine, an amino acid, in the treatment of celiac/gluten intolerance.  L-Carnitine helps in the absorption and transport of essential fatty acids into cells, and also helps to protect nerve membranes from free-radical damage.

    You may have good results with the tummy rescue smoothie recipe below, which I developed in response to a "gluten emergency" of my own.  The healing properties of each ingredient are also listed.  Puree in blender until smooth, and slightly thickened.  It is most soothing when consumed while still warm from the hot tea

    Tummy Rescue Smoothie:

    • 1 cup hot freshly brewed nettle leaf tea (anti-histamine, anti-spasmodic)
    • ¼ cup Santa-Cruz pear juice (flavoring/sweetener - pears are the least allergenic of fruits)
    • ¼ - ½ teaspoon whole fennel seed (reduces gas & bloating)
    • 2 Tablespoons slippery elm powder (healing & soothing to mucous membranes and the gut)
    • 1 Tablespoon flax seed oil (soothing, anti-inflammatory)
    • ¼ - ½ cup rice milk (hypoallergenic, use to thin to desired consistency)

    This smoothie is best consumed in small sips over an hour or so.  Magnesium also helps with pain and relaxes muscle spasms, so taking a little extra magnesium may be of benefit. For severe symptoms, drink the smoothie while reclining in bed, with a warm castor oil pack over the abdomen, covered by a heating pad set on low.  Do not leave the pack in place for more than an hour.

    There is also an enzyme coming on the market that may help reduce some symptoms of gluten exposure, although this product is in no way meant to replace the gluten-free diet.  Use it only for emergencies.


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    Hello Wendy, yes, long term health-boosting strategies should be at the forefront. Indeed, coconut oil is an anti-inflammatory dietary fat and is renowned for enhancing the immune system. 80% of our immune system is located in the intestinal tract.

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    Lots of Celiacs I know (including me) are violently ill starting about an hour after consuming even small amounts gluten. Sorry if it is TMI, but I have projectile vomiting for 3-4 hours accompanied by severe cramping in my stomach (not intestines) .... and then feel like I have the worst hangover the next day.

     

    Frankly diarrhea, or loose stools would be a welcome change...easily fixed with Imodium.

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    Thank you for the Tummy Rescue Smoothie! I've often wondered if there is a little help/relief when accidental gluten exposure occurs. Thank you! Thank you!

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    Thanks for the smoothie idea, it definitely sounds like something worth trying!

     

    And just a note to Jen: It's a bit presumptuous of you to assume that those of us who suffer from severe intestinal pain and D as a result of being glutened somehow have it easier. It is literally the WORST pain I have ever felt, and it is most definitely not 'easily fixed with Imodium.' Just wanted to clear that up.

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    Hello, I sympathize with you gluten symptom sufferers but do be thankful (though it may be difficult for you) that you do get a reaction to gluten to alert you. My daughter has no external symptoms though her biopsy showed her gut to be in a very bad state... there is literally no way of knowing when a mistake has been made and therefore no way of avoiding food with hidden gluten ...

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    The problem is not as simple as obvious croutons in a salad. The problem is when I discover that I ate hidden gluten after the server, manager, or cook has assured me multiple times that my food is gluten-free. I do not get tummy aches that can be cured with a tummy remedy. I get some of the severe symptoms mentioned in the article. My gut is severely damaged, possibly permanently, and the symptoms last for days if not longer. Restaurant owners and managers have to take responsibility for their actions, and this article does not help in that regard.

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    I have found that drinking two or three tall glasses of water right after being glutened helps some too! Then my old friend Mylanta. I'll try that brewed nettle leaf tea should there be a next time (let's hope not!).

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    Hi Wendy! I'm glad to see this here... I've also found that the nettle works well for bladder disturbances, often related to gluten exposure.

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    Guest Mary Lou Archambault

    Posted

    I have to say that intestinal pain and diarrhea are not to me considered easier. If this happens to me at a restaurant possibly caused by cross-contamination, the reaction is usually immediate and hopefully there is a restroom handy and empty. When I go for walks even that sometimes brings it on so I therefore have become dependent on Imodium. To me this is not a good thing.

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  • About Me

    An RN for 14 years, I have been following a strict gluten-free diet for six years of improving health! Now I help others as a Celiac Disease/Gluten Intolerance Educator. I work one on one with people on meal planning, shopping, cooking and dining out gluten-free. I will also work with children who have behavioral issues related to gluten or other food sensitivities.  My book "Gluten-Free PORTLAND" is a comprehensive resource guide to the gluten-free diet and is available on my website www.glutenfreechoice.com. My other websites are: www.WellBladder.com and www.neighborhoodnurse.net.

  • Related Articles

    Kristen Campbell
    Celiac.com 01/03/2009 - Recently on a gluten-free forum, I found a post asking for advice on what to do after a woman had accidentally consumed a large amount of gluten.  After unknowingly eating from her daughter’s takeout box, the woman had realized her mistake and was simply devastated to have broken her diet and subjected herself to the old, too-familiar symptoms that were on their way.
    It was interesting reading the various responses, which resulted in a debate over whether or not to induce vomiting, drink pineapple juice, take enzymes or engage in a certain illegal activity.  In all the debate, the woman eventually disappeared off the forum, which probably meant that she took some action or another, though I never heard the final result.
    This whole subject inspired some research on my part.  I first consulted my extensive gluten-free library, which led me to one solitary, repetitive answer: do not eat gluten.  In a world where doctors and authors alike are so concerned that their advice on the subject will lead people with gluten sensitivities to forgo a gluten-free diet in favor of a “band aid” of sorts, that finding a documented recommendation is near impossible.
    These experts are right to reinforce the importance of maintaining a gluten free lifestyle, and the fact that there is no “cure” for gluten intolerance and celiac disease (other than complete avoidance of gluten from wheat, barley and rye).  But mistakes do happen, and from time to time people do get "glutened,” and when they do, which action is best?
    No matter what the size is of the offending dose of gluten, all experts agree, inducing vomiting is too dangerous and disruptive to the body to be considered.  But there is one option that at least two noted experts in field of celiac research agree upon: enzymes.
    When I contacted the renowned Dr. Kenneth Fine of EnteroLab, and asked him if perhaps a dose of enzymes that are designed to break down gluten might help, he had this to say: “The good news is that everyone will survive and recover from the gluten exposure.  The enzymes you mention might help, but not completely, unless they consumed at the same time (as the gluten) for best results.”  And like all good doctors, he did go on to warn, “Avoidance is still the best policy.”
    Shari Lieberman, PhD, CNS, FACN and author of The Gluten Connection very humbly admits that “gluten slips happen.”  She also devotes a couple of pages in her book to research conducted using digestive enzymes to help manage those occasions when gluten does make its way into your diet, citing a research example in which “The study demonstrates that enzyme therapy can substantially minimize symptoms in people with celiac disease who are exposed to gluten.” 
    The enzyme used in this study does not seem to be currently available, but other gluten enzymes are at your local health food store.  I contacted one company in regard to their product, which according to them helps to reduce inflammation caused by the introduction of gluten in an individual with celiac disease or gluten intolerance.  According to them their enzymes will not prevent all damage, but may reduce some inflammation and help the body to better digest the protein.
    Ultimately, gluten sensitive individuals should recover from one accidental “gluten slip” here and there, and keeping some digestive enzymes handy to help cope with such an accident is not a bad idea.  But do keep in mind that repeated offenses, even the most minute, will damage your body and prevent it from healing.  Enzymes help treat the symptoms, but only complete avoidance of gluten can treat the disease.


    Jefferson Adams
    Celiac.com 11/02/2011 - With the rise in celiac disease diagnoses, increasing awareness of gluten-free issues, and an explosion of gluten-free related products, it is no surprise that supplements claiming to break down gluten would find their way onto the market.
    In fact, a number of supplements currently on the market claim to do just that: to break down gluten after it has been consumed.
    Are these claims accurate? Are these products in any way helpful for people following a gluten-free diet? Finally, do these supplements offer a safe alternative to a gluten-free diet for people who suffer from celiac disease and/or gluten-sensitivity?
    For example, GlutenEase, made by Enzymedica Inc., contains a blend of enzymes, including amylase, glucoamylase and dipeptidyl peptidase-4 (DDP-IV) — that are intended to "digest both gluten and casein, a protein found in milk," according to the company.
    The website for GlutenEase says that the supplement can "support" people who have trouble digesting gluten. However, and most importantly, the site says that GlutenEase is "not formulated" for people with celiac disease.
    Gluten Defense, made by Enzymatic Therapy Inc., contains a similar blend of enzymes that includes DDP-IV, lactase and amylase.
    The site for Gluten Defense says the product is "specifically formulated to defend against hidden gluten" that can cause gas, bloating and indigestion.
    But what does that mean? Does that mean that taking the supplement might offer people with celiac disease some extra protection against accidental gluten contamination? That seems doubtful, and unproven from a scientific standpoint.
    Unlike GlutenEase, Gluten Defense offers no specific disclaimer for people with celiac disease. There is also no claim that the product is safe, or in any way formulated for people with celiac disease.
    Dave Barton, whose title is "Director of Education" for Enzymedica, claims that many people who say they have celiac disease see improvement when taking product, and that some even manage to begin eating wheat again.
    However, Barton is quick to warn consumers that there's "no way to guarantee that it would break down 100% of gluten proteins."
    But that's the problem isn't it? It would need to break down nearly all of the gluten proteins in order for those proteins to not cause damage to the person with celiac disease.
    The fact is that these enzyme supplements may break down a few molecules of gluten protein, but no supplement exists that will make it safe for people with celiac disease to eat gluten again.
    According to Dr. Stefano Guandalini, professor of pediatrics and director of the University of Chicago Celiac Disease Center, "[t]he amount of gluten that these would be able to digest is ridiculously low. For people with celiac disease, these are something to completely avoid."
    Dr. Peter Green, director of the Columbia University's Celiac Disease Center, agrees that current enzyme supplements would digest only a small percentage of gluten molecules.
    However, Green adds, the basic concept is sound. Pharmaceutical companies are spending hundreds of millions of dollars to create an enzyme-based drug that would permit people with celiac disease to consume gluten. However, Green points out, the companies wouldn't be spending that money if a successful over-the-counter alternative already existed.
    Bottom line: Enzymes currently claiming to help break down gluten protein will not permit people with celiac disease to safely consume products made with wheat, rye or barley. Any benefit these enzymes may provide for people with celiac disease is strictly theoretical, and likely minimal at best.
    A completely gluten-free diet is currently the only proven treatment for celiac disease. Talk with your doctor before making any changes to your gluten-free diet for celiac disease treatment.
    Source:

    http://www.latimes.com/health/la-he-skeptic-gluten-supplements-20110926,0,2998711.story

    Tina Turbin
    Gluten-Digesting Enzymes
    Celiac.com 01/23/2012 - After their diagnosis, celiac patients are put on the gluten-free diet, which is the only treatment option currently available. The diet requires total elimination of gluten, a protein found in wheat, barley, and rye, which when ingested causes an autoimmune reaction in celiacs which results in damage to the absorptive finger-like projections that line the small intestine, which are called villi. As diligent as celiacs can be, avoiding gluten can be a challenge, and slip-ups can happen, especially when eating out. In my research, I've come across gluten-digesting enzymes as a new medical treatment option for later down the line and have shared this good news with the gluten-free community. However, gluten-digesting enzymes are already available over the counter to help celiacs and gluten-sensitive people with managing their gluten-free diet. Dr. Nan Kathryn Fuchs, who helped to formulate the Advanced Bionutritionals product, Gluten Sensitivity Formula, shares some information regarding these enzymes and clears up a couple of misconceptions regarding their use.

    Furthermore, not all enzyme formulas containing DPP-IV are the same in terms of strength. Dr. Fuchs had her supplement creators formulate a gluten-digesting enzyme that was stronger than the other ones available on the market. The result was Gluten Sensitivity Formula. In her pamphlet, "How to Tell If You're Gluten Sensitive.And What to Do About It If You Are," Dr. Fuchs offers advice on how to take the supplement.
    Dr. Fuchs emphasizes that Gluten Sensitivity Formula isn't intended to replace a gluten-free diet; it is, however, designed to reduce or get rid of a reaction to "small amounts" of what would presumably be unintentionally ingested gluten, such as one may encounter at a restaurant or a dinner party due to cross-contamination. She also recommends taking one or two capsules of the formula "as insurance" before eating meals that might possibly be contaminated with gluten.
    Dr. Fuchs also clears up a myth regarding hydrocholoric acid (HCl), which has been believed to counteract digestive enzymes; this misconception has led to the incorrect advice that one shouldn't take hydrochloric acid and enzymes together. Hydrochloric acid is taken, according to Dr. Fuchs, in order to help with digesting proteins and minerals, for example calcium and iron. She says the supplement is more common among people over the age of 50. In fact, enzymes can only cancel out the benefits of hydrochloric if they alter the pH of the stomach by neutralizing its acids. Dr. Fuchs says that while animal-based enzymes can accomplish this, they are usually formulated with a protective coating or in a form that will prevent this from occurring. What's more, many enzymes, especially gluten-digesting ones, are made from plants. "So you can take them with HCl," Dr. Fuchs says.
    According to Dr. Fuchs, taking gluten-digesting enzymes "can make the difference between being successful on a gluten-free diet and failing." When used correctly, it can help alleviate the symptoms of a reaction caused by accidental gluten ingestion or prevent the reaction from occurring. As a celiac myself, I can say that inadvertent gluten ingestion is still a challenge I face on the gluten-free diet, even though I've been on the diet for years. Dr. Fuch's Gluten Sensitivity Formula is thus a welcome product that will make the lives of the gluten-free community a lot easier.
    Resources:
    Fuchs, Nan Kathryn, PhD. "How to Tell If You're Gluten Sensitive.And What to Do About It If You Are." Advanced Bionutritionals, 2010. "Digest This: Enzymes Can Help Your Food Intolerance." Living Without: August/September 2010. Food Reactions: Food Intolerance http://www.foodreactions.org/intolerance/index.html

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