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Celiac.com 08/27/2024 - With increasing awareness and diagnosis of celiac disease and non-celiac gluten sensitivity, strict adherence to a gluten-free diet is more critical than ever to prevent symptoms and long-term complications. However, despite best efforts, accidental gluten ingestion can still occur, causing significant distress for those affected. In fact, data shows that most celiacs are regularly exposed to gluten. Moreover, data also shows that most exposure to gluten is silent and ongoing. Fortunately, there are steps you can take to alleviate symptoms and support recovery. This article combines practical home remedies and strategies shared by our community members, along with insights from recent research. Understanding the Impact of Gluten Exposure Accidental gluten ingestion can lead to a range of symptoms for individuals with celiac disease, including upset stomach, inflammation, diarrhea, bloating, and skin rash. Recognizing these symptoms early is essential for implementing effective management strategies. Steps to Alleviate Symptoms Taking one or more of these ten-plus steps after gluten exposure can help minimize its impact. Hydration and Electrolyte Balance Stay hydrated and consider gluten-free electrolyte-replenishing drinks to maintain balance, especially if diarrhea is severe. Rest and Heat Application Rest and apply heat to alleviate stomach pain and cramping. Use a heating pad or hot water bottle for added comfort. Return to a Strict Gluten-Free Diet & Avoid Additional Irritants Recommit to a strict gluten-free diet immediately, avoiding processed or spicy foods that may further irritate the digestive system. Fasting: A Potential Immune System Reset Some studies suggest that intermittent fasting may help reset the immune system and reduce inflammation, which could be beneficial for those suffering from an adverse gluten reaction. However, always consult with a healthcare professional before starting any fasting regimen. Digestive Enzymes for Bloating Relief Digestive enzyme supplements, such as GliadinX (a site sponsor here) can provide relief from bloating by assisting in the digestion of gluten, although this enzyme is best taken before accidental gluten ingestion, for example, before you eat a gluten-free meal in a restaurant. Herbal Remedies and Medications Herbal remedies like green tea, peppermint tea, and echinacea are often reported to offer soothing effects for digestive discomfort. Additionally, antihistamines such as Benadryl, Claritin, or Zyrtec may provide relief for some individuals. Marshmallow root is known for its potential to soothe stomach and gas pain. However, before using herbal remedies, especially if you are on medication, consult your healthcare provider to avoid potential interactions. Probiotics for Gut Health Incorporating probiotics into a general gut maintenance program can be beneficial both before and after accidental gluten exposure. Recent research suggests that specific strains of probiotics, such as Lactobacillus reuteri and Bifidobacterium longum, may be especially beneficial for maintaining gut health in individuals with celiac disease. Nutrient-Rich Broth for Gut Healing Nutrient-rich broths, such as bone broth, which is rich in collagen and amino acids, can support gut healing and provide essential nutrition. Incorporating these broths into your diet can be particularly beneficial in promoting recovery after gluten exposure. Long-Term Strategies for Intestinal Health Rebuilding intestinal health is crucial for managing celiac disease. Implementing an anti-inflammatory diet, rich in omega-3 fatty acids, antioxidants, and low-FODMAP foods, can aid in reducing inflammation and promoting gut healing. Supplements such as L-Glutamine, tryptophan, coconut oil, fat-soluble vitamins (A, E, D, and K), calcium, magnesium, B-vitamins, essential fatty acids, and probiotics are also beneficial in the healing process. Personalized Approach and Seeking Medical Advice A personalized approach to managing accidental gluten ingestion is important. It is advisable to seek medical advice and consult healthcare professionals, such as dietitians, to develop tailored strategies and receive personalized guidance based on individual needs. Coping with Emotional Challenges Managing accidental gluten ingestion involves addressing not only the physical symptoms, but also the emotional challenges that may arise. Online support groups, teletherapy, and mindfulness practices, such as meditation and yoga, are valuable tools for navigating the emotional aspects of living with celiac disease. Prioritizing self-care and seeking support from loved ones or professional counselors can also help in managing the stress associated with gluten exposure. Tummy Rescue Smoothie Recipe This smoothie is designed to soothe the digestive system after accidental gluten exposure. 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) Directions: Purée in blender until smooth, and slightly thickened. It is most soothing when consumed while still warm from the hot tea. 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. Conclusion Accidental gluten ingestion can be distressing for individuals with celiac disease. While there is no clinically accepted treatment for gluten ingestion, practical steps can help manage symptoms and support recovery. By implementing strategies such as immediate symptom relief, adherence to a strict gluten-free diet, digestive enzymes, herbal remedies, probiotics, nutrient-rich broth, and long-term gut healing, individuals with celiac disease can minimize the impact of accidental gluten exposure and promote their overall well-being. Staying informed about new research and potential treatment options is essential as our understanding of celiac disease continues to evolve. By following these guidelines and seeking appropriate medical advice, individuals can navigate the challenges of accidental gluten exposure with greater ease and maintain their health. If you have any thoughts or insights on how best to treat accidental gluten ingestion for people with celiac disease or gluten intolerance, please share them in our comments section below.

Celiac.com 04/13/2023 - Contrary to popular medical wisdom, a recent study suggests that some celiac disease patients who occasionally ingest gluten may not experience significant clinical symptoms or small bowel damage. A gluten-free diet is currently the only medically accepted treatment for celiac disease, but adherence can be challenging, and many patients report occasional voluntary transgressions. Eating a gluten-free diet lowers the quality of life for most celiac disease patients, many of whom frequently ask if it's okay to occasionally ingest gluten-containing food. To get a better idea of the issue, a research team evaluated celiac patients reporting voluntary and occasional transgressions to their gluten-free diet. The Research Team The team included Luca Elli, Karla Bascuñán, Lorenzo di Lernia, Maria Teresa Bardella, Luisa Doneda, Laura Soldati, Stefania Orlando, Francesca Ferretti, Vincenza Lombardo, Giulio Barigelletti, Alice Scricciolo, Sabrina Fabiano, Maurizio Vecchi & Leda Roncoroni. They are associated with the Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; the Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan; the Department of Health Sciences, University of Milan, Milan, Italy; and the Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy. Celiacs Voluntarily Eat Gluten- The Study Researchers prospectively enrolled 109 celiac patients who reported occasional and voluntary gluten ingestion and a group of patients on strict gluten-free diet as controls. The study involved clinical examination, blood tests, duodenal biopsy, capsule enteroscopy, and a validated food-frequency questionnaire to assess gluten intake. The results showed that 57% of noncompliant patients did not present any histological alteration, and 70% did not present any alteration at capsule enteroscopy. Furthermore, 75% of patients reported no gastrointestinal symptoms after gluten ingestion. The findings suggest that celiacs can achieve a degree of tolerance towards gluten consumption can be reached, and occasional gluten intake may not necessarily lead to significant clinical symptoms or small bowel damage. However, the researchers highlight that strict gluten-free diet adherence is still the best course of action to prevent long-term complications, and more research is needed to understand the mechanisms behind tolerance towards gluten ingestion in celiac patients. Clearly this result runs counter to popular wisdom, and even to some science. The conclusion will likely cause a stir in the celiac and the medical and scientific communities. For people with celiac disease, it's crucial to have a clear picture of the proper parameters of treatment. With so much at stake, for both doctors and, especially patients, it's clear that more research is needed to get a truly clear picture of the effects of minor gluten-consumption on people with celiac disease. Read more at BMC Medicine

Celiac.com 02/24/2020 - Low FODMAP gluten and sham challenges show that nausea and vomiting after a meal are key signs of acute gluten ingestion, and reflect an active immune reaction in celiac patients who are otherwise following a gluten-free diet. This became clear recently after a team of researchers set out to establish acute gluten-specific symptoms linked to immune activation in celiac disease. The research team included A. James M. Daveson; Jason A. Tye-Din; Gautam Goel; Kaela E. Goldstein; Holly L. Hand; Kristin M. Neff; Leslie J. Williams; Kenneth E. Truitt; and Robert P. Anderson. They are variously affiliated with the Faculty of Medicine, University of Queensland, Brisbane in Queensland, Australia; the Immunology Division, The Walter and Eliza Hall Institute, Parkville, Vic., Australia; the Department of Medical Biology, University of Melbourne, Parkville, Vic., Australia; the Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia; the Centre for Food & Allergy Research, Murdoch Children's Research Institute, Parkville, Vic., Australia; the ImmusanT, Inc., Cambridge, MA, USA. For some people with celiac disease, FODMAPs in gluten-containing foods can trigger anxiety about a potentially harmful 'nocebo' effect, which can lead to acute symptoms after a gluten challenge. The team enrolled 36 celiac disease patients on a gluten-free diet who received placebo in the RESET CeD trial. The team put each of the study subjects through a course of double-blind, bolus vital wheat gluten and sham challenges that were both low in FODMAPs with two weeks between courses. The team measured daily Celiac Disease Patient Reported Outcome (CeD PRO) symptom scores on a scale of 0–10, adverse events and serum interleukin-2, at both baseline and 4 hours). The highest increase was seen in average CeD PRO score for nausea, with sham challenge score of 0 vs gluten challenge score of 5.5. Apart from tiredness and headache, changes in other symptoms were small or absent. Only nausea increased significantly in occurrence with gluten. Without nausea, only tiredness and flatulence were common after gluten. Nausea and vomiting were the only adverse events more common with gluten than sham. Nearly all of the patients fed gluten showed raised levels of Interleukin-2, which corresponded to the severity of the nausea and the presence of vomiting. These low FODMAP gluten and sham challenges show that nausea and vomiting after a meal are key signs of acute gluten ingestion, and reflect an active immune reaction in celiac patients who are otherwise following a gluten-free diet. However, IBS-like symptoms without nausea are unlikely to indicate recent gluten exposure. Lastly, these findings indicate that FODMAPs may be an issue for many people with celiac disease. Many celiacs on a gluten-free diet, who think that they are having issues with gluten, might actually be reacting to FODMAPs, and may benefit from a FODMAP elimination diet. Read more in Alimentary Pharmacology & Therapeutics; 2020;51(2):244-252.

Celiac.com 06/11/2019 - A potentially major breakthrough in celiac disease treatment owes at least part of its success to a simple drive-in hamburger from Seattle's beloved and legendary Dick's Drive-In. If you have celiac disease, and haven't heard of PvP Biologics, you likely will. PvP originated in 2011 as an award winning student biology project at the University of Washington Institute for Protein Design, a lab that has created several successful startups. PvP's enzyme-driven product, KumaMax, is designed to break down gliadin, the part of gluten that triggers an autoimmune reaction in people with celiac disease and gluten sensitivity. Like most similar enzyme therapies, KumaMax is not designed to be a cure for celiac disease, but to help prevent adverse reactions from accidental gluten contamination. KumaMax is designed to break down gluten in the stomach, and to help prevent a gluten reaction. Celiac.com covered part of the PvP story in 2017 in our article "Takeda Taps PvP Biologics to Develop Celiac Disease Therapy." That story covered PvP's deal with Japanese drug giant Takeda, which gave the startup $35 million to complete a phase 1 clinical trial, at which point Takeda has the option to purchase the startup. Apparently, when it was time for PvP Biologics to test KumaMax, the research team needed to make sure their enzyme would work in the stomach, and work only against gluten proteins, not against meat or dairy proteins. The team wanted a meal that would allow them to test the gluten-neutralizing properties of their drug in conditions that mimicked the human stomach. For that meal, the team turned to Dick's Drive-In, purveyors of fine burgers. “We got a hamburger and a vanilla milkshake from the Dick’s Drive-In in Wallingford,” said Ingrid Pultz, co-founder and chief scientific officer of PvP. “If we were going to get a hamburger, it might as well be from Dick’s. It’s a Seattle institution.” Team members labeled the food as lab equipment. They then blended and acidified the mixture, to mimic the stomach environment, and added the KumaMax enzyme. The enzyme worked well enough to become PvP's lead molecule, and to earn the support of Takeda. So there you have it. KumaMax, the breakthrough gluten dissolving enzyme that may offer celiacs some protection against accidental gluten ingestion has its roots in a simple hamburger and milkshake from Seattle institution, Dick's Drive-In. Read more at Geekwire.com

Celiac.com 05/13/2020 - With the collapse of the Nexvax 2 'vaccine" for celiac disease, which was really more like allergy therapy, but which has been abandoned after poor results in clinical trials, the hope for an outright cure, or "silver bullet" treatment for celiac disease seems a far-off possibility. That means that people with celiac disease are unlikely to gain immunity to gluten, and start freely eating gluten any time soon. Unlike a vaccine, which would theoretically make it possible for people with celiac disease to eat gluten, enzymes do not change the underlying celiac disease at all. People with celiac disease still have celiac disease, and need to follow a gluten-free diet to maintain optimal health. However, gluten-busting enzymes seem to hold the most promise for helping people with celiac disease to avoid accidental gluten ingestion, and to promote better overall health. New revelations from real world studies that show that even the most diligent celiacs are often exposed to gluten offer strong arguments in favor of using gluten targeting enzymes. Arguments Against Enzymes Arguments against enzymes include the idea that such enzymes might lead celiacs to deliberately consume gluten. There are good reasons why this viewpoint doesn't stand up too well to scrutiny. Anyone who would risk their health to deliberately consume gluten likely doesn't need an enzyme as an excuse to do so. Any extra protection against gluten contamination would seem to be a good idea for most celiacs, even those who willingly cheat on their diets, which some surveys put at over 20% of celiacs, especially in light of data that shows that many gluten-free people with celiac disease are accidentally, and unknowingly exposed to low levels of gluten that can trigger symptoms and cause gut damage. Other studies show that adverse gluten reactions are common in people with celiac disease on a gluten-free diet. Eating away from home, especially at restaurants and other homes, carries the greatest risk for gluten exposure. Arguments in Favor of Enzymes Arguments in favor of enzymes often include the idea that enzymes are unlikely to harm patients, and could provide an extra measure of protection against minor accidental gluten ingestion by people with celiac disease. Especially in sensitive people, the argument goes, enzymes could offer some protection. That argument has been borne out by the studies showing that most gluten-free celiacs are regularly exposed to gluten in their diets. There are currently numerous enzymes on the market that claim to break down gluten to one degree or another. Most of these enzymes target gluten in general, but one, AN-PEP, has been shown in several studies to break down gluten in the stomach before it gets to the intestine. This could be a crucial development in celiac disease treatment and management. Enzymes that Claim to Break Down Gluten AN-PEP AN-PEP, derived from the from aspergillus niger fungus, AN-PEP is one of the most promising enzymes. It has been clinically proven to break down gluten in the gut. There are several brands of aspergillum niger, including Gliadin-X. Kiwifruit Recent research shows that the kiwifruit produces enzymes that are great at breaking down gluten proteins, and could be effective supplements. Papaya The product, called GluteGuard, is based on a papaya fruit enzyme called caricain. This papaya enzyme is shown to be helpful for celiac patients. A 2015 study showed adding caricain to bread dough reduced gluten toxicity to gluten by 90% for celiac patients. Carnivorous Plant Enzymes Remember all those cool plants, like Venus Flytraps and Pitcher Plants, that eat bugs? Enzymes from carnivorous plants are excellent at breaking down the proteins that make up the plant's diet. Studies show that these enzymes are also great at breaking down gluten proteins. Latiglutinase Celiac patients appear to show symptomatic and QOL benefit from using latiglutenase with meals. Enzymes from Oral Bacteria A recent study of oral bacteria concludes that gluten-degrading Rothia and food-grade Bacillus subtilisins are the "preferred therapy of choice for celiac disease," and that their exceptional enzymatic activity, along with their connection to natural human microbial colonizers, make them "worthy of further exploration for clinical applications in celiac disease and potentially other gluten-intolerance disorders." Few Oral Enzymes Break Down Gluten in the Stomach Oral enzymes that break down gluten in the gut offer the best hope for most celiac patients in the near term. One enzyme in particular, AN-PEP, which is derived from aspergillum niger, has been clinically shown to break down gluten in the stomach, before it reaches the intestine. Breaking down gluten proteins before they reach the intestine, and provoke an immune reaction in celiacs, is key to any oral enzyme. As such, AN-PEP seems to hold tremendous promise. Gluten-Busting Enzymes Could Change Food Manufacturing Researchers at Clemson University are working to produce active enzymes that can be added to products to make them gluten-free, in much the same way that lactase enzymes are used to make lactose-free milk. Obviously many hurdles need to be cleared, and much testing and refinement must happen, but, in theory, such products would be safe for people with celiac disease. A growing body of evidence shows that enzymes may have a beneficial role to play in helping people with celiac disease to minimize potential damage from accidental gluten ingestion, which happens more frequently than previously thought. The key will be finding ways to deploy these enzymes that are proven to provide protection for people with celiac disease looking to follow a gluten-free diet, including oral enzymes that break down gluten in the gut, and possibly even in products that contain wheat, rye, or barley. Stay tuned for more developments on the role of enzymes in celiac disease treatment and management.

Celiac.com 01/07/2020 - Everyone with celiac disease needs to follow a gluten-free diet. However, celiac patients on a gluten-free diet often suffer from villous atrophy, which might point to regular accidental gluten ingestion. A group of international researchers called the Doggie Bag Study group, has found that gluten ingestion is common even among those who make a concerted effort to avoid gluten. The study group included Jocelyn A. Silvester, Isabel Comino. Ciarán P. Kelly, Carolina Sousa, and Donald R. Duerksen. The group's analysis found that antibody tests on celiac patients who report good or excellent gluten-free dietary practices show that most patients had ingested measurable amounts of gluten in the 10-days before biopsy. These findings indicate that most people with celiac disease are not as gluten-free as they might think, and would likely benefit from treatments other than the simple gluten-free diet, according to Jocelyn A. Silvester, MD, PhD, a pediatrician at Boston Children's Hospital and Harvard Medical School, Massachusetts, and colleagues. Silvester and her colleagues write that their findings indicate that a completely "gluten-free diet may be more aspirational than achievable, even by highly committed and knowledgeable individuals." In their study, which appears in Gastroenterology, the researchers report on 12 female and 6 male asymptomatic celiac patients who had not intentionally consumed gluten. All patients reported diligently following a gluten-free diet and avoiding gluten. Patients were recruited from the Manitoba Celiac Disease Inception Cohort study for the purpose of assessing potential gluten exposure in patients who were supposedly gluten-free. More than three out of four participants self-reported accidental gluten exposure on the Gluten-Free Eating Assessment. For 7 days, study participants allowed testing on a representative 25% portion of food they ate, including sauces, dressings, and flavored drinks, but excluding naturally gluten-free whole foods, such as fruits, vegetables, and wine. Using food testing and gluten-related antibody tests to detect gluten in both the food samples, and in stool and urine samples, of adults with celiac disease who claimed to strictly follow a gluten-free diet, the investigators found substantial evidence that these "gluten-free" diets still included gluten in various amounts. In food testing samples from nine participants, 40% contained detectable gluten over 20 ppm, while 20% contained contained detectable gluten over 200 ppm. In excretory assays, gluten immunogenic peptides were detectable in 30 of 519 (6%) samples from eight participants and in 8 of 75 (11%) stool samples from five participants. Positive samples were distributed throughout the day. Read more at Sciencedirect.com

Celiac.com 08/07/2018 - A new drug designed to reduce symptoms of accidental gluten ingestion in celiac disease sufferers has yielded some encouraging data. The drug in question is a monoclonal antibody designed to reduce adverse reactions in celiacs who are accidentally exposed to gluten. The results, presented at Digestive Disease Week, held in Washington DC from 2–5 June 2018, suggest that monoclonal antibodies could provide protection for people with celiac disease. Celiac patients on a gluten-free diet who randomly received six injections of a monoclonal antibody, called AMG 714, over a ten-week period, enjoyed a substantial reduction in intestinal inflammation. Over a ten week study period, celiac patients on a gluten-free diet received six randomly assigned injections of either a placebo, or of AMG 714 at a dose of either 150mg or 300mg. Patients then underwent a dietary gluten challenge from week through until week twelve. As tested, the drug did not reduce damage to intestinal villi for either treatment group, which was the trial’s primary goal, but it did significantly reduce celiac-related inflammation and symptoms in response to gluten consumption. Patients receiving the highest dose of AMG 714 had no clinically active disease at week twelve of the study, and also had a significant improvement in self-reported outcomes, compared with the placebo group. No matter how diligently people with celiac disease follow a gluten-free diet, they can still suffer accidental gluten exposure ingestion. Treatments like AMG 714 could become important adjunct to gluten-free diet in for people with celiac disease, including non-responsive celiac disease. Read more in Pharmaceutical-journal.com

Celiac.com 12/14/2017 - Can enzyme supplements help people with gluten sensitivity, including those with celiac disease? An Australian company is touting the results of a recent randomized, double blind study that supports enzyme supplements might be helpful for celiac patients in certain circumstances. The enzyme supplement was designed for people with celiac disease to use when facing likely or possible exposure to gluten, such as when traveling or eating food prepared outside their direct control. The company is careful to state that "enzyme supplementation won't cure celiac disease, and sufferers still need to avoid gluten." But the evidence from the two most recent studies does suggest that the product does help digest dietary gluten and could make life much easier for many people with celiac disease. The product, called GluteGuard, is based on a papaya fruit enzyme called caricain. This enzyme is shown to be helpful for celiac patients. A 2015 study showed adding caricain to bread dough reduced gluten toxicity to gluten by 90% for celiac patients. GluteGuard was recently evaluated in two clinical studies in Poland. The first study looked at 20 patients with celiac disease who were in clinical remission on a gluten-free diet. In that study, all patients ate one gram of gluten, equal to about one slice of bread, each day for 42 days, with 14 patients also taking GluteGuard and six taking a placebo tablet. Patients noted their symptoms and well-being each day, and received biopsies both before and after the study. Thirteen of the 14 celiac patients (93%) taking GluteGuard showed no adverse changes in clinical symptoms, biopsy results or well-being throughout the 42 day trial. Only one GluteGuard patient withdrew due to celiac-associated symptoms, while 4 of 6 taking placebo withdrew after 14 days due to adverse celiac symptoms. The second Polish study looked at the effectiveness of GluteGuard in patients with dermatitis herpetiformis, a gluten-triggered skin condition common in celiac patients. As with the first study, all patients in these study were in clinical remission. Patients consumed around six grams of gluten daily for seven days, with ten patients also receiving GluteGuard tablets and ten getting a placebo. The GluteGuard showed better results compared with the placebo group, with 81% showing no increase in areas of skin lesions and 71% showing a reduction in the appearance of skin lesions. The GluteGuard group also showed a 38% reduction in skin itchiness. Of the seven patients who withdrew from the study due to gluten symptoms, six were taking placebo. Both clinical trials met high scientific standards. In both studies, participants were randomly allocated to receive the treatment or placebo, and neither the participants nor the researchers knew owhich patient was receiving which intervention. So, yes, enzyme supplements may provide some help for people with celiac disease, especially as a hedge against minor or occasional gluten ingestion. So far though, they are not a magic bullet, and cannot replace a gluten-free diet. Read more at Medicalexpress.com.