If you are diagnosed with celiac disease, you must completely avoid gluten for the rest your life. It is time to turn the corner and focus on enjoying the benefits of being gluten-free rather than on the loss of all those foods containing gluten.
But we do not live in a gluten-free world. At some point, no matter how careful you are, you will accidentally consume a little gluten. So how much gluten is too much? And more importantly, what do you do when it happens?
Measuring Your Daily Gluten
While the most common understanding is that 100 mg of gluten per day is the minimum amount of gluten to cause problems, a recent study conducted in Finland suggests that as little as 30 milligrams of gluten may be enough to show a change in antibodies and in the health of the mucosal lining of the small intestine (as measured with an intestinal biopsy).
To give you an idea of just how little this is:
An average slice of sandwich bread will often have a little less than 5000 milligrams of gluten (or about 4.9 grams). So you could have about 1/164th of a slice of bread once a day for about 30 days and you might do measurable damage to your small intestine.
This will vary by individual (see more below), and it is important to recognize that all these studies involve consistent exposure over time (although a very short time period; usually a couple of weeks to a month).
In all studies, there were statistical outliers, which means there were less common cases within each study where people would experience more damage with even less gluten consumption, and people who could consume more gluten yet experience less damage.
Please remember that both celiac disease and a non-celiac gluten sensitivity are not allergies. In more cases than not, you may not experience clear and tangible celiac disease symptoms after consuming a small part of a slice of bread.
This isn’t to suggest you can get away with eating those small amounts — you can’t. But it’s important — it is absolutely vital — that you understand how the damage can be done without you even feeling it.
Two Common Misconceptions About Gluten Intolerance
The most profound misunderstanding I’ve witnessed when consulting people with gluten intolerance is when people believe in one of two polar opposite (but equally inaccurate) perspectives:
1) Either they treat their celiac disease like an allergy and think that if there is a trace of gluten in their food they’ll become terribly ill right away. But again, celiac disease is not a Type 1 Hypersensitivity or a food allergy; celiac disease is very different than a true wheat allergy.
2) Because they don’t feel anything after eating a plate of pasta (surprisingly common among people in the early stages of celiac disease), they think they can just “cut down” on gluten and not eliminate it altogether. This is a big mistake and could in fact even be deadly if they let their celiac disease go untreated for years as it can lead to chronic inflammation and a host of other health problems.
To summarize: The important thing to understand is that it takes a very small amount of gluten to do damage to your small intestine, but you may not even feel it — not right away or maybe not even for days.
But just because you can’t feel it soon after consumption doesn’t mean the damage isn’t being done.
Will That Hurt Me?
A common question I receive from my newsletter subscribers is something like, “I accidentally consumed a soup with soy sauce in it. Will this make me sick?”
I want to stress that if you have been diagnosed with celiac disease you must avoid gluten for the rest of your life.
There are 3 variables that make it so I can’t answer this main question for any single person:
1) How advanced is your celiac disease?
Someone who just recently developed celiac disease will not have as much villous atrophy along the walls of their small intestine, and thus a tiny trace of gluten consumed a single time may not set them back as far (but it will still do damage).
But someone who has suffered for years and only recently went gluten-free may experience more suffering and damage.
There are no layman measuring sticks for “how advanced” your celiac disease is, just a wide swathe of gray area, which makes it very difficult for me to answer how bad it was that you had that soup.
2) Everyone’s body is different.
I mean this literally. Even every person with celiac disease generates a different volume of the damaging antibodies when they consume the same amount of gluten. And it’s almost impossible to measure just how severely your body reacts to a small trace of gluten compared to another person with celiac disease.
3) How much gluten was really in that soup?
Without constantly carrying around a gluten testing kit with you, it’s unlikely you can say exactly how much gluten you accidentally consumed.
And the difference between a damaging amount and an amount that won’t make too much of a difference is incredibly tiny according to a recent study conducted in Finland, so it’s really hard to tell if the soy sauce used to make that soup exposed you to 25 mg of gluten or 35 mg of gluten, which according to the Finland study is the difference between damaging you or not damaging you.
So those three variables are what keep me from being able to answer isolated, individual queries in a real meaningful way.
So What Can You Do If You Think You’ve Ingested Some Gluten?
Here are my quick suggestions:
1) For the following two weeks, be obsessively vigilant about avoiding gluten. I don’t like to encourage an irrational gluten phobia, but if you’re confident you accidentally consumed gluten and you have celiac disease, do your best to let your body repair itself.
2) While I’m a little skeptical of supplements where the manufacturer claims their supplement can let you eat a little gluten (it’s just not true, no matter how they market these products), keeping something on hand for the occasional and possibly inevitable times when a little gluten might slip into your food is probably a good idea. Quality products of this nature are just enzymes that help you digest certain proteins.
I’ve read quite a few good things about this one:
3) In the third orientation email I send to new subscribers of my gluten intolerance newsletter, I offer several suggestions for helping people heal the damage done by gluten intolerance. In particular, the three following have an uncommon agreement of support from both the conventional science community and the naturopathic community:
Just make sure the supplement you choose in each of these areas is a gluten-free supplement.
My comprehensive guide to healing the damage done by gluten is a free email you’ll receive for subscribing to my newsletter, which you can join here.
Because the autoimmune response triggered by gluten tends to damage the proximal small intestine first, you might integrate foods rich in the vitamins and minerals absorbed by that part of your intestine. Calcium, magnesium, iron and fat-soluble vitamins (vitamins A, D, E and K) are all absorbed by this part of your small intestine. Discuss this with your doctor, however, because you don’t want to assume you’re experiencing symptoms of low ferritin and take too much iron.
I hope this helps you better understand how little gluten it takes to do damage and how to respond when you do accidentally “glutenate” yourself.