As a celiac disease expert, one question I am asked most often is “what if you have celiac disease and are exposed to gluten?” Unfortunately there are no magic bullets. There is no cure for this disease. Sadly, many celiac disease organizations estimate over 75% of celiac disease patients confirm exposure to gluten over a short period of time. It is important to state what I hope is obvious, but it is critical to communicate that you have celiac disease to whomever is preparing your food. Regardless, sometimes things do not go as planned. If you, like me, have celiac disease, you may have experienced that dining out doesn’t always go as planned regardless of how much planning you do, or orate the seriousness of the disease. So, when exposure happens, this is what I believe is a logical course of action.

1. Call your doctor’s office (preferably the office that diagnosed you or at least is knowledgeable of your condition) and let them know what transpired and the symptoms you are experiencing. Take their advice.
2. Hydrate! If diarrhea is a primary symptom of celiac disease prior to diagnosis, or you have been strictly gluten free for a period of time and have been exposed to gluten, diarrhea may be your main symptom. Drinking plenty of water can help prevent diarrhea induced
3. Do your best to get plenty of rest. Sometimes gluten exposure in the celiac disease patient can cause sleepiness and in others cause insomnia. My advice is if it is at all possible to get some rest, do it and that includes taking a nap during the day.
4. Build your post gluten exposure meals on a foundation of healthy food that is more on the bland, plain side of the flavor palette. This is not the time for a super spicy chicken dinner following your gluten spiked lunch. Homemade chicken soup is a better option.

Speaking personally and professionally, speak with your doctor about keeping pharmaceutical grade L-glutamine powder in your home for emergency exposure to gluten. I have used this tactic and based my opinion on multiple studies on the role of glutamine in intestinal diseases. The findings suggest that glutamine supplementation may be beneficial for individuals with impaired gut permeability by enhancing the expression of tight junction proteins. A wonderful scientific review that includes the mention of celiac disease is by Kim and Kim in the international journal of molecular sciences from back in 2017 titled “The Roles of Glutamine in the Intestine and Its implication in Intestinal Diseases.^[1] I have taken as much as one tablespoon dissolved in water as part of my healing process.

Extrapolating from a study of celiac disease patients with IBS and from my experience in clinical practice, probiotics may be of benefit. In a randomized study of 109 celiac disease patients strictly adhering to a gluten free diet but with irritable bowel syndrome (IBS) symptoms by Francavilla and colleagues published in the journal of clinical gastroenterology back in March of 2019, enrolled patients were randomized to probiotics (a mixture of five strains of lactic acid bacteria and bifidobacteria: Lactobacillus casei LMG 101/37 P-17504 (5 Å~109 CFU/sachet), Lactobacillus plantarum CECT 4528 (5 Å~109 CFU/sachet), Bifidobacterium animalis subsp. lactis Bi1 LMG P-17502 (3.4 Å~109 CFU/sachet), Bifidobacterium breveBbr8 LMG P-17501 (3.4 Å~109 CFU/sachet), Bifidobacterium breve Bl10 LMG P-17500 (3.4 Å~109 CFU/sachet)), or placebo for six weeks, and then followed up for six more weeks. The results revealed that the probiotics were efficacious in ameliorating the severity of IBS symptoms measured by IBS severity score (IBS-SS) ^[2]

I discuss this topic mone in-depth during my podcast “On Gluten Exposure Recovery for Celiacs” which can be found on iTunes and Spotify.