SHOW NOTES

Statistics of gluten exposure in diagnosed celiac disease patients [0:40]

• Celiac.org (Dr. Pastore is patient advocate for group) reports that:
  • 83% of celiac disease patients are exposed to gluten in the last 30 days
    • Other studies have shown the lowest exposure rate to be 75%
• Celiac disease is an autoimmune disease, damages the intestines & destroys villi & microvilli, leading to reactions in other parts of the body
• Many health comorbidities linked to celiac disease
• Only treatment is a strict gluten-free diet
• Link to what to do if you’ve been exposed to gluten as a celiac: https://drrobertpastore.com/articles/2020-02-20-what-if-you-have-celiac-disease-and-consumed-gluten

Celiacs may not have the time or accessibility to see a physician after suspected gluten exposure. New options are making it accessible to the masses [2:45]

• New clinical trials
• Not 100% approved by FDA yet, slow approval process
• Data and clinical validation makes Dr. Pastore confident enough to commend it
  • Clinical validation = repeated analysis on humans that have the disease
• New methods of assessing gluten consumption by examining for specific proteins in the stool and urine
• Methodology will continue to improve
• No test is 100% accurate - bloodwork (serology) and biopsy included
• Allows patient empowerment
  • Eating a “gluten free” food at home, but isn’t certified gluten-free. Could be exposing yourself to small amounts gluten daily

What amount of gluten is needed to cause a celiac to react? [5:30]

• It can take as little as 50mg to be harmful to the majority of celiacs, start damaging villi & microvilli
• 1 piece of whtie bread = 12,400mg of gluten & 50mg can cause harm
  • In parts per million - 124,000 parts per million, as little as 20 parts per million can affect some celiacs
• ½ crouton or ¼ of a standard playing die
• It’s important to monitor gluten consumption as a celiac patient because it takes such a small amount

Restaurant gluten cross-contamination & allergy/celiac staff awareness [8:30]

• Restaurant staff awareness is key
• May 2020 in an American Society for Nutrition Journal from Eastern Michigan University
• 28 question survey sent to restaurant staff throughout United States
  • Chef, sous chef, general manager, position managers, servers
• Questions asked around their knowledge of food allergies and celiac disease specifically
• 583 complete responses
  • 37.1% general managers
  • 23% lower level managers
  • 9.8% executive chefs
  • 11% sous chefs
  • 10% cooks & line cooks
  • 7.9% servers
• Only 43.5% of chefs & cooks, 26% of servers had complete food allergy training
• Most had heard of a gluten-reaction & gluten free diet
• Only 52.6% knew celiac disease was an autoimmune disease triggered by gluten
• Communicate with server “I have celiac disease which means I cannot consume gluten because I have an immunological reaction to it”
  • Many restaurants have a chef or manager speak to you at the table
    • Ensure they truly understand what celiac disease is
  • Can also say “I have an allergy to gluten. Do you know what gluten is?”
• Lack of education, knowledge & training throughout many industries, even gastroenterologists
• 24.3% of restaurant employees had no training around food handling with allergies & celiac disease
• Those that did receive training were significantly more aware of gluten restrictions
• More government & private programs needed for food allergies for restaurant staff, ideally government-mandated programs
• Gluten is the largest group of food-based reactions of all foods, gluten is omni-present and difficult to avoid
• Food supply & amount of gluten in processed foods has increased

2 studies about new testing methods to determine gluten  [25:40]

• 1 in the American Journal of Gastroenterology
• 1 in the American Journal of Clinical Nutrition
  • Meta Analysis by Syage & colleagues that identified consumed gluten in celiacs can present in the stool
  • Measured by searching for gluten immunogenic peptides (GIP)
    • Sequence that stimulates t-cell lines found in the blood, stool & urine of individuals with celiac disease
    • Standardize an assay
      • ELISA Sandwich G12/21 assay
      • Well-respected, almost 100%
      • Could be ruined by the individual’s response to gluten (rare) to not showing the GIP is present, leading to a false negative
      • Will not show false positive if you were not exposed to gluten
  • Also used urinalysis quantitative immunoflow assay A1/G12 Ivy check reader
    • Accurately tested & repeated multiple times in multiple studies
  • Test validation can save lives
  • This meta analysis showed the average inadvertent exposure to gluten by celiac disease patients was estimated to be 150-400mg of gluten DAILY for those eating out at restaurants [27:30]
    • Mean average 150-400mg daily using stool analysis
    • Median average 100-150mg daily using stool analysis
    • Mean average 300 - 400mg daily using urinalysis
    • Median average 150mg daily using urinalysis
  • Stool analysis 10x more sensitive than urine
    • Gluten consumption is in digestive tract, cleared from the body through stool
    • To get to urine has multiple processes to go through from digestive tract to get into urine
  • If patient is negative in urinalysis, Dr. Pastore recommends using stool analysis

Stool analysis test recommended by Celiac.org can be found at http://glutendetective.com/ [30:30]

• Dr. Pastore is not affiliated with the company in any way, but endorses the technology
• Technology used is clinically validated
  • What was used the the meta-analysis with promising data
• In the FDA approval process, but Dr. Pastore recommends now due to data
• Reads like a pregnancy test - easy to determine results
• Can identify exposure up to 5 days after consumption
• Some risk of false negative
• Not just for celiacs - wheat/gluten allergies can also test for exposure
• Physicians & dieticians can use this rather than a just a food questionnaire
  • Cross-contamination is so prominent that a food log isn’t sufficient enough to rule out gluten
    

If a celiac does test positive for gluten consumption on the stool analysis test, what should they do? [39:30]

• Dr. Pastore recommends seeing your physician for serology / blood work
• What to do after gluten exposure as a celiac
  • https://drrobertpastore.com/articles/2020-02-20-what-if-you-have-celiac-disease-and-consumed-gluten
• See physician regularly for general bloodwork with tTG IgA & whatever tests that were run for you for original diagnosis
  • Can identify long-term gluten exposure that could lead to diseases
• After celiac diagnosis, follow up with doctor at 3/6/12 months after diagnosis: https://drrobertpastore.com/articles/2020-02-27-what-is-the-proper-medical-follow-up-for-a-celiac-patient

Dr. Pastore’s closing 5 thoughts [42:10]

• There is an unmet need to protect the celiac/gluten allergy/gluten intolerant community from unintended gluten ingestions
• Studies show chronic gluten exposure that destroys villi in celiac patients in a fast-track to other medical comorbidities, even cancer
• Exposure should be lower than 50mg per day, studies showed average celiac is consuming 100-150mg daily
• There is no perfect test. The more data we can get, the better
• Further food allergy education within the restaurant industry is needed
  
  

Wrap Up [45:00]

• For the undiagnosed celiac or the diagnosed celiac being exposed gluten, their immune system is likely suppressed, increasing the risk of infection including COVID-19
• Be more vigilant than ever
• www.drrobertpastore.com
• help@poweronpoweroff.com
• @drrobertpastore

LINKS

[PODCAST] What to do after gluten exposure as a celiac

https://drrobertpastore.com/podcasts/046-on-gluten-exposure-recovery-from-celiacs

[ARTICLE] What to do after gluten exposure as a celiac

https://drrobertpastore.com/articles/2020-02-20-what-if-you-have-celiac-disease-and-consumed-gluten

[ARTICLE] After celiac diagnosis, follow up with doctor at 3/6/12 months after diagnosis

https://drrobertpastore.com/articles/2020-02-27-what-is-the-proper-medical-follow-up-for-a-celiac-patient