Dr. Robert Pastore, PhD, CNS


#069 - On New Gluten Exposure Testing

Dr. Pastore discusses a new, at-home test that celiacs can utilize to determine if they have been exposed to gluten, why it’s important to monitor gluten exposure, the shockingly high rates of unknown gluten exposure among celiacs following a gluten-free diet at home and in restaurants, and what the research has to say about the accuracy of the new test.

2020-06-266 min read

The Pastore Podcast


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’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


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


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


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