People with Celiac disease follow a lifelong gluten-free diet to manage their condition. I too follow a strict gluten-free diet. When I travel, I am always concerned about being exposed to gluten–20-40% of restaurant foods that are labeled gluten-free and 20% of grocery items that are labeled gluten-free actually have detectable gluten in them.1,2
Protein is supposed to be fully digested in the gut, broken down into amino acids which then pass from the gut into the bloodstream. If a person has incompletely digested proteins in their gut and increased permeability of the gut lining (leaky gut), gluten from the meal they ate may get into the bloodstream. If that person was meticulously eating gluten-free but ate food cross-contaminated with gluten, they may have just been “glutened” without being aware of the exposure.
If you are severely gluten sensitive as I am, you may have anxiety about eating food you did not prepare. It has happened to me–I have had adverse reactions to a restaurant meal labeled gluten-free that was probably contaminated with gluten.
When eating a meal someone else is going to prepare, I always offer to bring food. Unless people are gluten-sensitive themselves, they are unlikely to be aware of the perils of cross-contamination that can easily occur in the kitchen. They may not be aware that gluten is often a hidden ingredient in sauces and packaged foods. For the gluten-sensitive person, even a tiny amount of gluten in the bloodstream will activate the immune system, causing a flare of autoimmune disease processes.
The older we are, the more likely we are to have an increased leakiness of the gut as well as decreased production of enzymes needed to digest protein and carbohydrates. This combination increases the risk of developing food sensitivities and having a flare if we are exposed to even small amounts of gluten. If you are noticeably bloated, particularly after eating protein, you are more likely to have poor protein digestion. This increases the risk of muscle wasting as we age. Patients with multiple food sensitivities who have difficulty finding foods they can safely consume may benefit from adding digestive enzymes and betaine to increase stomach acid.
There has been considerable interest in finding a digestive enzyme formulation that would make it possible for someone with Celiac disease to consume gluten regularly. Thus far those efforts have been unsuccessful. However, there is an interesting report on gluten-digesting enzymes improving symptoms for people with Non-Celiac Gluten Sensitivity. In a randomized trial, patients took active enzymes or a placebo prior to a gluten challenge. Then they scored their symptoms and had blood markers of T-cell activation and inflammation measured (interleukin 8, tumor necrosis factor (TNF)). The enzyme preparation protected participants from symptoms and prevented activation of the immune system when exposed to gluten.3
I would not consider using digestive enzymes and betaine to provide sufficient protection to eat gluten-containing breads and pastas. However, I do think they are useful in decreasing the risk of symptoms that may arise from eating foods labeled gluten-free that actually have low level cross-contamination.
I now travel with digestive enzymes and begin taking them as soon as I start eating away from home. For me, gluten exposure brings a devastating level of face pain. Because so many foods are contaminated with gluten, I take enzymes to help guard against possible painful reactions to supposedly gluten-free food.
I still am meticulous about what I eat away from home.
- I order foods that are naturally gluten-free and avoid gluten-free versions of bread, pasta, and other traditionally gluten-containing foods.
- I avoid sauces and salad dressing. If I order a salad, I ask for olive oil on the side.
- I opt for a grilled source of protein and always take digestive enzymes.
For patients who have multiple food sensitivities and are having difficulty finding foods they can safely consume, adding digestive enzymes and a betaine supplement to increase stomach acid can facilitate the digestion of the small amount of gluten that the “gluten-free” meal may be contaminated with. It also helps to break down other food proteins that may be the source of multiple food sensitivity issues. These supplements are not enough to allow for consumption of regular bread, but they can prevent the severe side effects some get from being “glutened” by cross-contamination. I know I feel safer when I travel by taking digestive enzymes and betaine.
Adding digestive enzymes to their supplement program has also been very helpful for those with multiple food sensitivities, allowing them to eat a less restrictive diet.
The Wahls Protocol® Collection carries Gluten Shield MD, the digestive enzymes I use when I travel, or before I eat when at a restaurant or with friends and family who may not eat a gluten free diet.
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References:
Lerner BA, Phan Vo LT, Yates S, Rundle AG, Green PHR, Lebwohl B. Detection of Gluten in Gluten-Free Labeled Restaurant Food: Analysis of Crowd-Sourced Data. *Am J Gastroenterol.* 2019;114(5):792-797.
Falcomer AL, Santos Araujo L, Farage P, Santos Monteiro J, Yoshio Nakano E, Puppin Zandonadi R. Gluten contamination in food services and industry: A systematic review. *Crit Rev Food Sci Nutr.* 2020;60(3):479-493.
Ido H, Matsubara H, Kuroda M, et al. Combination of Gluten-Digesting Enzymes Improved Symptoms of Non-Celiac Gluten Sensitivity: A Randomized Single-blind, Placebo-controlled Crossover Study. *Clin Transl Gastroenterol.* 2018;9(9):181.
