How do you know if your patients' diets are really gluten free?

To eat gluten, or not to eat gluten?

Charlotte Hunter Nutrition

To eat gluten, or not to eat gluten? That certainly seems to be the burning question frequently posed by practitioners, the media and cutting-edge research. However, here at Regenerus Laboratories we all agree there is so much more to the gluten story than simply debating whether we should eat it. In the wake of Coeliac Awareness Week , we decided to consider the following questions: is going gluten free really enough to manage gluten related disorders; just how prolific is the phenomenon of being ‘glutened’ and more importantly what can we do about it?

Have you been glutened?
Gluten free diets are most commonly associated with the long-term management of coeliac disease (CD), a lifelong autoimmune disease caused by a reaction to gluten. According to Coeliac UK , 1 in 100 people are affected by this condition however a growing body of evidence suggests these statistics are the tip of the iceberg due to the prevalence of other gluten related disorders such as Non-Coeliac Gluten Sensitivity (NCGS), a spectrum of gluten reactivity.

Accidental gluten exposure, a.k.a. being ‘glutened’, can lead to unpleasant and, in some cases, debilitating intestinal or exintestinal symptoms. The consequences of long term complications relating to this exposure, such as anaemia, infertility, osteoporosis and neurological conditions should never be underestimated as they pose significant threats to the health of CD and NCGS sufferers. Alarmingly for asymptomatic individuals, being ‘glutened’ is even more of an enigma. How can they monitor their compliance to a gluten free diet and are they really being as careful as they ought to?

Staggering statistics

The conventional treatment of CD (and NCGS) is very simple: stop eating gluten and as if by magic all your symptoms will disappear. Is this reflected in your personal or professional experience? I’m guessing not as the recent research on the incidence and scope of accidental gluten exposure is mind blowing.

A 2017 study in Gut, using urinary analysis of Gluten Immunogenic Peptides (GIPs), revealed that an unbelievable 45% of children and 48% of adults on long term gluten free diets were exposed to measurable amounts of gluten. This certainly backs up concerns over CD sufferers who do not fully recover whilst following a strict gluten free diet.

More recently in February of this year, a study in The American Journal of Clinical Nutrition  examined gluten exposure among CD sufferers using stool and urine analyses. The researchers found the mean daily consumption for adults on a gluten free diet was 244mg (urine analysis) and 363mg (stool analysis). This is astonishing given that as little as 10mg, or an eighth of a teaspoon of flour, is enough to trigger an immunological response in susceptible individuals.

What does this research reveal?
These figures clearly demonstrate that simply removing gluten from the diet is not enough for the successful clinical management of CD. Although the research above solely analysed CD data, one can assume these findings relate to any gluten related disorder when the adherence to a gluten free diet is essential.  

Even with 100% perceived compliance, avoiding gluten is evidently problematic for many sufferers. Farming practices, processed foods, incorrect labelling, cross contamination, personal care products and dining out all potentiate accidental exposure. Gluten is undoubtedly around every corner so what can we do to reduce the risks of being ‘glutened?’

GlutenDetect

The good news is we have a new test on the block, designed to address this very problem.
GlutenDetect is an exciting diagnostic tool that can be applied to the management of gluten related disorders to identify if, despite carefully following a gluten free diet, a person has been exposed. GlutenDetect is a lateral flow test with specific and highly sensitive G12 monoclonal antibody for the most dominant gluten immunogenic peptides 

(GIPs). GIPs are fragments of gluten resistant to digestion so are eliminated in the urine and stools.

GlutenDetect, available as a stool or urine test, is sensitive, specific and simple and can be carried out at home for the identification and monitoring of possible gluten exposure. The urine test should be used if a significant exposure is suspected within the past 24 hours whereas the stool test, which is more sensitive, can be used for regular monitoring as it can detect gluten exposure over a seven-day period.

Become a gluten detective…
Accidental exposure is a major problem for those with or without symptoms so GlutenDetect is the perfect tool for monitoring compliance, transgressions and accidental exposure. Alongside practitioner support, food records, lifestyle diaries, diagnostic testing and supplementary measures there is a clear way forward for the successful management of all gluten related disorders. Click here for more detailed information on GlutenDetect.


Charlotte Hunter is a Registered Nutritional Therapist from The University of West London in 2010. She runs a busy practice from locations in Surrey and West Sussex and is the founder of The Nourish and Flourish Club and The Yummy Tummy Club. She is currently working towards becoming a Certified Functional Medicine Practitioner with The Institute for Functional Medicine.