On the Gluten-Free Diet But Still Feeling Unwell? Is Gluten Sneaking In?

Melinda Dennis, MS, RDNThis is a common scenario among my patients with celiac disease and non-celiac gluten sensitivity. Melinda Dennis, MS, RDN, is a registered dietitian specializing in celiac disease and gluten-related disorders, author, nationally acclaimed speaker, and the Nutrition Coordinator of the Celiac Center at Beth Israel Deaconess Medical Center in Boston. She offers gluten-free consulting through her private firm, Delete the Wheat, LLC.

Symptoms can include (but are not limited to) gas, bloating, cramping, abdominal pain, loose stool, diarrhea, constipation, abnormal stool patterns, fatigue, headaches, nausea, and the list goes on. So, let’s explore what might be causing these persistent symptoms.

Gluten is sneaking into the diet. More often than not, whether accidental or intentional, this is the most common reason for feeling unwell. Other than the obvious gluten-containing foods and beverages such as bread, crackers, baking mixes, beer, etc., gluten can appear in condiments, medications, supplements, Communion wafers, Matzo, and as fillers in processed meat, to name just a few. It can even be found in yeast extract or autolyzed yeast extract if it’s derived from barley. Or through cross contamination, such as a non-dedicated fryer, when dining out. You may be frustrated if you have gone over your diet with a fine-toothed comb to find and remove the gluten. Consider sitting down with a dietitian skilled in the gluten-free diet to help you search carefully for any exposure. In some cases, it is a matter of gaining a better understanding of the labeling laws and caveats. In others, it means asking more pointed questions in restaurants or carefully checking your own kitchen if you share it with others – do you have your own toaster or toaster oven? Do you have a system to avoid cross-contamination if you share condiments and butter, etc.?

If you and your dietitian have reviewed your gluten-free diet and lifestyle and can find no gluten sneaking in, follow this series as we share Ms. Dennis’ insights:
• Lactose and food intolerances and sensitivities
• Small intestinal bacterial overgrowth (SIBO)
• Nutrient deficiencies
• FODMAP malabsortion

Other Reasons: Less common causes of continued symptoms on the gluten-free diet include, but are not limited to, microscopic colitis, pancreatic enzyme insufficiency, and refractory celiac disease (very uncommon) and can be discussed with your doctor.

Bottom line: Don’t assume it’s normal to be feeling unwell. I hear many patients say “I just assumed everyone had diarrhea twice a day and I got used to living with it.” If you are still experiencing symptoms, talk to your doctor and ask for testing. You deserve to be in excellent health.
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For labeling laws in the United States and cross contamination resources, visit: www.glutenfreedietitian.com (Tricia Thompson MS, RDN)

Cross Contamination: Level 3 on celiacnow.org See http://www.bidmc.org/Centers-and-Departments/Departments/Digestive-Disease-Center/Celiac-Center/CeliacNow/NUTRAGFD/NUTRCNSDRGFD/LCTSINT/Level3.aspx

Disclaimer: As Nutrition Coordinator of the Celiac Center at Beth Israel Deaconess Medical Center, I am the lead writer and editor of the website www.celiacnow.org and co-author of the book Real Life with Celiac Disease. Otherwise, I have no business/financial stake in the resources listed in my article above.

Note: The References and Further Reading resources above represent only a portion of the excellent information available on these topics. I recommend PubMed, in particular, for the multiple peer-reviewed journal articles you will find.

Would you like to immerse yourself in nutrition and health at a gluten-free weekend retreat with me in New Hampshire or Santa Barbara, California? We’ll cover all of these nutrition topics and many more in great detail.

Visit: http://www.deletethewheat.com/WellnessRetreatsv2.html or email me for more information: [email protected]

© 2015 Melinda Dennis, MS, RDN/Delete the Wheat. LLC. All rights reserved. http://www.DeleteTheWheat.com