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Nutrition

How Big of a Problem is Accidental Gluten Exposure?

by Valerie Polley | Jan 17, 2019 | 0 comments

Many individuals follow a gluten-free diet for various reasons. An individual could have a celiac diagnosis, wheat allergy, gluten sensitivity, leaky gut, or even IBD, such as Crohn’s or Colitis. Many of the diets for various disease states take gluten off the menu, such as Specific Carbohydrate or Paleo. Why someone has to follow one of these diets or chooses to is a personal story.

For this blog post I am going to focus on celiac disease with gluten exposure, not because others without celiac disease aren’t bothered by it, but with celiac disease a blood test can be run or another biopsy performed to see if someone is getting gluten. Sometimes an individual can be very sensitive to even a tiny amount of gluten exposure, and others do not even know they have had gluten.

The University of Chicago Celiac Disease Center recommends those with celiac disease receive follow-up testing on a yearly basis, with a blood draw to check their tTG and DGP.

Three million people in the United States have celiac disease. In a February 2018 study in the American Journal of Clinical Nutrition, they looked at gluten exposure detected by two tests. One was using urine and the other stool. These tests can detect the gluten peptides that make it through the digestive tract intact.

Just to give a reference range, the average woman (without avoiding gluten), consumes as high as 7,500mg gluten per day. The average man consumes 10,000mg gluten per day. For someone with celiac disease, the recommended limit for gluten consumption is no more than 10mg per day. That is a HUGE difference! If someone with celiac disease has more than 10mg of gluten on an ongoing basis, they can start to have symptoms and intestinal damage.

The study from the American Journal of Clinical Nutrition found that even though the participants were consuming a gluten-free diet, they were getting 244mg per day of gluten (by stool analysis), and 363mg per day (by urine analysis). That is a lot more than the 10mg recommended. These are individuals following a gluten-free diet! What is happening?

If someone is following a gluten-free diet, but they are still having symptoms, or their labs/biopsy indicate repeated exposure, where is it coming from? Here are some ideas!

1. The first place it can start is in the fields.
Cross-contamination can occur from one crop to another. Gluten-free crops may sit next to gluten containing crops. There is space between them, but the wind can carry. An animal passing by can easily cause cross-contamination, such as deer or a bird flying overhead.
Gluten-free crops may be rotated with gluten containing crops.

2. Processing, Packaging and Shipping.
If a train car carries gluten-free flour, it needs to be certain that same train car didn’t carry a gluten containing grain on another ride. Or, it was thoroughly cleaned.
Even though a food item is labeled gluten-free, is it made in a dedicated gluten-free facility? There are many foods labeled gluten-free that are not made in a dedicated gluten-free facility, and that is OK to eat this food, if you are not having symptoms, and repeat lab work/biopsy shows you aren’t getting gluten.

The recommendation is to purchase certified gluten-free flour and oats, as they are at a higher risk of cross-contamination. If you are newly diagnosed, the recommendation is no oats for 6-12 months (depending on severity of biopsy), and after that no more than a ½ cup of dry oats/day as tolerated.

3. Medications (OTC/Prescription)
Many over-the-counter (OTC) medications are labeling gluten-free.
Prescription medications have fillers, so be sure to ask the pharmacist if it is gluten-free. If they don’t know, make sure to call the Pharmaceutical Company. With a celiac diagnosis, it is a good idea to have the pharmacist flag your name, so they know.

4. If there are still family members that eat gluten in your home, this is a way to get exposure.
These are recommendations to decrease exposure in the kitchen.
You will want to have a separate toaster and strainer.
Purchase new sponges-may want separate sponges
Purchase new cutting boards-preferably non-porous and color code if there are individuals that eat gluten in the house.
Replace wooden utensils with something non-porous, such as metal.
Purchase new measuring cups and spoons if they have cracks. Gluten can get trapped. Assess if you need two sets.
Replace appliances that have easy places for gluten to hide, such as a bread maker, waffle iron, and pancake griddle.
Replace pots and pans that have scratches/crevices that could hide gluten, such as non-stick.
Replace bakeware and mixing bowls that hide gluten.
Flour becomes airborne and can settle. If you are going to have regular flour in the house, make sure cookware, utensils, etc. are stored upside down.
Always keep your sinks and countertops clean!
Use squeeze condiments or have separate ones labeled gluten-free.
Store gluten-free food above gluten containing food.

5. Restaurants are an easy place to get gluten exposure.
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​​6. There are varying opinions on toiletries and if they should be gluten-free, but here are a few things to think about.
Lipstick, lip gloss or lip balm. They are on your lips, so can easily get in your mouth. Use a brand that is labeled gluten-free.
Lotion. If lotion is on your hands and you eat something, there is potential there. It is best to get a lotion that is labeled gluten-free.
Shampoo/Conditioner. Some would say that it is not a big deal, but these are running down your face, past your mouth. We are not eating it, but there is a chance that it could get in your mouth. Repeated exposure could add up.
Make-up. Anything near your mouth should be labeled gluten-free. Some are very sensitive, so if this is the case, make sure all make-up is gluten-free. This is a personal decision. You can ask the company or if it is a direct sales company, ask the consultant to see which products are gluten-free.
Sunscreen. If it is near your mouth, you will want to find one that is gluten-free.

Some would argue that the skin is the biggest organ in the body and it absorbs everything. So, it is a personal decision what you use, but be aware if your celiac antibody levels are still elevated, you are continuing to have symptoms or a follow-up biopsy reveals continued inflammation/damage, it could be something other than food.

This blog is intended for you to be aware of the many places gluten can be found, not to make you feel that you can’t eat or use anything! Some are very sensitive to gluten exposure, while others do fine just buying gluten-free food items.

References:
Syage, J.A, Kelly, C.P, Dickason, M.A, Ramirez, A.C, Leon, F, Dominguez, R, Sealey-Voyksner, J.A. (2018). Determination of gluten consumption in celiac disease patients on a gluten-free diet. American Journal of Clinical Nutrition, Volume 107, Issue 2, Pages 201-207.

The information in this blog is not a substitute for professional medical advice, examination, diagnosis and treatment. Always seek the advice of your physician or other qualified healthcare provider before altering your diet, starting a new treatment or making changes to an existing treatment.

Our gut microbiome (the community of trillions of microbes that live in our gut) plays a key role in maintaining metabolic and immune health. Gut dysbiosis occurs when the composition and diversity of our gut microbiome shift. This could include overgrowth of harmful bacteria or a decrease in beneficial bacteria. Gut dysbiosis has been linked to a wide range of negative health outcomes, including increased levels of inflammation and changes in metabolism.

Many people switch to non-nutritive sweeteners like sucralose, aspartame, and stevia for health reasons, and for decades, we've believed that they pass through our bodies without affecting us. But emerging research shows that these compounds interact directly with our gut microbiome and may have potential negative effects on our health. 

This article will review what we currently know about the relationship between non-nutritive sweeteners (including artificial sweeteners and calorie-free natural sweeteners) and the gut microbiome, plus practical advice for navigating sweeteners.

Sucralose

Sucralose (Splenda) is an artificial sweetener commonly used in baked goods, gums, and sugar-free beverages and is approximately 600 times sweeter than sucrose (table sugar). However, recent research has linked it to adverse health effects such as systemic inflammation, metabolic disease, and gut dysbiosis. For example, a 2022 study found that sucralose consumption increased harmful bacteria and reduced beneficial bacteria, which was associated with changes in insulin and glucose levels.

Additionally, a 2025 randomized controlled trial examining the effects of replacing added sugars with sucralose found that people with type 2 diabetes who consumed sucralose experienced reductions in both alpha diversity (the number and types of species present in a single person) and beta diversity (differences in microbial composition between people). Interestingly, the people with overweight and obesity without type 2 diabetes did not experience the same changes.

Overall, animal studies and limited human studies suggest that sucralose may trigger intestinal inflammation, likely through its effects on the gut microbiome. However, since most of the evidence we have comes from test tube or animal studies, these results should be interpreted cautiously.

Aspartame

Aspartame is another commonly used artificial sweetener that is about 200 times as sweet as sucrose. While it does contain some calories, because you don't need much of it to reach the same sweetness levels as sucrose, these calories are negligible.

Like sucralose, most of the research into the gut effects of aspartame has been done in animals. However, we do have some very small human studies. A 2022 randomized controlled trial (RCT) involving 20 healthy adults found that participants taking aspartame showed changes in both probiotic (beneficial) and pathogenic (harmful) bacteria, but the changes were specific to each individual. 

Why the differences? It's likely due to the "responder vs. non-responder" phenomenon. We all have differences in our "baseline" microbiome. While certain bacterial species are common in healthy populations, our microbiome is as unique as a fingerprint. Whether an artificial sweetener has positive or negative effects on our microbiome may depend on which species are already present in our gut, as well as on our habitual diet. This difference in responses makes it very challenging to draw firm conclusions about whether artificial sweeteners are harmful.

Stevia

Many people choose stevia because it's a "natural" zero-calorie sweetener. Studies have shown mixed results regarding the effects of stevia on the gut microbiome. For example, while some in vitro (test tube) and in vivo (animal) studies have reported potentially harmful effects of stevia on the gut microbiome, others have found no impact, and some even reported beneficial effects through inhibition of inflammatory pathways.

Additionally, a 2024 human study found that stevia had no significant effect on the gut microbiome. This highlights the importance of not forming conclusions based solely on test tube and animal studies. Overall, it appears that stevia is a potentially less-harmful alternative to artificial sweeteners like sucralose and aspartame.

Practical Advice for Navigating Sweeteners

Since the research on artificial sweeteners is still evolving, the decision to include or avoid them comes down to personal preference. Here are some tips for including them in your diet in moderation:

  • Try gradually reducing the amount you use: If you typically use two packets of sweetener in your coffee or tea, try gradually reducing to one packet. Our taste buds are highly adaptable, and you may find that one packet is sweet enough once you get used to it.
  • Check your labels: Low- or no-calorie sweeteners (such as sucralose, aspartame, and sugar alcohols like erythritol) are often hidden in low-sugar foods like protein bars, yogurt, and diet sodas. Awareness is the first step to reducing your intake.
  • Rotate your sources: If you do use artificial sweeteners, try switching up the types you use. Since different sweeteners may affect your gut microbiome in different ways, this may reduce the concentrated impact on your gut.
  • Switch to stevia: While animal and test-tube studies show mixed findings, human research indicates that stevia has a limited effect on the gut microbiome, making it a better choice for people seeking to support their gut health.

Another way to support your gut if you regularly use artificial sweeteners is to rebuild gut diversity with fiber and fermented foods, while focusing on whole-food sweeteners.

  • High fiber prebiotic foods (like legumes, whole grains, garlic, onions, asparagus, and under-ripe bananas) act as "fuel" for your healthy gut microbes. Aim to include a variety of these foods in your diet to support the microbes already in your gut.
  • Add fermented foods, like unpasteurized sauerkraut and kimchi, kefir, or kombucha, to your diet. Some fermented foods contain live, beneficial bacterial cultures, while others are rich in "postbiotics" (beneficial compounds like short-chain fatty acids, which are produced when bacteria break down prebiotics).
  • Try using whole-food sweeteners instead of artificial ones. For example, sweeten plain yogurt with vanilla extract and berries or add dates to smoothies or homemade energy bites.

Final Thoughts

Emerging research suggests that certain low- or no-calorie sweeteners, including sucralose and aspartame, may affect the gut microbiome, whereas stevia appears to have a less negative effect. While individual responses can vary with a person's unique baseline microbiome, certain artificial sweeteners may increase inflammation or reduce gut microbiome diversity.

If you need personalized support navigating sweeteners or supporting your gut health, Blue Tree Nutrition can help. Click here to get in touch!

 

 

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Hello, I am

Valerie

My name is Valerie Polley. I am a Indianapolis-based registered dietitian and owner of Blue Tree Nutrition. I consult with clients both local and far away.
I have a bachelor’s degree in nutrition from Purdue University and I have been practicing for 20 years.
I thoroughly enjoy helping clients through their gut health journey. I see a range of GI issues including, but not limited to celiac disease, IBS and SIBO. I also specialize in the FODMAP elimination diet.

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