A single exposure to gluten can turn on your immune system in a way that makes inflammation worse for weeks. If you have an autoimmune disease, a single gluten exposure can active the autoimmune process, causing an increase in tissue destruction associated with the disease. If you have rheumatoid arthritis, a gluten exposure can cause further destruction of your joints. If you have Hashimoto’s disease, a gluten exposure can cause further destruction of your thyroid gland.

Even a trace amount of gluten exposure can trigger a long-lasting immune response. One thousandth of the amount that causes the original immune system sensitization can trigger a damaging immune reaction in a person who is sensitive to gluten. In other words, if a salad comes to you at a restaurant with croutons on it, and you take them off, the amount of gluten remaining on the salad can cause a destructive reaction.

Topical exposures count. Read the labels on your shampoo, conditioner, soap, etc. Each time you go to buy a new bottle, even if you’ve read the label before, read it again. Formulas can change. Several patients have experienced problems caused by undetected formula changes.

For many patients, other foods like dairy, coffee, or yeast, can create cross-reactions, where the body sees these foods as if they were gluten. If the lab work to identify these cross-reactive foods has not been done in your case, ask Dr. Yanuck about it.

Virtually all oats contain gluten, even “gluten-free” oats. A very few companies do the work to verify that their oats have fewer than twenty parts per million of gluten. Bob’s Red Mill is currently doing this, both at the point of harvest and after transportation to the packaging plant. This is important, because transportation containers are often contaminated with gluten. This is why research has shown that even most so-called gluten-free oats have higher levels of gluten than the twenty parts per million cutoff to be considered gluten free in the U.S. (In Canada, it’s nine parts per million). Until you are feeling and functioning completely well, you need to totally avoid all oats, except perhaps Bob’s Red Mill. Once you’re better, it might be reasonable to consider introducing infrequent, small servings of other gluten free oats and seeing how you respond. But, until you’re well, you have no reliable way to judge your reaction to these exposures.

Be aware that soy sauce has wheat in it. If you eat Chinese food or sushi, bring your own bottle of gluten-free soy sauce to the restaurant and ask them to make your dish with it. Keep a bottle of gluten-free soy sauce in the glove compartment of your car, so you always have it if you end up at a restaurant where you need it. Thai food is also an excellent choice. Thai restaurants are usually much easier to navigate gluten free.

Read labels. Learn to recognize gluten-containing ingredients like malt. If you’re not sure about an ingredient, google “ingredient+gluten” using the ingredient you’re wondering about. See what comes up. You can also use the book “Gluten Safe and Unsafe Ingredient List” that’s listed under books on the main Gluten Free Resources page.

Be aware of exposures around your kitchen, if you live in a household with people who are not gluten free. If someone toasts bread in a toaster oven, you need to clean the rack before you put your food on it. If someone bakes with flour, you’re likely to get some exposure unless they clean up carefully.

Having fun is important to your health, and to the success of your case. Learn how to cook gluten-free food that’s fun, so the process feels comfortable and sustainable for you. Remember, learning to eat gluten-free is like learning to drive. The first day is the hardest. After a while, you just hop in the car and go.