Getting Tested for Celiac, Gluten Intolerance, Gluten Senstivity or Gluten Allergy: A Brief Analysis

13 Sep

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Gluten free as a trend is helpful for increasing availability of foods to individuals on a once extremely restrictive diet, but getting diagnosed with celiac, gluten intolerance or gluten allergies is becoming increasing difficult in 2013.

(1)    Medical practitioners are viewing “Gluten Free’ as a new ‘Low Carb’ trend.

(2)    Specialists are telling patients to go gluten free (just try it out) before getting tested for celiac.

(3)    With 310 symptoms associated with Celiac Disease, patients with non-classic symptoms are often not tested: distended belly, diarrhea or constipation

(4)    People are getting false information regarding how to be tested for Celiac Disease, Gluten Intolerance, Gluten Sensitivity & Gluten Allergies.

(5)    Many practitioners do not understand the differences between Celiac Disease, Gluten Intolerance, Gluten Sensitivity & Gluten Allergies

(6)    People are often told that they do not need a gluten free diet due to an IGA test coming up negative, but this is not always true.

Back in 2001, I learned that there was a disease called Celiac and I had a lot of the symptoms.  In 2002, a dietitian took me off gluten for 6 weeks and the results where miraculous. My skin stopped itching and I didn’t feel like I was exhausted, I didn’t feel like I was going to be sick when I finished meals and the brain fog I was under for years was drifting away. I was then instructed by my GI doctor to eat gluten for 2 weeks and was then tested for IGA only antibodies and sent in for a biopsy.

Six years later, I learned that Celiac Disease runs in my family.  I also learned that I was not properly tested for Celiac and that as of yet, the only way I can currently get tested is if I consume at least one slice of bread and one cookie everyday for at least 6 months. A test can be run at 3 months, but generally it takes 6 months for accuracy.

Before You Are Tested for Celiac:

·       Do not change your diet, continue eating gluten.

·       Choose a competent lab to process your tests

o      familiarity with reading celiac tests accurately is a must)

·       Know which tests you need to have run

o      insurance companies tend to discourage all tests from being run as a cost reduction technique

·       Understand the some tests are not accurate if you have auto-immune disease or  if you are under 7 years of age.

·       Know that the Celiac tests do not test for gluten allergy, gluten intolerance or gluten sensitivity. If celiac tests run negative, other tests can still be performed.

Stage 1 of Celiac Diagnosis:

·       A Genetic Test must be run for the HLA fingerprint for both Celiac Genes – HLA-DQ2 & HLA-DQ8

·       A Celiac Antibody Assay Panel must be run, which should include all of the following: tTG – both IgA & IgG, EmA, ARA, AGA – IgG & IgA

·       Most clinics run a total Serum IgA which should include:

o      Anti-gliadin ELISA, IgA specfic (AGA-IgA) and Anti-gliadin ELISA

o      Anti-human tissue transglutaminase (Hu-tTG) ELISA, IgA Recombinant antigen

o      Anti-endomysial (EMA) antibody by Immunofluorescence Assay

·       Endoscopy – biopsy of villi (make sure your surgeon has experience taking celiac biopsy – it generally takes 12-18 months of training for accuracy)

Stage 2 of Celiac Diagnosis:

·       You must have one of the HLA fingerprint gene’s to have Celiac Disease. However, as of early 2000, ‘25-30% of people who do have the gene, don’t have Celiac Disease’*.

·       Positive Antibody Results:

o      Raised IgA antibodies indicate short term immune response

o      Raised IgG antibodies demonstrate long term immune response

o      Negative antibody tests (for both IgA & IgG) can be interpreted negative only if individual has consumed gluten regularlry for 3-6 months.

·       Alternative Test Result & Diagnosis

o      It’s important to note not all Celiac’s will have positive antibody results

§       IgA deficiency (exists in 1 out of 500-700 healthy blood donors)

o      Serological test can be a ‘false negative’ & if this is suspected an alternative serologic test can be conducted

o      Celiac Diagnosis 4 out of 5 can also be done from a positive:

§       Villi biopsy

§       Genetic test

§       Symptoms associated with Gluten Free Diet

§       Symptoms go away with implementation of strict gluten free diet

o      Negatives to villi biopsy & serological test could mean individual does not have active celiac disease. If the genetic test is positive, individual should continue serological testing into the future.

The next stage of testing:

Allergies (IgG & IgE) – an immunologist can give you more information. Symptoms can be from gluten or potentially other food proteins

Gluten Intolerance – Antibody test can be run: IgA antibody (AGA), anti-tissue transglutaminase antibody (ATTA), and anti-endomysial antibody (EMA). Positive results + reduction or elimination of gluten related symptoms = need for adherence to a strict gluten free diet.

Gluten Sensitivity – Diagnosed using a gluten elimination test. The black box of gluten reactions. If you eat gluten and it makes you sick, don’t eat it. If you can handle a little gluten, then only eat a little bit of it. This diagnosis can only be given if the celiac, gluten intolerance & allergy tests have negative results after consuming gluten for 3-6 months (1 slice of bread and a cookie – 3 to 6 months depending on which resource you observe)

Book Resources:

Kids with Celiac Disease by Danna Korn (2001)

Recognizing Celiac Disease – Libonati & Capuzzi (2007)

Web Resources:

http://www.celiacdiseasecenter.org/C_Doctors/C01-HOME.htm

http://www.csaceliacs.info/diagnosis_of_celiac_disease.jsp

http://www.cureceliacdisease.org/living-with-celiac/screening

http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/

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One Response to “Getting Tested for Celiac, Gluten Intolerance, Gluten Senstivity or Gluten Allergy: A Brief Analysis”

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  1. Happy Celiac Awareness Day! | Gluten Free Specialty Grocery Market - September 14, 2013

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