Celiac disease
Gluten sensitivity part 3: living gluten-free
by Kate Whimster, BCom, MIFHI, ND
If you missed my previous blogs on this topics, check out Gluten sensitivity part 1: definitions, prevalence, presentation and Gluten sensitivity part 2: diagnosis.
Many people think that living gluten-free is impossible. While it can be difficult during the initial transition and to avoid gluten 100% (because it can be hidden in foods you don’t suspect - see below), for most people living nearly completely gluten-free is totally doable!
I’ve been avoiding gluten most of the time for many years, gradually getting closer and close to 100%. In my own life, I avoid gluten 100% in my own home and I make sure to avoid obvious gluten sources the majority of the time when I eat out. Because I am not celiac, this works for me, and I find this way of life quite easy, actually, as there are many other foods to eat.
In my practice, I have found that most patients that avoid gluten soon feel better, look better, lose weight more easily, and get into the habit of eating a wider variety of foods like fruits, vegetables, and other whole foods rather than bread, pasta, etc.
The most important key to success living gluten-free is NOT to just find substitutes for the gluten you used to eat (ie: replacing bread, pasta, cookies, cake, etc with gluten-free alternatives) but rather to rebalance your diet away from grains in favour of other food groups.
Treatment
For those with celiac disease, it is very important to follow a strict 100% gluten-free diet for the rest of their lives in order to regain the health of their digestive tract and avoid further damage and associated diseases. There are some celiac disease patients who will react to even the smallest amount of gluten and must therefore use completely separate cooking tools and utensils to prepare food and who cannot even tolerate gluten in the environment (ie: in the air, in personal care products such as toothpaste and shampoo, etc).
However, if you are gluten sensitive (which is still a much more fluid and less defined diagnosis), I believe it may be possible to reduce your sensitivity such that the reaction to gluten is less severe or possibly even eliminated. I recommend strict adherence to a gluten-free diet for at least 1 year while continuing with other naturopathic treatments to see major improvement and continuing almost completely gluten-free for 3-5 years, after which patients may be able to eat gluten again (as long as they are not celiac). However, keep in mind that this depends on the severity of gluten sensitivity and symptoms and it is important to test at the beginning of treatment and do follow-up testing to compare.
In both cases, treatment beyond diet is key to healing the digestive system. This is best accomplished via:
Here are some more detailed lists of gluten grains, places you may find hidden gluten (read labels and ask questions if you are not sure!), and gluten-free grains/starches:
Gluten grains:
If you missed my previous blogs on this topics, check out Gluten sensitivity part 1: definitions, prevalence, presentation and Gluten sensitivity part 2: diagnosis.
Many people think that living gluten-free is impossible. While it can be difficult during the initial transition and to avoid gluten 100% (because it can be hidden in foods you don’t suspect - see below), for most people living nearly completely gluten-free is totally doable!
I’ve been avoiding gluten most of the time for many years, gradually getting closer and close to 100%. In my own life, I avoid gluten 100% in my own home and I make sure to avoid obvious gluten sources the majority of the time when I eat out. Because I am not celiac, this works for me, and I find this way of life quite easy, actually, as there are many other foods to eat.
In my practice, I have found that most patients that avoid gluten soon feel better, look better, lose weight more easily, and get into the habit of eating a wider variety of foods like fruits, vegetables, and other whole foods rather than bread, pasta, etc.
The most important key to success living gluten-free is NOT to just find substitutes for the gluten you used to eat (ie: replacing bread, pasta, cookies, cake, etc with gluten-free alternatives) but rather to rebalance your diet away from grains in favour of other food groups.
Treatment
For those with celiac disease, it is very important to follow a strict 100% gluten-free diet for the rest of their lives in order to regain the health of their digestive tract and avoid further damage and associated diseases. There are some celiac disease patients who will react to even the smallest amount of gluten and must therefore use completely separate cooking tools and utensils to prepare food and who cannot even tolerate gluten in the environment (ie: in the air, in personal care products such as toothpaste and shampoo, etc).
However, if you are gluten sensitive (which is still a much more fluid and less defined diagnosis), I believe it may be possible to reduce your sensitivity such that the reaction to gluten is less severe or possibly even eliminated. I recommend strict adherence to a gluten-free diet for at least 1 year while continuing with other naturopathic treatments to see major improvement and continuing almost completely gluten-free for 3-5 years, after which patients may be able to eat gluten again (as long as they are not celiac). However, keep in mind that this depends on the severity of gluten sensitivity and symptoms and it is important to test at the beginning of treatment and do follow-up testing to compare.
In both cases, treatment beyond diet is key to healing the digestive system. This is best accomplished via:
- Avoidance of other food sensitivities that may be a problem (which will differ by patient)
- Supportive nutrition to reduce inflammation in the gastrointestinal tract, rebalance gut flora, and support healing of the absorptive surface of the intestines
- Concurrent treatment of any other health concerns
- Whole body detox and improvement of elimination organ functioning
Here are some more detailed lists of gluten grains, places you may find hidden gluten (read labels and ask questions if you are not sure!), and gluten-free grains/starches:
Gluten grains:
- Barley
- Bran
- Bulgar
- Couscous
- Durum flour
- Einkorn
- Emmer
- Farina
- Faro
- Graham flour
- Kamut
- Matzo flour/meal
- Orzo
- Panko
- Rye
- Seitan
- Semolina
- Spelt
- Triticale
- Udon
- Wheat
- Ales, beers, lagers
- Bouillon cubes, soup base
- Breading/coating mix
- Brown rice syrup
- Communion wafers
- Croutons
- Candy
- Chips/potato chips
- Luncheon meats, hot dogs, salami, sausage
- French fries
- Gravy
- Marinades, sauces
- Pasta
- Rice mixes
- Seasoned tortilla chips
- Stuffing
- Self-basting poultry
- Soy sauce (soy sauce is made of wheat, tamari sauce is made of soy!0
- Thickeners
- Prescription and over-the-counter medications (check out www.glutenfreedrugs.com)
- Vitamin, mineral, and herbal supplements
- Lipstick, lip gloss, balm
- Play Dough
- Shampoo and conditioner
- Toothpaste
- Amaranth
- Arrowroot
- Buckwheat
- Corn
- Flax
- Millet
- Montina
- Oats (if gluten-free, such as Bob’s Red Mill)
- Potato
- Quinoa
- Rice
- Sago
- Sorghum
- Soy
- Tapioca
- Teff
- Flours made from nuts, beans, seeds
Comments
Gluten sensitivity part 4: why?
by Kate Whimster, BCom, MIFHI, ND
This blog is all about “why.” As in, why (and how) do we become gluten sensitive and why does it matter?
If you missed my previous blogs on this topics, check out Gluten sensitivity part 1: definitions, prevalence, presentation, Gluten sensitivity part 2: diagnosis, and Gluten sensitivity part 3: living gluten-free.
Why are so many people gluten sensitive?
I am often asked: why so many people are gluten sensitive? It seems like just a few years ago this was a relatively rare diagnosis. Also, why might someone who has tolerated gluten his or her entire life suddenly become gluten sensitive? The short answer is that right now we cannot be sure of the exact causes. Really, gluten sensitivity, like most modern health issues, is due to many causes that come together to cause illness. Here are a few of my own thoughts on why more and more people are gluten sensitive:
Improved diagnostics:
The most obvious answer is that we are getting better and better at recognizing and diagnosing gluten sensitivity. Awareness has skyrocketed, so more people are getting tested and the tests are getting better. For more on diagnosis, see my blog Gluten sensitivity part 2: diagnosis
Higher gluten content in foods:?
I’ve heard some talk that foods we eat today contain higher gluten content than those same foods would have 10, 20, 30 years ago. Also, I’ve heard that the gluten content of grains in Europe is much lower (possibly due to greater restrictions on genetic modification) than in North America. I’ve not been able to find any real evidence to support this.
Immune system imbalance:
In people with gluten sensitivity, the immune system is no longer tolerating gluten (which is a non-harmful substance) and makes an response that causes damage to tissues. But why? This is really part of a larger problem of immune system dysfunction that may lie at the root of many chronic diseases (allergies, asthma, cancer, autoimmune disease, etc). Our immune systems simple do not develop the same way that they used to. Possible causes?
Digestive problems can be caused by poor diet, stress, toxins in the environment, poor elimination function, medications/drugs, chronic inflammation, food sensitivities, and many more factors. Specifically, intestinal permeability (also known as “leaky gut”) could explain why we begin reacting to gluten and also the reaction to gluten can cause leaky gut, so this is a vicious cycle.
A simplified explanation of “leaky gut”:
My simple answer to this question is that in the search for the root cause behind digestive issues, gluten sensitivity can be a valuable piece of the puzzle to help patients heal. In the long-term and with a view to disease prevention, gluten sensitivity can help understand other chronic illnesses. Research is still developing in this area, but thus far there is already lots of evidence to link gluten sensitivity with many other serious illnesses.
Diseases associated with gluten sensitivity:
This blog is all about “why.” As in, why (and how) do we become gluten sensitive and why does it matter?
If you missed my previous blogs on this topics, check out Gluten sensitivity part 1: definitions, prevalence, presentation, Gluten sensitivity part 2: diagnosis, and Gluten sensitivity part 3: living gluten-free.
Why are so many people gluten sensitive?
I am often asked: why so many people are gluten sensitive? It seems like just a few years ago this was a relatively rare diagnosis. Also, why might someone who has tolerated gluten his or her entire life suddenly become gluten sensitive? The short answer is that right now we cannot be sure of the exact causes. Really, gluten sensitivity, like most modern health issues, is due to many causes that come together to cause illness. Here are a few of my own thoughts on why more and more people are gluten sensitive:
Improved diagnostics:
The most obvious answer is that we are getting better and better at recognizing and diagnosing gluten sensitivity. Awareness has skyrocketed, so more people are getting tested and the tests are getting better. For more on diagnosis, see my blog Gluten sensitivity part 2: diagnosis
Higher gluten content in foods:?
I’ve heard some talk that foods we eat today contain higher gluten content than those same foods would have 10, 20, 30 years ago. Also, I’ve heard that the gluten content of grains in Europe is much lower (possibly due to greater restrictions on genetic modification) than in North America. I’ve not been able to find any real evidence to support this.
Immune system imbalance:
In people with gluten sensitivity, the immune system is no longer tolerating gluten (which is a non-harmful substance) and makes an response that causes damage to tissues. But why? This is really part of a larger problem of immune system dysfunction that may lie at the root of many chronic diseases (allergies, asthma, cancer, autoimmune disease, etc). Our immune systems simple do not develop the same way that they used to. Possible causes?
- Suppression of normal immune responses like fevers prevents the normal learning and development of the immune system. For more on this subject, see my blog Give me fever.
- Changes in management of minor illnesses (including the overuse of antibiotics) also impacts the normal development of the immune system. For more on this subject, see my blog Sick kids.
- Vaccinations at a young age supercede or alter the natural immune response to many common illnesses that we used to get during childhood. The subject of vaccines is large and is beyond the scope of this blog. However, I think is it clear that vaccines do not replicate the experience of actually having the same illness. Research in this area is constantly evolving, so there is still much debate about the long-term effects of vaccines.
- Finally, we simply do not get sick with the same things anymore! Our food and environment are highly sanitary, so we are exposed to many fewer pathogens and in North America, we are also far less likely than in the past to have parasitic infections. Again, this will effect the education of our immune systems.
Digestive problems can be caused by poor diet, stress, toxins in the environment, poor elimination function, medications/drugs, chronic inflammation, food sensitivities, and many more factors. Specifically, intestinal permeability (also known as “leaky gut”) could explain why we begin reacting to gluten and also the reaction to gluten can cause leaky gut, so this is a vicious cycle.
A simplified explanation of “leaky gut”:
- Junctions between cells lining the small intestine become permeable (due to factors listed above)
- This allows undigested food particles to enter bloodstream
- The immune system views these as “foreign” and creates immune response, causing inflammation and further damage
My simple answer to this question is that in the search for the root cause behind digestive issues, gluten sensitivity can be a valuable piece of the puzzle to help patients heal. In the long-term and with a view to disease prevention, gluten sensitivity can help understand other chronic illnesses. Research is still developing in this area, but thus far there is already lots of evidence to link gluten sensitivity with many other serious illnesses.
Diseases associated with gluten sensitivity:
- Autoimmune disorders (rheumatoid arthritis, lupus, Sjogren’s syndrome, thyroid autoimmunity, and likely many more)
- Bone disease (Osteoporosis, osteopenia, kyphoscoliosis, fractures)
- Anemia
- Infertility or repeated miscarriages
- Addison’s disease
- Down syndrome
- Intestinal cancer or lymphoma
- Lactose intolerance
- Thyroid disease
- Diabetes type I
- Low blood sugar (hypoglycemia)
- Liver disease
Gluten sensitivity, part 1: definitions, prevalence, presentation
by Kate Whimster, BCom, MIFHI, ND
What do osteoporosis, anemia, hypothyroidism, irritability, diarrhea, and constipation have in common? They are all signs and symptoms of gluten sensitivity. I’ve been meaning to write about this topic since I attended a seminar on gluten sensitivity in October 2009! A recent article in the Wall Street Journal called “Clues to Gluten Sensitivity” has helped me get in gear to cover this enormous topic. This is part 1 of a multi-part series of blogs I plan to write. Stay tuned for more!
What is gluten sensitivity?
As mentioned in the article linked above, it is important to understand the difference between celiac disease and gluten sensitivity. “Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.(1)” “Gluten sensitivity (GS) encompasses a collection of medical conditions in which gluten has an adverse effect.(2)” These medical conditions can be related to damage to the small intestine or may present in other ways.
Which foods contain gluten?
Gluten-containing foods:
Oats should technically be safe to eat on a gluten-free diet but most commercial oats are contaminated with gluten as they are farmed, transported, and packaged. You can buy gluten-free oats, such as Bob’s Red Mill Gluten-Free Oats. A small number of gluten sensitive people may also be sensitive to oats, so it is important to assess this for each patient individually.
Prevalence
This information is specific to celiac disease (see definition above), but still gives a good idea of the prevalence and importance of diagnosis.
Prevalence of celiac disease (3):
Those diagnosed with celiac disease between 2-4 years of age had a 10.5% chance of developing an autoimmune disorder. Additional findings show that the later one is diagnosed, the more likely her or she is to develop and autoimmune condition (5):
Age at diagnosis and chance of developing an autoimmune condition:
4-12 yrs: 16.7%
12-20 yrs: 27%
Over 20 yrs: 34%
As is now becoming clear, patients may have “silent” or atypical form that presents with no gastrointestinal symptoms. (6)
(7)
Signs and symptoms
Signs and symptoms of celiac disease (1):
Signs and symptoms of “silent” celiac disease (8):
Children:
References:
What do osteoporosis, anemia, hypothyroidism, irritability, diarrhea, and constipation have in common? They are all signs and symptoms of gluten sensitivity. I’ve been meaning to write about this topic since I attended a seminar on gluten sensitivity in October 2009! A recent article in the Wall Street Journal called “Clues to Gluten Sensitivity” has helped me get in gear to cover this enormous topic. This is part 1 of a multi-part series of blogs I plan to write. Stay tuned for more!
What is gluten sensitivity?
As mentioned in the article linked above, it is important to understand the difference between celiac disease and gluten sensitivity. “Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.(1)” “Gluten sensitivity (GS) encompasses a collection of medical conditions in which gluten has an adverse effect.(2)” These medical conditions can be related to damage to the small intestine or may present in other ways.
Which foods contain gluten?
Gluten-containing foods:
- Wheat (all forms, including durum, semolina, spelt, kamut, couscous, bulgar, etc)
- Rye
- Barley
Oats should technically be safe to eat on a gluten-free diet but most commercial oats are contaminated with gluten as they are farmed, transported, and packaged. You can buy gluten-free oats, such as Bob’s Red Mill Gluten-Free Oats. A small number of gluten sensitive people may also be sensitive to oats, so it is important to assess this for each patient individually.
Prevalence
This information is specific to celiac disease (see definition above), but still gives a good idea of the prevalence and importance of diagnosis.
Prevalence of celiac disease (3):
- In average healthy people: 1 in 133
- In people with related symptoms: 1 in 56
- In people with first-degree relatives (parent, child, sibling) who are celiac: 1 in 22
- In people with second-degree relatives (aunt, uncle, cousin) who are celiac: 1 in 39
- 60% of children and 41% of adults diagnosed during the study were asymptomatic (without any symptoms).
Those diagnosed with celiac disease between 2-4 years of age had a 10.5% chance of developing an autoimmune disorder. Additional findings show that the later one is diagnosed, the more likely her or she is to develop and autoimmune condition (5):
Age at diagnosis and chance of developing an autoimmune condition:
4-12 yrs: 16.7%
12-20 yrs: 27%
Over 20 yrs: 34%
As is now becoming clear, patients may have “silent” or atypical form that presents with no gastrointestinal symptoms. (6)
(7)Signs and symptoms
Signs and symptoms of celiac disease (1):
- Abdominal pain, bloating, gas, or indigestion
- Constipation
- Decreased appetite (may also be increased or unchanged)
- Diarrhea, either constant or off and on
- Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)
- Nausea and vomiting
- Stools that float, are foul smelling, bloody, or “fatty”
- Unexplained weight loss (although people can be overweight or of normal weight)
Signs and symptoms of “silent” celiac disease (8):
Children:
- Short stature
- Anemia
- Neurologic symptoms
- Dermatitis herpetiformis
- Anemia
- Reduced bone density (osteopenia/osteoporosis)
- Apthous stomatitis, dental enamel defects
- Infertility, recurrent miscarriage
- Irritable bowel syndrome (IBS)
- Dyspepsia
- Esophageal reflux
- Neurologic symptoms
- Autoimmune diseases
References:
- http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001280/
- http://en.wikipedia.org/wiki/Gluten_sensitivity
- Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.
- Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, Mcmahon DJ, Absan H, Neugut AI. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol. 2001 Jan;96(1):126-31.
- Ventura A, Magazzù G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology. 1999 Aug;117(2):297-303.
- Sanders DS, Hurlstone DP, McAlindon ME, Hadjivassiliou M, Cross SS, Wild G, Atkins CJ. Antibody negative coeliac disease presenting in elderly people--an easily missed diagnosis. BMJ. 2005 Apr 2;330(7494):775-6.
- Feighery C. Fortnightly review: coeliac disease. BMJ. 1999 Jul 24;319(7204):236-9.
- Green PH, Alaedini A, Sander HW, Brannagan TH 3rd, Latov N, Chin RL. Mechanisms underlying celiac disease and its neurologic manifestations. Cell Mol Life Sci. 2005 Apr;62(7-8):791-9.
Gluten sensitivity part 2: diagnosis
by Kate Whimster, BCom, MIFHI, ND
It’s now been over a year since my first blog about gluten sensitivity, so it’s about time to follow that up with more information! If you’d like a refresher, check out Gluten sensitivity part 1: definitions, prevalence, presentation.
Definitions:
Common:
Diagnosis seems to be constantly changing and evolving, so I’ll share what my current knowledge is on the subject from my own experience being tested and what I use with my patients.
Diagnosis of Celiac Disease:
To unequivocally diagnose celiac disease, a patient must complete 3 steps:
1. Blood tests: must be eating gluten regularly (I recommend at least 1 serving daily for at least 3-4 weeks) before testing
3. Positive results from a gluten-free diet
Diagnosis of Gluten Sensitivity:
Gluten sensitivity is often a diagnosis of exclusion, meaning that you have to rule-out celiac disease while still demonstrating a reaction to gluten and improvement in symptoms when the patient avoids gluten.
1. Blood tests: must be eating gluten regularly (I recommend at least 1 serving daily for at least 3-4 weeks) before testing
What do I use in my practice?
I’ve used 3 different tests in my practice so far, but I haven’t settled on just one because they each have advantages and disadvantages.
1. CELIACSURE
This is an in-office test for tissue transglutaminase (tTG) only and can be completed with quick results in-office at a reasonable price.
The advantage is quick diagnosis using only a finger-prick while the patient is still eating gluten. The disadvantage is that tissue transglutaminase (tTG) antibodies may be negative while other antibodies (such as deamidated gliadin peptide (DGP)) are positive, so even with a negative result, further testing is indicated to really rule-out gluten sensitivity or celiac disease.
2. Gamma Dynacare Celiac Profile Panel
This is how I tested myself because it includes the combination of 4 tests that is currently considered to be the most comprehensive: total IgA, transglutaminase IgA, deamidated gliadin IgA, deamidated gliadin IgG.
The advantage is that it is most complete and highly accurate as long as the patient is eating gluten daily for 3-4 weeks before testing. None of these tests cover endomysial antibodies, but this test can be added onto the Gamma Dynacare testing at additional cost. The disadvantage is that this test is more expensive, involves a blood draw rather than finger-prick, and I have to send patients to a Gamma Dynacare lab location for the blood draw, which also involves a collection fee.
This is currently my test of choice because it minimizes the need for future testing, although the test below is also a great option.
3. Rocky Mountain Analytical Celiac Profile
I’ve recently ordered some of these test kits for in-office finger-prick blood collection that then needs to be sent away for results. This kit tests tissue transglutaminase, gliadin IgA, and gliadin IgG.
The advantage is an easier in-office finger-prick collection that covers 3 key tests at a lower price than the Gamma Dynacare testing. For most people this testing is sufficient and at a lower price without having to do a full blood draw at a lab. The disadvantage is that testing gliadin rather than deamidated gliadin is less sensitive and specific and this test does not include total IgA (which is helpful to rule-out IgA deficiency).
References:
It’s now been over a year since my first blog about gluten sensitivity, so it’s about time to follow that up with more information! If you’d like a refresher, check out Gluten sensitivity part 1: definitions, prevalence, presentation.
Definitions:
- Celiac disease is a condition in which eating gluten causes damage to the small intestine which impacts the ability to absorb nutrients from food
- Gluten sensitivity is less specific - it includes medical conditions which are caused by and made worse by exposure to gluten and covers patients who feel better while gluten-free but may not fit the definition of celiac disease
Common:
- Diarrhea
- Fatigue
- Borborygmus (fun word for rumbling or gurgling in the abdomen)
- Abdominal pain
- Weight loss
- Abdominal distention/bloating
- Flatulence
- Irritability, mood swings (especially children)
- Short stature
- Osteopenia/osteoporosis (especially premature)
- Abnormal liver function
- Nausea, vomiting
- Iron-deficiency anemia
- Neurological dysfunction
- Constipation
Diagnosis seems to be constantly changing and evolving, so I’ll share what my current knowledge is on the subject from my own experience being tested and what I use with my patients.
Diagnosis of Celiac Disease:
To unequivocally diagnose celiac disease, a patient must complete 3 steps:
1. Blood tests: must be eating gluten regularly (I recommend at least 1 serving daily for at least 3-4 weeks) before testing
- Serum immunoglobulin A (IgA) must be normal (rule-out IgA deficiency)
- Endomysial antibodies (IgA)
- Tissue transglutaminase (tTG) IgA antibodies
3. Positive results from a gluten-free diet
Diagnosis of Gluten Sensitivity:
Gluten sensitivity is often a diagnosis of exclusion, meaning that you have to rule-out celiac disease while still demonstrating a reaction to gluten and improvement in symptoms when the patient avoids gluten.
1. Blood tests: must be eating gluten regularly (I recommend at least 1 serving daily for at least 3-4 weeks) before testing
- Serum immunoglobulin A (IgA) must be normal (rule-out IgA deficiency)
- Deamidated gliadin peptide (DGP) IgA and IgG are considered more sensitive and specific than gliadin antibodies (1) especially if other tests are normal
- Endomysial antibodies (IgA) and/or tissue transglutaminase (tTG) IgA antibodies may be negative
What do I use in my practice?
I’ve used 3 different tests in my practice so far, but I haven’t settled on just one because they each have advantages and disadvantages.
1. CELIACSURE
This is an in-office test for tissue transglutaminase (tTG) only and can be completed with quick results in-office at a reasonable price.
The advantage is quick diagnosis using only a finger-prick while the patient is still eating gluten. The disadvantage is that tissue transglutaminase (tTG) antibodies may be negative while other antibodies (such as deamidated gliadin peptide (DGP)) are positive, so even with a negative result, further testing is indicated to really rule-out gluten sensitivity or celiac disease.
2. Gamma Dynacare Celiac Profile Panel
This is how I tested myself because it includes the combination of 4 tests that is currently considered to be the most comprehensive: total IgA, transglutaminase IgA, deamidated gliadin IgA, deamidated gliadin IgG.
The advantage is that it is most complete and highly accurate as long as the patient is eating gluten daily for 3-4 weeks before testing. None of these tests cover endomysial antibodies, but this test can be added onto the Gamma Dynacare testing at additional cost. The disadvantage is that this test is more expensive, involves a blood draw rather than finger-prick, and I have to send patients to a Gamma Dynacare lab location for the blood draw, which also involves a collection fee.
This is currently my test of choice because it minimizes the need for future testing, although the test below is also a great option.
3. Rocky Mountain Analytical Celiac Profile
I’ve recently ordered some of these test kits for in-office finger-prick blood collection that then needs to be sent away for results. This kit tests tissue transglutaminase, gliadin IgA, and gliadin IgG.
The advantage is an easier in-office finger-prick collection that covers 3 key tests at a lower price than the Gamma Dynacare testing. For most people this testing is sufficient and at a lower price without having to do a full blood draw at a lab. The disadvantage is that testing gliadin rather than deamidated gliadin is less sensitive and specific and this test does not include total IgA (which is helpful to rule-out IgA deficiency).
References:
