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If Your Body Is Making Anti-Gliadin Antibodies, Doesn't That Mean You're Gluten Sensitive?


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#16 U Gluten Free

 
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Posted 12 January 2013 - 10:33 AM

GottaSki,
I don't claim to be a clinician, and just rely on the published literature and information from celiac disease resource websites. However, it's well known that clinical guidelines are just guidelines. Physicians will use more or less diagnostic resources depending on several factors: particular case, personal preferences, ability to pay for tests. From what I can gather, anti-gliadin serology has poor specificity for celiac disease, and offers little extra value, except in special cases (such as IgA deficiency or diagnosis of infants).

Unfortunately, no test is 100% accurate, and the reliability depends both on the test itself and the particular testing laboratory used. There are several scientific reviews and articles which address the pros and cons of different diagnostic approaches. In general, these reviews are consistent with the two links I posted earlier.

One illustration of current practice would be the University of Chicago celiac disease Research Center, whose website states:

AGA are anti-food protein antibodies; as such, they are not indicative of any autoimmune reactions. They appear only if the patient has been eating gluten, but–and this is the point–they are not linked to any detectable adverse reaction to gluten. In other words, they can appear in individuals who eat gluten as a response to it touching the gut, but do not necessarily correlate with any clinical expressions.
Thus, patients with true non-celiac gluten sensitivity, patients with IBS and no gluten sensitivity, as well as individuals who are totally healthy (perhaps a bit less commonly, but not significantly so) may all have positive (or negative) AGA.
AGA should not be relied upon to prove or disprove the diagnosis of celiac disease or non-celiac gluten sensitivity.


As with everyone else on this forum, I'm here to learn, so please let me know if you have more information.
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#17 mushroom

 
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Posted 12 January 2013 - 11:56 AM

Ultimate Gluten Free, I'm glad you clarified that you were talking about the AGA IgA and IgG test only. Certainly I concur that this test is not used much any more since it has been replaced by the DGP (IgA and IgG), a test which some doctors are unfortunately reluctant to run.
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Neroli


"Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted." - Albert Einstein

"Life is not weathering the storm; it is learning to dance in the rain"

"Whatever the question, the answer is always chocolate." Nigella Lawson

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Caffeine free 1973
Lactose free 1990
(Mis)diagnosed IBS, fibromyalgia '80's and '90's
Diagnosed psoriatic arthritis 2004
Self-diagnosed gluten intolerant, gluten-free Nov. 2007
Soy free March 2008
Nightshade free Feb 2009
Citric acid free June 2009
Potato starch free July 2009
(Totally) corn free Nov. 2009
Legume free March 2010
Now tolerant of lactose

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#18 gatita

 
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Posted 12 January 2013 - 01:03 PM

"they are not linked to any detectable adverse reaction to gluten."

Arrggh. Feeling very frustrated right now that anti-gliadin IgA, total IgA, and ttg were the only tests my doctor ordered back in July before I went gluten-free.

Why did he bother with this test if it's meaningless?
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Diagnosed with wheat hates me 4/13


#19 mushroom

 
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Posted 12 January 2013 - 01:24 PM

The tests run were not all meaningless, gatita. The total IgA is important, and the tTG is commonly used as a 'screening' test in the (IMHO) mistaken belief that this test must be positive for you to have celiac disease. The pp is correct that the DGP has replaced the AGA testing because of its high degree of specificity for celiac disease but it is taking a while for the medical profession to 'relearn' what they 'know' about celiac disease. :(
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Neroli


"Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted." - Albert Einstein

"Life is not weathering the storm; it is learning to dance in the rain"

"Whatever the question, the answer is always chocolate." Nigella Lawson

------------

Caffeine free 1973
Lactose free 1990
(Mis)diagnosed IBS, fibromyalgia '80's and '90's
Diagnosed psoriatic arthritis 2004
Self-diagnosed gluten intolerant, gluten-free Nov. 2007
Soy free March 2008
Nightshade free Feb 2009
Citric acid free June 2009
Potato starch free July 2009
(Totally) corn free Nov. 2009
Legume free March 2010
Now tolerant of lactose

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#20 jebby

 
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Posted 12 January 2013 - 01:28 PM

"they are not linked to any detectable adverse reaction to gluten."

Arrggh. Feeling very frustrated right now that anti-gliadin IgA, total IgA, and ttg were the only tests my doctor ordered back in July before I went gluten-free.

Why did he bother with this test if it's meaningless?

Hi Gatita,
You may want to check with your lab to see what they mean by anti-gliadin antibodies....my recent labs were done through LabCorp through my M.D.s office and the results which were reported as anti-gliadin antibodies were actually DGP antibodies (as if things weren't confusing enough at baseline). So, perhaps you did actually have the right tests done.

Also, in response to the original post, I have been doing a lot of literature reviews on breastfeeding and gluten and Celiac Disease, and what I learned is that anti-gliadin antibodies are present in the breast milk of all women who consume gluten (even women without celiac disease or non-celiac gluten sensitivity). This supports the notion that very small titers of these antibodies are normal.
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#21 dilettantesteph

 
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Posted 12 January 2013 - 08:11 PM

I have seen this thread for awhile, but I didn't actually read it until now. My thinking on this is that if we are producing antibodies, we are reacting. What I think happened is that celiac disease was defined by GI docs by damage to the intestine observed by endoscopy. Sometimes antibodies were observed when GI damage to the intestine was not observed. By their definition, that could not be celiac disease. So, they had to come up with other reasons why the antibodies to gliadin might be elevated. None of those have made sense to me. I think that they don't want to admit that maybe the endoscopy doesn't pick up all damage that might be caused by the auto immune response to gluten. There is DH. There are many with a positive diagnosis for celiac disease because they had a positive test for DH, but a negative endoscopy. The GI docs had to admit that in this case, with DH, it is possible to have a negative endoscopy but still have celiac disease, but in every other case of a negative endoscopy, it isn't celiac disease. Gluten intolerance is a term given to those who experience negative symptoms in response to ingesting gluten, but do not have a positive endoscopy. Whether or not these people create antibodies to gluten is not defined.

I think that the auto immune response damages much more than just the intestine. Just look at all our symptoms, and look at how fast they come on when we get glutened. Surely they can't be just from nutritional deficiencies. I have heard neurologists who are convinced that it is the autoimmune response which is causing the problem. We need more immunologists studying this condition. We need more specialists besides just gastroenterologists looking at this.
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#22 plumbago

 
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Posted 13 January 2013 - 06:20 AM

Dr Hasan goes even further by asking - what if the three antibody tests are negative but I still suspect celiac disease?

He says that celiac disease is much more than just a GI disease, citing DH, too, and gluten ataxia, and many other cases. And he notes the nervous system has poor regenerative ability.

He cites the pyramid:
The tip of the iceberg is Active celiac disease - signs and symptoms, check; genetic, check; serology, positive; mucosal damage.

There is Potential - relatives and patients who are at high risk.

And with Latent celiac disease you have normal mucosa, but you have the genetics and presence of antibodies.

Silent celiac disease - with abnormal mucosa and no symptoms.

We need to treat the disease, not the mucosa, he says.

So in the case of suspecting celiac disease in the face of negative testing, Dr Hasan recommends doing a genetic study. If positive, go on a trial of gluten-free diet.

He says 20% of patients w/ DH, have normal mucosa.

Plumbago
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#23 mushroom

 
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Posted 13 January 2013 - 12:13 PM

He says that celiac disease is much more than just a GI disease, citing DH, too, and gluten ataxia, and many other cases. And he notes the nervous system has poor regenerative ability.


My own theory is that celiac disease is just one form of gluten intolerance :D
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Neroli


"Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted." - Albert Einstein

"Life is not weathering the storm; it is learning to dance in the rain"

"Whatever the question, the answer is always chocolate." Nigella Lawson

------------

Caffeine free 1973
Lactose free 1990
(Mis)diagnosed IBS, fibromyalgia '80's and '90's
Diagnosed psoriatic arthritis 2004
Self-diagnosed gluten intolerant, gluten-free Nov. 2007
Soy free March 2008
Nightshade free Feb 2009
Citric acid free June 2009
Potato starch free July 2009
(Totally) corn free Nov. 2009
Legume free March 2010
Now tolerant of lactose

Celiac.com - Celiac Disease Board Moderator

#24 Seeking2012

 
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Posted 13 January 2013 - 12:37 PM

...anti-gliadin antibodies are present in the breast milk of all women who consume gluten (even women without celiac disease or non-celiac gluten sensitivity).


Are they present in women who have been 100% gluten free for over 2 years?
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- Diagnosed Celiac in May 2014. Gluten-free diet immediately

- Tested VERY high for thyroid antibodies May 2014 but T4, T3 and TSH are in "normal" ranges

- Have experienced chronic fatigue and decreased cognitive and memory function for years

- Sister has been diagnosed with Celiac, autism, schizophrenia and depression

- Mom, dad and other sister are "weak positives" for Celiac
- Mom has been diagnosed with type 2 diabetes


#25 Seeking2012

 
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Posted 13 January 2013 - 01:42 PM

Here's my attempt. The numbers are mine, and not meant to refer to the sequence of your questions.

[1]
"When antigens (foreign substances that invade the body) are detected, several types of cells work together to recognize them and respond. These cells trigger the B lymphocytes to produce antibodies, specialized proteins that lock onto specific antigens.

"Once produced, these antibodies continue to exist in a person's body, so that if the same antigen is presented to the immune system again, the antibodies are already there to do their job. So if someone gets sick with a certain disease, like chickenpox, that person typically doesn't get sick from it again.

"This is also how immunizations prevent certain diseases. An immunization introduces the body to an antigen in a way that doesn't make someone sick, but does allow the body to produce antibodies that will then protect the person from future attack by the germ or substance that produces that particular disease.

"Although antibodies can recognize an antigen and lock onto it, they are not capable of destroying it without help. That's the job of the T cells, which are part of the system that destroys antigens that have been tagged by antibodies or cells that have been infected or somehow changed. (Some T cells are actually called "killer cells.") T cells also are involved in helping signal other cells (like phagocytes) to do their jobs.

"Antibodies also can neutralize toxins (poisonous or damaging substances) produced by different organisms. Lastly, antibodies can activate a group of proteins called complement that are also part of the immune system. Complement assists in killing bacteria, viruses, or infected cells.

"All of these specialized cells and parts of the immune system offer the body protection against disease. This protection is called immunity."

SOURCE: http://kidshealth.or...ics/immune.html

[2]
"Under certain situations, gliadin (digested gluten) can get to the lamina propria, where it will it will be deamidated (roughly: altered) by tissue transglutaminae (an enzyme). This is a very important step because deamidated gliadine can combine with HLA DQ2 and HLA-DQ8 (genetic markers) on the antigen-presenting cell (macrophages and B cells strategically located in places places antigens are likely to penetrate, including the GI tract) and then will be presented to the T cell, which will secrete cytokines."

From a grand rounds lecture, by Dr Hasan H. Hasan from a couple of years ago, who in turn got much of his information from Fasano (I think). I found it on iTunes U.

[3]
"Patients with Celiac disease create antibodies to gliadin, but these antibodies can also be found in other conditions and in normal people."

Celiac Disease: A Hidden Epidemic (not that much help if you ask me!)

[4]
But how did the immune system get confused and think that the "self" cells were antigens or pathogens?

Picking Dr Hasan back up again (and this is just a slightly educated guess to your question):
" The deamidated gliadin has high affinity for HLA2 and HLA8 (I think he means HLA DQ2, etc), which you have if you have Celiac disease. They are both on the antigen-presenting cell. Will be presented to the T cell. The T cell secretes cytokines which cause pathological changes we see in celiac disease. At the same time, it will also cause stimulation and expansion of B cells and B cells will produce the antibodies which we screen for when we try to diagnose celiac disease."


All of that does help me understand the subject better (I hope). What it sounds like to me, in very basic language, is this:

1. The presense of gliadin causes the intestine's epithelial cells to overproduce zonulin (why does this happen?)
2. Zonulin is a protein that causes the tight junctions between epithelial cells to open up.
3. Due to this opening, gliadin particles are allowed to reach the lamina propria, which is known to be an area that produces lots of antibodies.
4. While in the lamina propria, the body attempts to break down gliadin further because it is a long chain protein molecule that cannot be used by the body in its original amidated state. The enzyme tissue transglutamase deamidates (breaks down partly) the gliadin protein.
5. In people with the HLA-DQ2 and/or HLA-DQ8 halotype, their cells will recognize the deamidated (broken-down gliadin) protein as an antigen, and begin producing antibodies against it. Perhaps this is because those people who evolved the HLA-DQ2 and/or HLA-DQ8 halotype long ago were selected for some other reason (and the antibodies they make against self tissue were meant to attack a different antigen that looks like the self tissue) that has nothing to do with gliadin; perhaps it gave them an advantage in their original environment. Perhaps someone can clue me in as to the reason that the HLA-DQ2/DQ8 halotype would have been naturally selected and in what environment it would have been selected.
6. For some unknown/unclear (to me) reason, the body will then also produce antibodies against the enzyme that helped break down gliadin protein (tissue transglutaminase). Perhaps someone else can figure this part out.

All of this is just about convincing me to go into the field of biology; it is quite fascinating to me.

Dr. Alessia Fassano seems to believe that one of the solutions to fix this problem is a medication that suppresses the release of zonulin. Although this would allow people to eat gluten-containing foods without a reaction, it would also create a dangerous situation in which the body would not be able to send viruses and bacteria down to the lamina propria for destruction (unless I'm presenting this too simplistically).

Any comments/corrections/thoughts on this?
  • 0

- Diagnosed Celiac in May 2014. Gluten-free diet immediately

- Tested VERY high for thyroid antibodies May 2014 but T4, T3 and TSH are in "normal" ranges

- Have experienced chronic fatigue and decreased cognitive and memory function for years

- Sister has been diagnosed with Celiac, autism, schizophrenia and depression

- Mom, dad and other sister are "weak positives" for Celiac
- Mom has been diagnosed with type 2 diabetes


#26 gatita

 
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Posted 13 January 2013 - 11:26 PM

Hi Gatita,
You may want to check with your lab to see what they mean by anti-gliadin antibodies....my recent labs were done through LabCorp through my M.D.s office and the results which were reported as anti-gliadin antibodies were actually DGP antibodies (as if things weren't confusing enough at baseline). So, perhaps you did actually have the right tests done.


Alas, no, it was not DGP...
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Diagnosed with wheat hates me 4/13


#27 GottaSki

 
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Posted 13 January 2013 - 11:44 PM

Not to worry - I cannot recall your serology - but I think you have improved gluten-free? Blood data is good to have - yet is not the end of the equation.

Hang in - it does get better :)
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-Lisa

Undiagnosed Celiac Disease ~ 43 years

3/26/09 gluten-free - dignosed celiac - blood 3/3/09, biopsy 3/26/09, double DQ2 / single DQ8 positive

10/25/13 - MCAD

Health history since celiac diagnosis became too long -- moved to the "about me" section of my profile

My children and I all have multiple copies of the genes for Celiac Disease, along with large variety of symptoms/resolution gluten-free

Current tally from me, three kids and two grands: 4 diagnosed with Celiac Disease, 2 NCGS

Get PROPERLY tested BEFORE REMOVING GLUTEN.

ALWAYS independently research health related information found on internet forums/blogs.

"LTES" a Gem :)


#28 dilettantesteph

 
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Posted 14 January 2013 - 05:04 AM

My own theory is that celiac disease is just one form of gluten intolerance :D

Mine too.
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#29 plumbago

 
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Posted 14 January 2013 - 05:25 AM

Mine too.


Then what are the other forms of celiac disease? And, what is celiac disease?

Plumbago
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#30 GottaSki

 
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Posted 14 January 2013 - 05:45 AM

Then what are the other forms of celiac disease? And, what is celiac disease?

Plumbago


I think Mushroom means there are many forms of Gluten Intolerance -- one being Celiac Disease and I agree.
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-Lisa

Undiagnosed Celiac Disease ~ 43 years

3/26/09 gluten-free - dignosed celiac - blood 3/3/09, biopsy 3/26/09, double DQ2 / single DQ8 positive

10/25/13 - MCAD

Health history since celiac diagnosis became too long -- moved to the "about me" section of my profile

My children and I all have multiple copies of the genes for Celiac Disease, along with large variety of symptoms/resolution gluten-free

Current tally from me, three kids and two grands: 4 diagnosed with Celiac Disease, 2 NCGS

Get PROPERLY tested BEFORE REMOVING GLUTEN.

ALWAYS independently research health related information found on internet forums/blogs.

"LTES" a Gem :)





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