So, by extension, serum AGA is an even worse predictor of outcome? So, if you need a of paper to wave at a family member or doctor to get care, I would think you would be more likely to get it from Enterolab than from, e.g., Labcorp. My point is, your advice to "save your money and try the diet" applies even more to serum AGA labs. That was the advice I took from a Celiac eye doctor in 2002, before either of us had ever heard of Enterolab.
The fecal AGA is a worse predictor of outcome than simply trying the diet. You gain nothing from buying Enterolab, unless you need a $300 piece of paper to wave at a family member or doctor to get care.
But, that was pretty much the picture in 2004, Dr. Fine saw a number of those points before then. For example, he was “not convinced that all gluten sensitivity is a result of TTG-driven autoimmune attack”:
I also think gluten sensitivity is a much broader set of reactions to wheat than just HLA-B mediated autoimmunity. Wheat germ agglutinin and gliadin peptides seem to have some inflammatory effects that are entirely different from the mechanisms of celiac disease. Because of that research, I'm not convinced that all gluten sensitivity is a result of TTG-driven autoimmune attack on the small intestinal mucosa. Wheat is allergenic as well, and the idea in the literature that most childhood wheat allergy resolves in adulthood is probably a little glib. On top of that, there is the issue of fructans in wheat and the millions of people with unrecognized fructose malabsorption. That's what I mean by the research being a bit of a quagmire.
You see a quagmire, 8 year later I see the swamp being drained, but IMO, Dr Fine’s sites needs more updating.
However, the most widely held and clinically troublesome misconception is that a negative screening blood test, or one only showing antigliadin antibodies (without the autoimmune antiendomysial or anti-tissue transglutaminase antibody) rules out any problem caused by gluten at that time or permanently.
Look, I’m all for encouraging the diet when obvious symptoms are there, but Dr. Fine is explicitly offering the test before there are obvious symptoms.