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  • Scott Adams

    Anti-tissue Transglutaminase Antibodies May Be Associated with Cow's Milk Protein in Addition to Gluten Intake

    Scott Adams
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    Reviewed and edited by a celiac disease expert.

      Study shows that levels of anti-tissue transglutaminase antibodies are not always related to gluten intake.


    Abandoned Milk Can. Image: CC BY 2.0--TunnelBug
    Caption: Abandoned Milk Can. Image: CC BY 2.0--TunnelBug

    Celiac.com 02/08/2021 - Anti-tissue transglutaminase antibodies (tTG) are a strong indicator of celiac disease, but positive anti-tTG antibodies have also been reported in some non-celiac patients. A team of researchers recently set out to examine positive anti-tTG antibodies that are not related to gluten intake.

    The research team included Mónica Garcia-Peris, Ester Donat Aliaga, María Roca Llorens, Etna Masip Simó, Begoña Polo Miquel, and Carmen Ribes Koninck.



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    They are variously affiliated with the Pediatric Service, Lluís Alcanyís Hospital, Xàtiva (Valencia), Spain; the Pediatric Gastroenterology Unit, Hospital Universitari i Politécnic La Fe, Valencia, Spain; and the Celiac Disease and Digestive Immunopathology Unit, Instituto de Investigación Sanitaria La Fe in Valencia, Spain.

    The research team performed a review and follow up of suspected celiac patients, who showed increased anti-tTG levels and gastrointestinal symptoms, but atypical blood screens, positive anti-tTG with gluten-free diet, along with decreased anti-tTG levels, independent of gluten intake.

    They reviewed cases for a total of 9 patients, all of whom were positive for HLA DQ2/DQ8. In 5 cases (Group A), patients showed Marsh 3 involvement in the initial biopsy, and were diagnosed with celiac disease. 

    Cow's Milk Protein Raises anti-tTG Levels
    Study subjects began diets that were both gluten-free, and free of cow's milk protein. When cow's milk protein was re-introduced, anti-tTG increased, and returned to normal after it was withdrawn again. 

    CMP-Free Diet Normalizes anti-tTG Levels
    Because the clinicians suspected a non IgE mediated CMP allergy in the other four patients with normal initial biopsy (Group B), that group did not eat a gluten-free diet, but did begin a cow's milk protein free diet. In this group, symptoms disappeared, and anti-tTG normalized on a non-gluten-free, cow's milk protein free diet. 

    Consuming cow's milk protein after an exclusionary diet can elevate anti-tTG levels in some celiac patients. 

    The elevation of anti-tTG levels by cow's milk protein can happen even without gluten ingestion. Researchers have seen this response in non-IgE mediated CMP allergy patients with positive HLA DQ2/DQ8.

    Discovering that consuming cow's milk protein after an exclusionary diet can elevate anti-tTG levels in some celiac patients gives clinicians one more thing to look for in their quest to diagnose and treat celiac disease. 

    Read more at ScienceDirect.com

    Edited by Scott Adams

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    For many years, I have noted a close association in people with "milk protein" intolerance and gluten sensitivity or intolerance.  I was wondering when the medical community would take notice. 

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    "Milk derived from cows fed pasture-based diets, is reported to have a higher fat and protein content with improved nutritional status (higher PUFA [polyunsaturated fatty acid] concentrations and better n-6:n-3 ratio) compared to milk that is derived from a TMR feeding system. Although TMR diets might provide improved ruminal conditions to enhance milk fat and protein yields, TMR can also produce milks with higher concentrations of SFA.[short chain fatty acids]" The “Grass-Fed” Milk Story: Understanding the Impact of Pasture Feeding on the Composition and Quality of Bovine Milk Mohammad Alothman 1 , Sean A. Hogan 1 , Deirdre Hennessy 2 , Pat Dillon 2 , Kieran N. Kilcawley 3 , Michael O’Donovan 2 , John Tobin 1 , Mark A. Fenelon 1 and Tom F. O’Callaghan 1,*

    "Schwendel, et al. [132] reported higher amounts of total αs1 and κ caseins in organic milk vs higher amounts of β-casein and β-lactoglobulin in conventional milk."  

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  • About Me

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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