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    Do I have to Re-introduce Gluten in Order to have an Accurate Gluten Sensitivity Test Done?


    Dr. Tom O'Bryan
    Image Caption: Photo-CC-aldenchadwick_thumb.jpg

    Question:  Do I have to re-introduce gluten in order to have an accurate gluten sensitivity test done?
     Answer: Yes and No


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     If a person knows they are sensitive to gluten and have gone on a gluten-free diet, and want to know if they can have gluten again, then a  challenge is in order (reintroduce gluten). THIS IS STRONGLY NOT RECOMMENDED. The gluten challenge has many cases of people who were damaged (some permanently) from the reaction to reintroducing gluten Even Small Amounts of Gluten Cause Relapse in Children With Celiac Disease, Journal of Pediatric Gastroenterology and Nutrition 34:26­30,   and it is no longer a requirement for diagnosing celiac disease Am J Clin Nut 1999;69:354-65.

     Among 374 children in whom celiac disease was diagnosed before the age of 2, 5% developed an auto-immune disorder while on a gluten-free diet. Of those who went gluten-free, had years of no symptoms, then went back on a gluten-containing diet, 3.65% prevalence of systemic auto-immune disease with less than 12 months of eating gluten 9.1  % prevalence for 13-36 months of eating gluten again 26.3% prevalence for > 36 months of eating gluten again This means 1 out of 4 people who were sensitive to gluten, went gluten-free and eliminated all of their symptoms developed auto-immune diseases within 3 years of eating gluten again. Gastroenterology 1999;117:297-303.

     If you know you are Gluten Sensitive, and you've gone on a gluten-free diet, and you want to know "am I better", then testing will confirm you are being successful in 'quieting down' the inflammatory cascade that occurs with gluten sensitivity and which sets one up for the development of autoimmune disease.

     And if you want to 'throw the dice', if you want to gamble that you won't be the '1 out of 4' who develops an autoimmune disorder, then you would want to first check and make sure your tests are negative while being on a gluten-free diet, then do your gluten challenge and test again 1-2 months later. Once again, not recommended to do this.

     Many people do not develop celiac disease until later in life. So even if one tests negative now, if they're genetically vulnerable, celiac disease can develop at any time as a result of the body no longer able to handle the stress of life. Something will be the 'straw that broke the camels back' and a person who has had negative tests in the past will begin producing the antibodies and begin the tissue destruction that will eventually manifest as Gluten Sensitivity and/or celiac disease. So in this scenario, these people want to know if they're genetically vulnerable.

     The question is, am I sensitive to wheat?  When a test looking at Gluten Sensitivity comes back positive, it tells us the immune system is reacting to an exposure to gluten. And if you are not eating gluten, it's one of a few things:

    •  A hidden exposure to gluten
    •  A cross-reactive food
    •  A cross-reactive virus or bacteria
    •  A poorly functioning GI Tract (consider Array #2-Intestinal Antigenic Permeability Screen)
    • An unknown cause (potentially Refractory Sprue).

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    I agree wholeheartedly! Why take a risk of damaging your GI tract when it is unnecessary. I believe gluten is bad for most of us!

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    Guest Carolyn

    Posted

    Interesting article. Is there another way to determine if you have celiac disease without consuming gluten again?

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    I wish this article were more coherent. I've read it and I still don't know what sort of test I should get to find out if I'm gluten sensitive without doing a gluten challenge. I found the end particularly confusing. Very poorly written.

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    I wish this article were more coherent. I've read it and I still don't know what sort of test I should get to find out if I'm gluten sensitive without doing a gluten challenge. I found the end particularly confusing. Very poorly written.

    Vivian,

     

    You might want to look at the tests available through Enterolab. They can do a gene test to determine if you have one of the genes known to cause celiac disease, or if you have the genes that are known to cause gluten sensitivity/intolerance. They can also do other tests for immune response to gluten and a test for fat malabsorption. The tests are not diagnostic - but they can provide helpful information if you are not eating gluten. The website has a valuable FAQ that should answer your questions. I decided to test my kids when I found I carry one of the celiac genes. So far they don't have any immune response. Good luck!

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    I've suspected I had celiac for some time now. I had the blood test last year but I wasn't eating gluten, it was negative. Now the Gi doc wants to do a biopsy of my small intestine to see, she states that is the only way to tell if I have celiac. I read that I should not go on the diet until after the test, because it could come back negative again. I have been eating small amounts of gluten, with no major outbreaks. but I don't feel as well as when I am gluten free. This article gave no no clue as what to do. So I guess if I want to know for sure, which I do, I will continue to eat gluten until my test. I already have auto immune disease and I'm definitely not a child. Also my mom was gluten sensitive all her life, and my dad probably had it too, he had severe IBS. Odds are I am too.

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    Guest mcoffeesnob

    Posted

    I'm disappointed. The article does not answer the question: "Do I have to Re-introduce Gluten in Order to have an Accurate Gluten Sensitivity Test Done?" My suspicion is that if we are gluten-free for a certain period of time we don't have those antibodies there to TEST...so if we are gluten-free (it obviously makes us feel better) then how do we separate between a sensitivity and celiac without reintroducing?

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    I've suspected I had celiac for some time now. I had the blood test last year but I wasn't eating gluten, it was negative. Now the Gi doc wants to do a biopsy of my small intestine to see, she states that is the only way to tell if I have celiac. I read that I should not go on the diet until after the test, because it could come back negative again. I have been eating small amounts of gluten, with no major outbreaks. but I don't feel as well as when I am gluten free. This article gave no no clue as what to do. So I guess if I want to know for sure, which I do, I will continue to eat gluten until my test. I already have auto immune disease and I'm definitely not a child. Also my mom was gluten sensitive all her life, and my dad probably had it too, he had severe IBS. Odds are I am too.

    I'm in the same boat and going for the endoscopy tomorrow, I was told the only way to get a for sure answer is the endoscopy while eating gluten. As soon as I get tested, going gluten free, even if it tests negative... what a terrible way to do it tho, eat this, it'll make you feel like crap, but we can then diagnosis you! My dad has "IBS" but if I come back celiac I told him to get tested for it as well. I also have Grave's disease, an auto immune thyroid condition. Some of my other autoimmune bloods are coming back high. I think the biopsy will come back positive for celiac.

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    Blood test for genetic coeliac. blood test for TTG antibody ELISA. Eat gluten for 1 meal a day for 2 weeks (the most the average coeliac can bear - you'll feel miserable), have the gastroscopy (uses an endoscopy) and you'll have a certain result. I have had Graves disease and suspect genetic coeliac my entire life (constipation and gut pain since I can remember) and now at 43 finally found the symptoms match reaction to gluten. Only stopped (on my own diagnosis) gluten for 10 days and now my gastro asked me to start again just for 10 days before my gastroscopy. I had wheat laden bread (just a slice) at 11.30 am and by 4 pm I look 6mths pregnant (slim size usually) and gut pain and so tired I'm in bed. I'm not looking forward to the 10 days of pain but I put up with it previously for my life, so whats another 10 days to know for sure? Ive already stuffed up my insides and have Graves Disease so what's to loose? I want to know 100 percent if I'm giving up gluten for the rest of my life. Confusing article and not to directive on what to do, but hey! at least it got us all thinking, sharing and leaving a post to help each other. Good luck fellow bloaters, I'm looking forward to knowing coeliac or not. If I am then I know I can do a gluten free diet for life and you never know, I may for the first time this summer have no pot belly protruding from the top of the bikini - and no grumpiness from the pain. All good.

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    Guest Beverly Kendrick

    Posted

    I have reason to believe I'm celiac. I plan to have the test sometime this Fall. Looking back at some problems my relatives had, I think they had it too, but were told it was something else. I dread having to eat gluten. I have had allergy tests. I have allergies to at least 5 gluten free flours as well. I have allergies to many fruits and vegetables too.

    I listen to my body and I have found out many interesting facts. I have concerns for some of my other relatives too. that is why the test are important to me.

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    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
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    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
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    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
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    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics