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    Do you have questions about celiac disease or the gluten-free diet?

  • Scott Adams
    Scott Adams

    Celiac Disease Treatment

    Celiac.com 02/08/2007 - There is presently no cure for celiac disease. Celiac patients can vary greatly in their tolerance to gluten. Some patients may not notice any symptoms when they ingest tiny amounts of gluten, for example if something they ingest has been cross-contaminated, while others suffer pronounced symptoms after ingesting even the slightest amount of gluten.

    Avoiding gluten is crucial

    A life-long diet free of gluten is the standard treatment for celiac disease. To manage the disease and prevent complications, its essential to avoid all foods that contain gluten. That means it is crucial to:

    • Avoid all foods made with wheat, rye, or barley. Including types of wheat like durum, farina, graham flour, and semolina. Also, bulgur, kamut, kasha, matzo meal, spelt and triticale. Examples of products that commonly contain these include breads, breading, batter, cereals, cooking and baking mixes, pasta, crackers, cookies, cakes, pies and gravies, among others.
    • Avoid oats, at least during initial treatment stages, as the effects of oats on celiac patients are not fully understood, and contamination with wheat in processing is common. So, its best to eliminate oats at least until symptoms subside and their reintroduction into the diet can be fairly monitored and evaluated.
    • Avoid processed foods that may contain hidden gluten. Wheat is commonly used in many processed foods that one might never suspect. A few examples include:
      • candy bars
      • canned soup
      • canned meat
      • energy bars
      • ketchup
      • ice cream
      • instant coffee
      • lunch meat
      • mustard
      • pastas
      • processed meat
      • sausages
    • Avoid capsules and tablets that contain wheat starch, which is a common used binding agent in their production. Gluten is also commonly found in many vitamins and cosmetics, such as lipstick.
    • Avoid beer (wine, brandy, whiskey and other non-wheat or barley alcohols are okay).
    • Eat a diet rich in fish, fresh meats, rice, corn, soybean, potato, poultry, fruits and vegetables.
    • Avoid milk and other dairy products, as it is common for patients with untreated celiac disease to be lactose intolerant. Successful treatment often means dairy products can be slowly reintroduced into the diet over time.
    • Identify gluten-free foods. Because a gluten-free diet needs to be strictly followed, and because food ingredients may vary from place to place and even over time for a given product, it is important to always read the label. Consider purchasing commercial listings of gluten-free foods and products. For specific advice on adopting, shaping and maintaining the gluten-free diet that is right for you, you may wish to consult a registered dietitian who is experienced in teaching the gluten-free diet.
    • Always read labels, as ingredients often change over time and products that that were once gluten-free may be reformulated and now include gluten in some form. Products that are gluten-free in one country are sometimes not gluten-free in another.

    Most patients who remove gluten from their diets find that their symptoms improve as inflammation of the small intestine begins to subside, usually within several weeks. Many patients who adopt a gluten-free diet report an improvement within 48 hours.

    Results of a gluten-free diet can be especially dramatic in children with celiac disease. Not only does their diarrhea and abdominal distress usually subside but, frequently, their behavior and growth rate are often markedly improved.

    A reappearance of intestinal villi nearly always follows an improvement in symptoms.

    In younger people, the villi may complete healing and regrowth in several months, while in older people, the process may take as long as two to three years.

    In cases where nutritional deficiencies are severe, celiac patients may require vitamin and mineral supplements to help bring about a healthier vitamin profile: folic acid and B12 for patients with anemia due to folate or B12 deficiency; vitamin K for patients with an abnormal ProTime; calcium and vitamin D supplements for patients with low blood calcium levels or with osteoporosis. For all such cases, individuals should consult their health professional.

    Skin lesions common in patients with dermatitis herpetiformis often improve with adherence to a gluten-free diet.

    For patients with celiac disease, the importance of maintaining a life-long diet free of gluten can hardly be over-stressed. Research indicates that only half of those patients who have had celiac disease for at least 20 years were following a strict gluten-free diet. Up to 30% of those patients showed evidence of bone loss and iron deficiency. These are but a few of the long-term consequences for celiac patients failing to follow a gluten-free diet.

    health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.

     



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    It's very interesting. I would like to forward this text to a friend in Europe but she can't understand neither English or French language.

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    I found this very informative and found all the information I was looking for as I have had symptoms of celiac deficiency and did not know how to proceed I will now have a test to find out if I have this. Excellent website.

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    It's very interesting. I would like to forward this text to a friend in Europe but she can't understand neither English or French language.

    Haha, thats funny. I have the same problem. I have a friend in America who can speak neither English nor redneck.

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    Thank you for the great article, Scott!

    It is very important to treat celiac disease because if left untreated, celiac disease can lead to some serious problems. In children especially the disease can lead to problems with bone development and can be very damaging. Here are some other possible complications of celiac disease:

     

    Weight loss and, in children, stunted growth

    Osteoporosis

    Iron deficiency anaemia

    Loss of tooth enamel

    Damage to the intestines

    Rectal prolapse

    Infertility

    Anxiety and depression

    Lymphoma

    Good Luck to Everyone!

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  • About Me

    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

  • Related Articles

    Scott Adams
    Celiac.com 01/11/2005 - After being diagnosed with celiac disease and going on a 100% gluten-free diet, make sure your doctor: Tests your bone density (osteoporosis is more likely in those with untreated celiac disease); Tests your blood for iron and folate deficiencies; Vaccinates you for pneumococcal disease (serious infections are common in immune-stressed individuals. This step will vary with your overall condition upon diagnosis and may not be necessary). Other recommendations for initial management of celiac disease:
    Referral to a dietitian and support group; Ensure all regular medications are gluten-free; If osteoporosis is found, assess vitamin D and parathyroid hormone concentrations; Blood screening of your parents, children, brothers and sisters for celiac disease. Check the Diseases and Disorders Associated with Celiac Disease section of Celiac.com and if you have any other health problems listed in that section be sure to discuss this with your doctor. Many people with celiac disease have additional food intolerance, and therefore never fully recover on a gluten-free diet alone. If you fall into this category try the following:
    Re-check your diet and make sure it is 100% gluten-free; Food allergy testing (finger-stick or ELISA); An elimination diet; Keep a food diary; Try a rotation diet--only eating the top food allergens once every few days. The most common additional food intolerance are: Cows milk, corn, soy and eggs. Many people who have had difficulty recovering from celiac disease have found that maintaining a "paleo" perspective which favors unprocessed meats, vegetables, and fruits while avoiding all grains, is the final step necessary for a complete recovery.
    For more information on this topic the Winter 2005 edition of Scott-Free Newsletter has an excellent article: Putting the Pieces Back Together by Roy S. Jamron, which is available on-line to all subscribers. A special thanks to Ron Hoggan for providing me with some of the information that appears in this article.

    Scott Adams
    Celiac.com 03/26/2007 - Ongoing digestive symptoms and other systemic problems for individuals with Celiac Disease who are on a gluten free diet are fairly common. While Celiac Disease itself is becoming more widely recognized, its effects on multiple parts of the body and its ongoing symptoms remain more obscure. While this article is not meant to provide medical advice, it is intended to provide a summary of possible causes that you and your health care provider may want to explore further. Celiac Disease Follow Up Treatment
    After a diagnosis of Celiac Disease is made, additional follow up tests are recommended immediately after diagnosis and on an ongoing basis. These include:
    Blood work for vitamin and mineral deficiencies Thyroid Screen (note: Patients on thyroid replacement and other medications may need frequent Monitoring for dosage adjustment as their absorption improves.) Bone density scan Liver enzymes Research from Stanford University School of Medicines Celiac Management Clinic is noting continued absorption problems with many individuals who are on a gluten free diet. A 72 hour quantitative fecal fat test and a 25-gram xylose sugar absorption test can help diagnose continued absorption problems.
    Healing progress on the gluten-free diet may be monitored by re-testing whichever diagnostic blood test was initially highest, at an interval of 6 - 12 months. Children are likely to heal within a few months; adults may take a few years, and some may never totally heal.
    Note: Calcium and Iron status will improve in most individuals even without supplements once the intestine heals. Several doctors recommend NOT prescribing drugs such as Fosamax and Evista until after the intestine heals and more calcium is being absorbed from the diet.
    Celiac Disease and Ongoing Symptoms After a Gluten-Free Diet
    Most individuals will experience a significant decrease of symptoms within a few weeks or months of starting a gluten free diet. However, some individuals may continue to experience significant digestive problems or may have a relapse of symptoms. Some possible explanations are summarized below:
    Hidden Gluten Exposure
    Look for any possible sources of gluten exposure. Binders in medication, cross contamination, misunderstanding of the strictness required of the diet, etc. should be explored. Repeat blood tests might give an indication of continued gluten exposure; however these may not be sensitive enough to note low level exposure.
    Lactose Intolerance
    Especially during the healing phase of celiac disease, intolerance to lactose, a protein found in dairy products, may be seen. Enzymes needed to digest lactose are manufactured by the intestinal villi, which have been damaged by exposure to gluten. Often once the villi have regrown, symptoms of lactose intolerance will subside. Testing includes Lactose H2 breath testing. Suggested treatment includes using an over-the-counter lactose enzyme when ingesting dairy products. Re-colonizing the small intestine with beneficial bacteria (see probiotics, below) is also recommended.
    Helicobacter Pylori
    A study by Villanacci, et. al, published 8/28/2006 in the American Journal of Gastroenterology noted that 44% of individuals diagnosed with celiac disease tested positive for Helicobacter Pylori at the time of, or within 1 year of their celiac disease diagnosis.
    Small Bowel Bacterial Overgrowth
    In a report published in the American Journal of Gastroenterology, Vol. 98, No. 4, 2003 of 15 persons with continuing symptoms, 10 showed evidence of overgrowth of bacteria within the small bowel. Testing included Lactulose H2 breath testing. Suggested treatment includes the non-systemic, prescription antibiotic, Rifaximin (800 mg. per day for one week). Note that the antibiotic used is called Rifaximin in England and Xifaxam in the U.S. Digestive function should also be evaluated as the underlying cause of SBBO.
    Yeast Overgrowth
    Some individuals report continuing symptoms due to overgrowth of yeast. Testing includes blood antibody testing for Candida. Suggested treatment includes ½ tsp Nystatin powder (mix with water), twice a day and 200 mg Ketoconizole once per day for 2-3 months. Monthly liver function testing during treatment is recommended. Nystatin powder may be ordered, by prescription, through pharmacies which offer custom compounding of medications. Digestive function should also be evaluated as the underlying cause of yeast overgrowth. Dietary changes may also be considered.
    Other Food Sensitivities
    Additional IgG food sensitivities may be seen. An IgG sensitivity is different from the IgE allergies most allergy doctors check for. Common food sensitivities include dairy casein, corn, soy and eggs. Treatment includes avoiding the food, and food rotation. There are some reports of a reduction of food sensitivities when digestive function improves.
    Digestive Function
    Multiple problems with digestive function may be found. A complete evaluation should be done. One source for a comprehensive stool analysis may be obtained, by mail and by prescription.
    Intestinal Motility
    Increased intestinal motility may contribute to continuing diarrhea. Try reducing motility by using a fiber supplement like Benefiber or Citracel. Particularly in individuals who have had their gall bladder removed, consider Cholestid, a prescription drug used for lowering cholesterol, which may also slow motility. It acts by binding to irritating bile salts.
    Decreased Stomach Acid
    Low stomach acid (hypochlohydria) may interfere with the effectiveness of ones own digestive enzymes and may create an environment that encourages yeast or bacterial overgrowth. Additional information may be found in the book "Why Stomach Acid is Good for You" by Wright & Lenard. Testing may be done using the Heidleberg Capsule or Gastrocap tests. Supplemental Betaine HCl, bitters, digestive enzymes and probiotics, available at a health food store, may be helpful.
    Beneficial Bacteria
    Probiotics are very helpful for regaining the balance of the intestinal flora. Use ones that have multiple kinds of bacteria. The ones found in the refrigerated section of health food stores will have the highest level of bacteria. Kefir, raw kimchee and raw sauerkraut, also found in the refrigerated section, have high levels of active cultures.
    Digestive Enzymes
    Pancreatic enzymes assist with more complete digestion, discouraging unhealthy bacterial growth. Recommendations have been made for the vegetable based enzymes Which may be ordered through the internet or found in health food stores. Animal derived enzymes are available by prescription. Experiment to see what works best. To avoid heartburn, start by sprinkling ½ of a capsule on food & increase as needed and tolerated. Be sure to carefully check the Gluten-Free status of all enzymes. It is common for the Maltase to be made from barley.
    Carbohydrate intolerance
    Some individuals do not digest carbohydrates and sugars well. The undigested carbohydrates encourage the growth of harmful yeasts and bacteria. More information on a diet low in carbohydrates may be found in the book "Breaking the Vicious Cycle" by Gottschall. She recommends eliminating all complex carbohydrates to kill off the bad bacteria.
    Parasites and other bacterial problems
    Check for parasites and other bacterial problems, including Giardia lamblia and Ascaris lumbricoides. Just because an individual has celiac disease, doesnt mean they cant have the bugs that a normal person with diarrhea may have!
    Other Autoimmune Diseases
    At least 1/3 of the people diagnosed with celiac disease as adults will also have another autoimmune disease. Many report a significant improvement in their other autoimmune disease after beginning a gluten free diet. However, some individuals with celiac disease may develop other autoimmune diseases even after beginning a gluten free diet. Watch for Type 1 diabetes, liver, thyroid, pancreas and adrenal diseases, peripheral and central nervous system damage, connective tissue and other rheumatoid inflammations.
    Ms. Anderies also serves as a member of the Denver Metro Chapter of CSA/USA Medical Education Committee

    Dr. Scot Lewey
    This article appeared in the Spring 2008 edition of Celiac.com's Scott-Free Newsletter.
    Celiac.com 08/17/2008 - Are you confused about genetic testing for celiac disease? Do you want to know what tests you should request and which laboratory to use?  Have you already had celiac DQ genetic testing but are not sure what the results mean or what your risk is of developing celiac disease or gluten sensitivity? These are the questions I will answer in the next few pages. 
    What is HLA DQ celiac genetic testing?
    To understand celiac DQ genetics and the risk estimates you must also understand how the DQ types are determined and some basic terminology.  Each of us has 46 chromosomes, 23 pairs received from our parents.  We all have two copies of chromosome 6, one from each parent.  Homozygous is when a person has two copies of the same gene, one from each parent.  Our white blood cells (leukocytes) have proteins called human leukocyte antigens or HLA proteins that are inherited from our parents.  The genetic code that determines our HLA patterns resides on chromosome 6.  We all have two DQ patterns, one from each of parents, such that we are all DQx/DQx, where x is a number between 1 and 9.  I am DQ2/DQ7 and my wife is DQ2/DQ5.  We are both therefore heterozygous for DQ2.  That is, we have only one copy of DQ2.  Scott Adams, the founder of celiac.com is DQ8/DQ8.  He is homozygous for DQ8.  There are several HLA patterns.  Some are proteins that reside within cells and others are on the outer surface of cells, and are called class II.  The class II HLA proteins have very important immune functions.  There are several class II HLA protein types but DQ have been found to be important in celiac disease, specifically DQ2 and DQ8. 
    What does it mean to be homozygous or heterozygous for celiac genes?
    Homozygous means that you have two copies e.g.  DQ2/DQ2, DQ8/DQ8 whereas heterozygous means you have one copy of DQ2 or DQ8.  Some people have one copy of DQ2 and one of DQ8 (DQ2/DQ8) and they have a greater risk for celiac disease than someone with only one copy of either DQ2 or DQ8 but not as great a risk as someone with two copies of DQ2 (DQ2/DQ2).  Since DQ2 is associated with a greater risk of celiac disease than DQ8, then one copy of DQ2 plus a DQ8 (DQ2/DQ8) indicates a higher risk than having two copies of DQ8 (DQ8/DQ8).  Hopefully, I have not lost you yet but if I have please continue to read on because the information that follows will still be helpful to you.
    What is this alpha and beta subunit typing and why is it important?
    HLA DQ typing consists of two subunits of the DQ molecule, an alpha and beta subunit.  So, both DQ types that indicate a risk of celiac disease, DQ2 and DQ8, are made up of two protein subunits designated alpha and beta.  They determine the complex letter and number combinations reported.  For example, the full DQ2 molecule is typically HLA DQA1*05xx DQB1*02xx.  The A1 is the alpha unit and the B1 is the beta subunit. 
    The beta subunit is the most important component of the DQ molecule, but the alpha subunit has also been shown to carry an increased risk for celiac disease.  Unfortunately, since testing for both is more complicated and expensive it is not always done. 
    Also, some think that since the beta subunit carries most of the risk and the alpha unit only minor risk, testing for only the beta subunit is adequate.  Several clinical laboratories have chosen this approach.  They only test for, and report on, DQ2 and DQ8 based on beta subunit types, so their results typically look like this: HLA DQB1*02 detected, DQ2 positive, etc.  This is the policy of the laboratory at Bonfils, who also does testing for Quest Diagnostics and Enterolab as well as many hospitals.  However, the alpha subunit of DQ2 also carries some risk for celiac disease. 
    What if you are positive for the beta subunit of DQ2 or DQ8 by testing from Bonfils, Enterolab or Quest?
    If the beta subunit is present then Bonfils, Enterolab and Quest tests will report DQ2 and/or DQ8 positive.  Sometimes the report will just report DQ2 negative and DQ8 negative, especially when a hospital is reporting the results obtained from Bonfils.  However, when the beta subunit is not present and they report DQ2 negative and/or DQ8 negative, it is still possible that an alpha subunit could be present.  Results reported in this manner are, in my opinion, potentially misleading.  I believe they can lead a doctor to assume that an individual is not at increased risk for, or cannot have celiac disease, when this may or may not be true.  Unfortunately, the patient in such circumstances may be told that they can not have celiac disease, yet they may not only be at risk for the disease, they may well have it while being told it is impossible or extremely improbable. 
    What does Prometheus do and how do they report their results?
    Prometheus, like Kimball and LabCorp, includes alpha and beta subunit typing.  In the past they did not indicate whether there was one or two copies of DQ2 or DQ8 if someone was positive.  If a patient was DQ2 and DQ8 positive then these labs reported their full genetic DQ type.  However, if one or the other was negative, their exact genotype was not reported.  Recently, not only has Prometheus started reporting the full DQ2 and DQ8 genotype, but they are now reporting whether someone is homozygous or heterozygous as well.  They are also reporting the relative risk for celiac disease based on the pattern shown by testing.  However, they are still not reporting the other DQ types. 
    What is the advantage of the new Prometheus reporting?
    Since Prometheus results now include a calculation of the individual’s risk of celiac disease, compared with the general population, the patient can see how high their risk of celiac disease is, as well as being able to estimate the risk for their parents and their children. 
    As you can see, the risk of celiac disease has a wide range of possibilities, which depend on the individual’s DQ results.  This risk can be below 0.1% if you do not have any portion of the high-risk genes DQ2 and DQ8.  On the other hand, the risk may be very high (more than 31 times the risk of the general population) if you have two copies of the full complement of DQ2 molecule.  Again, I would like to point out that if you have DQ2/DQ2, DQ2/DQ8, or DQ8/DQ8, then both of your parents and all of your children have to have at least one copy of an at-risk celiac gene.  Your child’s complete type will depend on the DQ contribution from their other parent. 
    What other laboratories do both alpha and beta subunit testing?
    Kimball Genetics and LabCorp also report both alpha and beta subunit results but the advantage of their testing is that they report the other specific DQ types detected.  Gluten sensitivity is found in all DQ types except DQ4.  Other DQ types, particularly DQ1, DQ5, are associated with a risk of gluten related neurological and skin problems.  Microscopic colitis, food allergies and oral allergy syndrome reactions are also found in association with other DQ types.  Though Enterolab does report other DQ types, including these markers of risk for gluten sensitivity, they do not test for, or report, alpha subunits since their DQ testing is done by Bonfils.  Based on the limited data I have accumulated so far, DQ2 and DQ8 also seem to carry a risk of mastocytic enterocolitis. 
    What if you do not have DQ2 or DQ8?
    According to data accumulated, but as of February 2008, not yet published by Dr. Ken Fine, unless you are DQ4/DQ4 you are still at risk for being sensitive to or intolerant of gluten.  According to Fine’s fecal gliadin antibody data all DQ types except for DQ4 carry a risk of gluten sensitivity.  My clinical experience supports this claim.  The presence of one copy of DQ1, DQ3, DQ5, DQ6, DQ7, or DQ9, even with one DQ4, is associated with a risk for elevated stool gliadin antibody and symptoms of gluten sensitivity that responds to a gluten free diet. 
    What if your genetic testing was done by Enterolab, Quest, Bonfils or a hospital that utilized Bonfils, and it indicated that you were DQ2 and DQ8 negative? 
    Since Bonfils does not test for the alpha subunit and they perform the testing for Enerolab and Quest, you may not be completely negative for DQ2 or DQ8.  You do not have the beta subunits associated with the highest risk for celiac disease.  For example, you could be “half-DQ2” positive and still be genetically at risk for the autoimmune form of gluten sensitivity that we know as celiac disease, along with all of its risks. 
    What if you have not yet had celiac DQ genetic testing? 
    I recommend that everyone have the testing.  I realize that most insurance companies and doctors, including some celiac experts, would disagree with me.  However, the value of DQ testing is that it can provide a great deal of information about your risk, especially if you have testing done for both alpha and beta subunits.  I recommend that you have testing done by Kimball Genetics, LabCorp or Prometheus if you have not yet had genetic testing done.  If your insurance or budget does not allow for this more expensive testing, but does cover testing by Quest or Bonfils or you can afford the $159 that Enterolab charges, then I still recommend that you get DQ testing using one of these laboratories.  You just need to be aware of the limitations of the results as I have reviewed them here.
    What are the advantages of DQ testing through Kimball Genetics?
    Kimball can perform testing on either blood or mouth swab samples.  The tests can be ordered without a doctor’s order.  You can purchase testing on mouth swab sample for $345.  The advantages of Kimball’s tests include alpha and beta subunit testing and full DQ typing to determine if you carry the other gluten sensitive DQ patterns besides DQ2 and DQ8.
    What about LabCorp?
    LabCorp also provides both alpha and beta subunit testing and they report the other DQ types.  They only provide testing on blood samples, a doctor must order the testing, and preauthorization is required. 
    Do health insurance companies cover celiac DQ genetic testing?
    Many but not all health insurance companies cover HLA DQ testing and almost all require preauthorization.  The ICD9 diagnostic codes that typically are honored are V18.5 genetic predisposition for gastrointestinal disease; V84.8, genetic predisposition for other diseases; and 579.0, celiac disease. 
    Why are the genetics so difficult to understand and why are so many doctors either unaware of the testing or reluctant to order the tests?
    I write and speak about DQ genetic testing frequently, and try to get testing for as many of my patients as possible.  However, many insurance companies will not cover the cost of these tests.  Most primary care doctors and even some GI doctors are completely unaware of the existence of a genetic test for celiac disease.  The testing is difficult to understand and the reporting by some labs is very confusing and even misleading. 
    I realize that understanding the DQ genetics is difficult for the average layperson.  Most scientists and doctors don’t understand this information, so don’t despair if you are having difficulty following this or understanding your results, and don’t be surprised if your doctor does not understand them either.  However, you do not need to completely understand the complexities of HLA typing to locate your DQ types and determine your risk of celiac disease, non-celiac gluten sensitivity, etc. 
    Then what do you need to know or remember about celiac DQ genetics?
    Hopefully, you now understand enough to know that you should consider having celiac DQ testing, if possible, especially if you have symptoms, laboratory tests, or an intestinal biopsy that is suggestive of celiac disease.  You should also know that the testing can be done on blood or mouth swabs, and many insurance companies will cover the testing but most require pre-authorization.  You should also be aware that the testing is available without a doctor’s order, if you are willing to pay for it, and that some tests are better than others.  I also hope you understand that the tests can help you determine your risk for celiac disease or if you are at risk for non-celiac gluten sensitivity.  You should also know that your results, especially when combined with those of one or more family members, may help you determine, to some degree, the risks for your parents and your children.  You should also know what laboratories offer testing, what test codes your doctor should use to order the tests, and that the absence of DQ2 or DQ8 does not exclude risk of gluten sensitivity or intolerance.  Depending on what laboratory conducts your DQ testing, your results also may fail to exclude your risk of celiac disease. 
    What if I am still confused or I don’t know how to interpret my genetic results or my previous evaluation for celiac disease?
    If you are still confused by your test results or want more a personalized review of your results, symptoms or diagnostic tests I recommend that you see a physician who is an expert in celiac disease and understands these tests.  I also offer on-line consultation for a reasonable fee through a secure consultation site, www.medem.com.  You simply register (registration is free) for secure on-line communication and request a consultation.  The consultation fee is $50, and some insurance companies will cover on-line communication.  I also see many patients from outside of Colorado Springs for consultation if you are willing to travel here. 


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    And he needs to be super strict in his gluten free diet! SUPER strict, not just low gluten. No cross contamination, NONE.  I am so sorry, there are no short cuts with the testing. It flat out sucks but there you have it.  Welcome to the forum!
    Hi TDZ, My understanding is the same, a full gluten challenge is needed for the DH diagnosis.  The method the use for DH is to take a skin biopsy from next to a lesion, not on it.  They check the biopsy for IgA antibodies. I don't know of any way to shortcut the process and avoid eating gluten to get tested.  There may be a test some  day that doesn't require it, but for now I don't think there are any out there. One thing he might not have tried is avoiding iodine.  Some of the m
    Hello, new here and new to the whole thing! My husband has been battling this rash and assorted digestive issues for years. He was diagnosed with contact dermatitis by the dermatologist, had some steroid injections and various creams over the last couple of years, and then in November he went to the ER and they said eczema and gave him steroid pills. This was after a huge bloom that pretty much hit him from head to toe, where it had been mostly arms and legs before. He finally concluded he
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