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How long must gluten be taken for the serological tests to be meaningful?**

Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: There is no simple answer to this question as the susceptibility of the patient to developing celiac disease is dependent upon several factors. One factor is the amount of gluten intake. Another is the genetic makeup of the individual. However, we feel that several weeks of gluten intake, especially in doses of 2 gm gluten/day, should result in positive serology in patients with CD.

Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: The result of serological tests depends on the diet. Generally, three to six months of a gluten-free diet may result in normal antibody levels in a new patient. A strict gluten-free diet for more than three months may result in inconclusive serological tests in patients, who have started a diet without any diagnostic test. In this case a gluten challenge should be introduced for a proper diagnosis.

Each patient has different sensitivity to gluten for reasons that are unclear. The period of gluten challenge and the amount of gluten necessary to provoke serological immune response are individually different.

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A 0.3 g/kg body weight/day of single gluten challenge causes immunological changes (cellular immunity) in the intestine (J Pediatr Gastroenterol Nutr 1989; 9:176-180) in patients on a gluten-free diet, however, the serological response is much slower.

Our recommendation is to ingest at least 0.3 g/kg/day of gluten for two months prior to the serological tests. However, if somebody experiences symptoms during the gluten challenge we recommend to perform serological tests earlier.

The protein content of wheat flour is between 7-15% and approximately 90% of the protein content is gluten. That means a slice of bread may have 2-3 g of gluten.

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3 Responses:

 
DavidJulian
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said this on
13 Jun 2012 1:50:24 PM PDT
Accurate but confusing information. My "executive" summary:
Eating 1 to maximum 2 slices of bread per day, minimum 2 weeks can give enough gluten to render a proper serologic (blood) test. Other factors apply, therefore read full article for important considerations.

 
Beth
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said this on
09 Jun 2015 2:28:55 PM PDT
This was helpful but if I'm having an upper GI and a biopsy, can I eat less gluten to show positive (over the blood test)? I've been off of gluten for a year and not sure it's helping anything but I'm so afraid to go back, however, I don't want to undergo the biopsy and upper GI if it's pointless.

 
james
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said this on
24 Dec 2015 12:58:09 PM PDT
My 5 year old daughter's symptoms point to celiac. After 6 months of symptoms the doctors are finally willing to entertain that there is a problem, blood work came back positive. The G.I. specialist isn’t available for 2 months to meet and schedule a test, another (2 months??). We can't feasibly continue to poison this poor girl waiting for the test as symptoms of distended stomach and malnutrition are apparent already. Knowing that the diet must have gluten to present proper results, we don't feel comfortable continuing behaviour that is damaging.

Question is; does it make sense to stop the gluten diet now, wait for improvement and not preform the test?
Should we resume eating gluten just prior to the testing? Will this still give correct and accurate results?
Continue feeding her gluten and wait for the doctors to become available?

Bear in mind that we have been on a Miralax dose twice the recommended for an adult and still suffer constipation and distended stomach.




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REALLY odd call out here, I am attending a anime convention called A-Fest in Dallas come August, I need someone to split the room with it who is gluten-free. I take extra precautions, I COOK all the food, bring only CERTIFIED foods into the room, The room will be Gluten Free, Corn Free, Dairy Free, Peanut Free. I am trying to find someone to split the room cost with, that would be safe to be around I CAN NOT AFFORD to get sick at one of these things, it is one of my few joys left in life and get very paranoid around them. So I need someone who is also gluten-free to make sure the room stays safe (YES I have done with with a non celiac with the rules down and well stuff happens so not chancing it). Room split is food coverage comes to $400 if it is just two people. 4 day convention, I will arrange a meal plan around your diet as long as it is free of my allergens. I will also provide various snacks, baked goods, and even stuff to take home with you. https://animefest.org/ ^Convention info.

Hi Jennifer, This thread might have some information that would help you. Your doctors are pretty lame IMHO. Perhaps you can find a celiac group in your area that has local meetings for support. They might also suggest a different doctor who knows how to treat celiac patients.

All the above posts are full of good advice. What I'd like to add is, if you have coeliac disease and continue to eat gluten, you run the risk of other autoimmune diseases in the future as well as osteoporosis, malnutrition and even cancer, so even if you had no symptoms at the beginning, and may also not have any symptoms if you eat gluten (not all coeliacs do), the damage is still being done to your gut and the rest of your body, so please be aware of this.

You could possibly try calling the places in Texas and Chicago to see if they can refer you somewhere that does accept your insurance. Oh good luck to you!

Hi Jennifer and welcome CyclingLady has given you some good advice above. You want certainty and that's entirely understandable. Go back to your doctors and explain that you need to know a little more and hopefully they will engage positively with you. If they don't, then do pursue a second opinion. I just wanted to address your last paragraph quoted above. The problem with celiac, or in my case non celiac gluten sensitivity, is that it presents or doesn't present in so many different ways. It can do hidden damage which may take many years to become apparent. It can impact in ways which are incredibly difficult to recognise or isolate. I am 'lucky' in that the way that gluten impacts on me is far worse than any mental or social isolation brought upon by the diet, so motivation is easy for me, even without the certainty of a celiac diagnosis, there really is no alternative, I don't think I'd last long on a gluten diet now. But I can well understand how difficult it may be to stay honest on the diet if you don't have any symptoms to deal with. The diet can be isolating, there does become a distance between you and 'normal' people. Who would want to deal with all that if they didn't have to? If you aren't satisfied with your doctors responses and choose to go back onto gluten I suggest you find another doctor and go back into the diagnostic process and properly exclude celiac, including a scope. Otherwise you could be taking a big risk with yr long term health. You may find that this process supplies you with an answer as if your diagnosis was correct your response to the reintroduction of gluten may surprise you, or not of course! best of luck!