• Join our community!

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

  • Ads by Google:
     




    Get email alerts Subscribe to Celiac.com's FREE weekly eNewsletter

    Ads by Google:



       Get email alertsSubscribe to Celiac.com's FREE weekly eNewsletter

  • Announcements

    • admin

      Frequently Asked Questions About Celiac Disease   04/07/2018

      This Celiac.com FAQ on celiac disease will guide you to all of the basic information you will need to know about the disease, its diagnosis, testing methods, a gluten-free diet, etc.   Subscribe to Celiac.com's FREE weekly eNewsletter   What are the major symptoms of celiac disease? Celiac Disease Symptoms What testing is available for celiac disease?  Celiac Disease Screening Interpretation of Celiac Disease Blood Test Results Can I be tested even though I am eating gluten free? How long must gluten be taken for the serological tests to be meaningful? The Gluten-Free Diet 101 - A Beginner's Guide to Going Gluten-Free Is celiac inherited? Should my children be tested? Ten Facts About Celiac Disease Genetic Testing Is there a link between celiac and other autoimmune diseases? Celiac Disease Research: Associated Diseases and Disorders Is there a list of gluten foods to avoid? Unsafe Gluten-Free Food List (Unsafe Ingredients) Is there a list of gluten free foods? Safe Gluten-Free Food List (Safe Ingredients) Gluten-Free Alcoholic Beverages Distilled Spirits (Grain Alcohols) and Vinegar: Are they Gluten-Free? Where does gluten hide? Additional Things to Beware of to Maintain a 100% Gluten-Free Diet What if my doctor won't listen to me? An Open Letter to Skeptical Health Care Practitioners Gluten-Free recipes: Gluten-Free Recipes
0
lao512

Not Sure What To Think - Just Got Blood Test Results

Rate this topic

Recommended Posts

Hi everyone,

 

I am totally new here and don't know much of anything about Celiac. I'm hoping those of you with more experience can shed some light for me. I was diagnosed with Hashimoto's (autoimmune hypothyroid) in 2009, and recently, in January 2013, I was diagnosed as B12 deficient and low Alkaline Phosphatase (a liver enzyme). I've been on B12 shots since January. My B12 and Alkaline Phosphatase tests were repeated a couple of week ago and both were still low. Knowing that I have an autoimmune thyroid disease and that both B12 deficiency and low Alkaline Phosphatase can be caused by malabsorption, my (thankfully thorough) doc ordered some blood tests for Celiac. Here are my results:

 

Gliadin Ab IgA - 6 (normal range <20)

TISSUE TRANSGLUTAM AB IGA - <1 (normal range <4)

GLIADIN IGG - 5 (normal range <20)

RETICULIN AB (IGA) SCREEN - negative

 

I have a couple of questions. First, from the limited material I've read, the Gliadin Ab IgA and GLIADIN IGG are no longer considered the best indicators and are being replaced more and more with Gliadin (Deamidated) tests. Is this true? Also, I haven't been able to find much of any info about the Reticulin AB (IGA) screen test. How good of an indicator is it? Also, it doesn't look like they tested my total IgA, which from what I've read would show if I'm IgA deficient or not.

 

I don't know if I have symptoms or not. I will occasionally (once a month or so) become very bloated, with pain if I press on my abdomen. I've tried bloat medicines (such as gas-x) which provide no relief. After a day or two, the bloat goes away on its own. Also, my bowel movements are not regular. Some days I will have very loose stools (sometimes with and sometimes without the urgency of diarrhea), and sometimes I will go several days without any bowel movement at all. Sometimes I will have very solid stool, but with a very sudden urge to go (I would compare it to the urgency of diarrhea, but with solid stool). I never thought much about all of this until the doc mentioned Celiacs.

 

I also have still had fatigue and brain fog (which I initially assumed were related to my thyroid) even though I'm on thyroid meds and my TSH is normal.

 

Basically, my major question is, should I be satisfied with the blood tests above and a negative Celiac diagnosis, or should I press for additional tests? I'm so confused by everything I've read online and want to be able to properly advocate for myself, but I just don't understand most of it.

 

Thanks for any insight you can provide!

 

 

 

 

Share this post


Link to post
Share on other sites
Ads by Google:
Ads by Google:


Hi everyone,

 

I am totally new here and don't know much of anything about Celiac. I'm hoping those of you with more experience can shed some light for me. I was diagnosed with Hashimoto's (autoimmune hypothyroid) in 2009, and recently, in January 2013, I was diagnosed as B12 deficient and low Alkaline Phosphatase (a liver enzyme). I've been on B12 shots since January. My B12 and Alkaline Phosphatase tests were repeated a couple of week ago and both were still low. Knowing that I have an autoimmune thyroid disease and that both B12 deficiency and low Alkaline Phosphatase can be caused by malabsorption, my (thankfully thorough) doc ordered some blood tests for Celiac. Here are my results:

 

Gliadin Ab IgA - 6 (normal range <20)

TISSUE TRANSGLUTAM AB IGA - <1 (normal range <4)

GLIADIN IGG - 5 (normal range <20)

RETICULIN AB (IGA) SCREEN - negative

 

I have a couple of questions. First, from the limited material I've read, the Gliadin Ab IgA and GLIADIN IGG are no longer considered the best indicators and are being replaced more and more with Gliadin (Deamidated) tests. Is this true? Also, I haven't been able to find much of any info about the Reticulin AB (IGA) screen test. How good of an indicator is it? Also, it doesn't look like they tested my total IgA, which from what I've read would show if I'm IgA deficient or not.

 

I don't know if I have symptoms or not. I will occasionally (once a month or so) become very bloated, with pain if I press on my abdomen. I've tried bloat medicines (such as gas-x) which provide no relief. After a day or two, the bloat goes away on its own. Also, my bowel movements are not regular. Some days I will have very loose stools (sometimes with and sometimes without the urgency of diarrhea), and sometimes I will go several days without any bowel movement at all. Sometimes I will have very solid stool, but with a very sudden urge to go (I would compare it to the urgency of diarrhea, but with solid stool). I never thought much about all of this until the doc mentioned Celiacs.

 

I also have still had fatigue and brain fog (which I initially assumed were related to my thyroid) even though I'm on thyroid meds and my TSH is normal.

 

Basically, my major question is, should I be satisfied with the blood tests above and a negative Celiac diagnosis, or should I press for additional tests? I'm so confused by everything I've read online and want to be able to properly advocate for myself, but I just don't understand most of it.

 

Thanks for any insight you can provide!

Are you still eating gluten? If you went gluten-free before the test it could be false negative.

Share this post


Link to post
Share on other sites

Are you still eating gluten? If you went gluten-free before the test it could be false negative.

 

I am still eating gluten, although I wouldn't say that my diet in general is high in gluten, as I try to eat mostly "whole" foods such as fruits, veggies, and unprocessed meat. My preferred "starch" side dishes are rice and quinoa. I love bread and pasta, but only eat those a few times a week. I try to stay away from processed foods, so I doubt I'm getting much gluten from additives.

Share this post


Link to post
Share on other sites
Gliadin Ab IgA - 6 (normal range <20)

TISSUE TRANSGLUTAM AB IGA - <1 (normal range <4)

GLIADIN IGG - 5 (normal range <20)

RETICULIN AB (IGA) SCREEN - negative

 

I have a couple of questions. First, from the limited material I've read, the Gliadin Ab IgA and GLIADIN IGG are no longer considered the best indicators and are being replaced more and more with Gliadin (Deamidated) tests. Is this true? Also, I haven't been able to find much of any info about the Reticulin AB (IGA) screen test. How good of an indicator is it? Also, it doesn't look like they tested my total IgA, which from what I've read would show if I'm IgA deficient or not.

 

....Basically, my major question is, should I be satisfied with the blood tests above and a negative Celiac diagnosis, or should I press for additional tests? I'm so confused by everything I've read online and want to be able to properly advocate for myself, but I just don't understand most of it.

 

Thanks for any insight you can provide!

Welcome to the board.  :)

 

You are right that the AGA tests (anti-gliadin antibodies) are not the best tests and are being phased out. DGP is a MUCH better test. The reticulin test is pretty old too. Very few labs use that anymore. I'm not that sure about it's reliability. On page 11-13 of this report, the various current blood tests for celiac disease are discussed. http://www.worldgastroenterology.org/assets/export/userfiles/2012_Celiac%20Disease_long_FINAL.pdf  The only up to date test you had was the tTG IgA, and it only has a sensitivity of 75-95% meaning that it misses up to 25% of celiac cases. 

 

I agree that you should get your total IgA tested. Approximately 5% of celiacs are deficient in this... which is why they check it. 

 

With your symptoms and Hashimoto's (around 6% of Hashi's patients have celiac disease compared with less than 1% of the regular population), I think celiac disease could be involved, although it could be Non-Celiac Gluten Intolerance/Sensitivity (NCGI) as well. Unfortunately, with NCGI there are no blood tests; diagnosis is through a positive reaction to the gluten-free diet for a few months. Once you have exhausted your testing options, NCGI and the gluten-free diet would be something I would consider.

 

Are you sure your thyroid is adequately managed? I have been gluten-free for a year and I still have some thyroid symptoms like brain fog even though my thyroid labs were declared "normal" by my doctor. I am disregarding my doctor's statement that I am normal and pursuing a TSH closer to a 1, and a Free T4 and Free T3 in the 50-75% range of my lab's reference range. I have switched to desicated thyroid and am starting to feel some energy. :)

 

Good luck. I hope you find your answers.  Keep asking questions, there are a lot of knowledgable people around here.  :)

  • Upvote 1

Share this post


Link to post
Share on other sites

here's a pubmed abstract relating to this, but I don't have the full text

 

http://www.ncbi.nlm.nih.gov/pubmed/23365209

 

http://www.celiac.com/articles/23250/1/Antireticulin-Antibodies-Obsolete-as-Test-for-Celiac-Disease/Page1.html

 

any chance you can get the DGP igg/iga combo tested?

 

 

 The reticulin test is pretty old too. Very few labs use that anymore. I'm not that sure about it's reliability.

Share this post


Link to post
Share on other sites
Ads by Google:


I emailed the doc to ask about the DGP igg/iga and total iga tests. I'm waiting to hear back and will post again when I hear from them.

As for my thyroid, my most recent TSH was 1.3. I've noticed great improvement in many other thyroid related symptoms (hair loss, dry skin, brittle nails, menstrual issues) since getting it down to that level. I'm slated for a TSH/Free t4/Free t3 test next month, so I'll be interested to see what that shows.

Thanks for all of the input. If anyone else has anything to add, I'd be happy to hear it!

  • Upvote 1

Share this post


Link to post
Share on other sites

excellent!  i'm hopeful they'll say absolutely  :)

 

I emailed the doc to ask about the DGP igg/iga and total iga tests. I'm waiting to hear back and will post again when I hear from them.
 

Share this post


Link to post
Share on other sites

So, the doctor's office called me back on Friday to answer my questions. Regarding the Total Serum IgA, the nurse said the doctor never orders that test, because it's too specialized and only GIs should order it.

 

Regarding the AGA IgA/IgG vs the DGP IgA/IgG, she said they don't know anything about how sensitive the AGA tests are vs the DGP tests and that they would have to call the lab and ask them. Based on what the lab says, the doc will decide if she will order the DGP tests (but she will not order the Total Serum IgA).

 

I also asked what could be causing the B12 deficiency if it's not celiac (we know I'm eating enough of it and we've ruled out pernicious anemia). The nurse's response was "some people are just b12 deficient." That doesn't make sense to me. If I'm eating enough of it, and my levels are low, there must be a reason my body isn't absorbing it.

 

They haven't checked any of my other nutrient levels, such as iron, vitamin D, etc. I pointed that out to nurse and she said she would ask the doc about it.

 

So, I'm once again waiting for them to call me. In the mean time, I've started to keep a journal of what I eat and how I feel. I had some pretty bad GI issues over the weekend and spent most of yesterday laying on the couch not really feeling like doing anything. I don't know if this is all in my head, like confirmation bias - someone said the word "celiac" and now I'm viewing every little thing through that lense. Or if I really have been missing/writing off symptoms for a while and now I'm just more aware.

  • Upvote 1

Share this post


Link to post
Share on other sites

here's a good Pub Med Abstract regarding AGA (they list it as antibodies against native gliadin) vs DGP:

http://www.ncbi.nlm.nih.gov/pubmed/20171961

 

that's frustrating that they won't test your total igA  <_< why don't doctors know if they use ttg iga they have to measure the total iga to make sure it's valid...argh

 

any chance that you take any type of PPI or acid suppressing drug?  they can lower B12.  however if you're getting enough of it, and you're still deficient in it, that indicates malabsorption.  the answer "some people are just B12 deficient," is a cop out IMO

 

the journal is a great idea  :)

 

keep us updated!

 

So, the doctor's office called me back on Friday to answer my questions. Regarding the Total Serum IgA, the nurse said the doctor never orders that test, because it's too specialized and only GIs should order it.

 

Regarding the AGA IgA/IgG vs the DGP IgA/IgG, she said they don't know anything about how sensitive the AGA tests are vs the DGP tests and that they would have to call the lab and ask them. Based on what the lab says, the doc will decide if she will order the DGP tests (but she will not order the Total Serum IgA).

 

I also asked what could be causing the B12 deficiency if it's not celiac (we know I'm eating enough of it and we've ruled out pernicious anemia). The nurse's response was "some people are just b12 deficient." That doesn't make sense to me. If I'm eating enough of it, and my levels are low, there must be a reason my body isn't absorbing it.

 

They haven't checked any of my other nutrient levels, such as iron, vitamin D, etc. I pointed that out to nurse and she said she would ask the doc about it.

 

So, I'm once again waiting for them to call me. In the mean time, I've started to keep a journal of what I eat and how I feel. I had some pretty bad GI issues over the weekend and spent most of yesterday laying on the couch not really feeling like doing anything. I don't know if this is all in my head, like confirmation bias - someone said the word "celiac" and now I'm viewing every little thing through that lense. Or if I really have been missing/writing off symptoms for a while and now I'm just more aware.

  • Upvote 1

Share this post


Link to post
Share on other sites

I don't get the "it is to specialized" line, on the total IgA testing.  Makes.no.sense.   at.all.

  • Upvote 1

Share this post


Link to post
Share on other sites


Ads by Google:


I don't get the "it is to specialized" line, on the total IgA testing. Makes.no.sense. at.all.

Agreed. There is no logic to that. Ttg IgA and aga IgA tests aren't specialized, but total IgA is? That's a BS line if I've ever heard one. Just how is one supposed to get referred to a GI if they have negative IgA results because they're IgA deficient but no one knows it?

I'd push for the total IgA test.

Share this post


Link to post
Share on other sites

I'm back! Finally heard back from the doctor's office today and I am infinitely frustrated. The nurse said she talked to the lab and they said that the panel that was done (TTG IgA, AGA IgA & IgG, and RETICULIN IgA) is entirely sufficient for diagnosing celiac, and that therefore the doctor will not order any additional tests (such as DGP IgA & IgG and total IgA).

 

Apparently the lab did suggest that they test me for food allergies (including wheat), but the doc doesn't want to do that either. The nurse asked if I'd had any changes in my bowel movements, and I said it's hard to say, because they've never been regular - sometimes I won't have one for days on end, and then other times I'll have D for several days in a row - she said "well, if it's always been like that, then there's no change." I can't help but think, though, that it shouldn't have "always been like that" in the first place - that's like saying the brakes on my car have never worked, so I'm not going to fix them now.

 

I asked again about the b12 deficiency and the nurse said to keep getting the monthly shots and have my levels tested again in 10 weeks. She then said that the doc did want me to get an EMG / nerve conduction test (because one of the b12 symptoms I'm having is peripheral neuropathy). I just had one in March (and it was normal)! I told the nurse that and all she could say was "oh, the doctor must not have seen that." That makes me wonder if she's even looking at my chart at all - it was just a few months ago, it's not like it would be buried somewhere from years ago!

 

any chance that you take any type of PPI or acid suppressing drug?  they can lower B12.  however if you're getting enough of it, and you're still deficient in it, that indicates malabsorption.  the answer "some people are just B12 deficient," is a cop out IMO

 

I am not taking any type of PPI or acid suppressing drug, so that can't be causing the b12 deficiency. Does anyone here with b12 deficiency have any advice? Would a gastro doc be able to help diagnose what's causing that? I'm thinking maybe I could kill two birds with one stone by seeing one - find out what's causing the b12 deficiency and get a better idea of whether or not celiac or NCGS is involved.

 

As I mentioned before, I started keeping a food/symptom journal last week. I also started to eat gluten more consistently - as I was not necessarily eating it every day. I don't know if it's just because I've been paying closer attention, but I feel like I have been more bloated, gassy, and had more urgent bowel movements in the past week and half that I've been eating gluten every day. It's not always consistent, though. Sometimes an hour or two will go by before I have symptoms, sometimes it won't be until the next morning, and sometimes it's right away. I had pasta and garlic bread for dinner one night last week and felt ok that evening and then the next morning I looked like I was 4 months pregnant. Then on Saturday morning I ate a bagel and immediately had D and felt sick to my stomach for most of the rest of the day. Is this inconsistency common with celiac or NCGS?

Share this post


Link to post
Share on other sites

Hmm, because the doctor did not order the "too specialized" total serum IgA, the AGA IgA, tTG IgA, and reticulin IgA could be invalid if you are IgA deficient; it's unlikely that you are one of the 1/20 celiacs who is deficient but it is possible. The AGA IgG has a really weak sensitivity of 17-100%, that means the test misses up to 83% of celiacs it tests for... not so good. The AGA test is not often used anymore (but you know that) and the reticulin test was used 20 years ago.... how old is your doctor??  LOL :blink:  That test is rarely rarely used anymore because superior tests have been introduced.

 

Could you go to another doctor or get into a gastro in a timely manner?  If not, you could try ordering a home Biocard test which tests for IgA and tTG IgA (in high levels). At least with the Biocard test you would know if your other IgA based tests are accurate.

 

I don't have a B12 deficiency but I know that the methylcobalamin sublingual B12 is better absorbed that a regular b vitamin that is digested in your small intestine.  Who knows, maybe the fact that I have good levels of B12 is because of that vitamin.

 

And yes, inconsistent BM's are common in both celiac disease and NCGS.

 

Geez, how frustrating for you... don't pull out all your hair yet.  ;)

Share this post


Link to post
Share on other sites

There are online labs where you can order complete celiac blood panels...and anything else you want. I'm in the US...don't know where you're at.

Share this post


Link to post
Share on other sites

Thanks for the input, everyone!

 

Could you go to another doctor or get into a gastro in a timely manner?  If not, you could try ordering a home Biocard test which tests for IgA and tTG IgA (in high levels). At least with the Biocard test you would know if your other IgA based tests are accurate.

 

I called this morning and scheduled an appointment with a gastro on July 29th - the earliest they could get me in. The practice was recommended to me by a friend who has celiac, so I'm hopeful that they will know what they're doing.

 

There are online labs where you can order complete celiac blood panels...and anything else you want. I'm in the US...don't know where you're at.

 

Thanks for the tip! I'm in the US, too, so I will definitely check that out. It might given me some extra info to share with the doc - and save time of him having to order it.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

0

  • Who's Online   4 Members, 0 Anonymous, 1,001 Guests (See full list)

  • Top Posters +

  • Recent Articles

    Jefferson Adams
    Celiac.com 04/18/2018 - To the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service animals.
    If you’ve flown anywhere lately, you may have seen them. People flying with their designated “emotional support” animals. We’re not talking genuine service animals, like seeing eye dogs, or hearing ear dogs, or even the Belgian Malinois that alerts its owner when there is gluten in food that may trigger her celiac disease.
    Now, to be honest, some of those animals in question do perform a genuine service for those who need emotional support dogs, like veterans with PTSD.
    However, many of these animals are not service animals at all. Many of these animals perform no actual service to their owners, and are nothing more than thinly disguised pets. Many lack proper training, and some have caused serious problems for the airlines and for other passengers.
    Now the major airlines are taking note and introducing stringent requirements for service animals.
    Delta was the first to strike. As reported by the New York Times on January 19: “Effective March 1, Delta, the second largest US airline by passenger traffic, said it will require passengers seeking to fly with pets to present additional documents outlining the passenger’s need for the animal and proof of its training and vaccinations, 48 hours prior to the flight.… This comes in response to what the carrier said was a 150 percent increase in service and support animals — pets, often dogs, that accompany people with disabilities — carried onboard since 2015.… Delta said that it flies some 700 service animals a day. Among them, customers have attempted to fly with comfort turkeys, gliding possums, snakes, spiders, and other unusual pets.”
    Fresh from an unsavory incident with an “emotional support” peacock incident, United Airlines has followed Delta’s lead and set stricter rules for emotional support animals. United’s rules also took effect March 1, 2018.
    So, to the relief of many bewildered passengers and crew, no more comfort turkeys, geese, possums or other questionable pets will be flying on Delta or United without meeting the airlines' strict new requirements for service and emotional support animals.
    Source:
    cnbc.com

    admin
    WHAT IS CELIAC DISEASE?
    Celiac disease is an autoimmune condition that affects around 1% of the population. People with celiac disease suffer an autoimmune reaction when they consume wheat, rye or barley. The immune reaction is triggered by certain proteins in the wheat, rye, or barley, and, left untreated, causes damage to the small, finger-like structures, called villi, that line the gut. The damage occurs as shortening and villous flattening in the lamina propria and crypt regions of the intestines. The damage to these villi then leads to numerous other issues that commonly plague people with untreated celiac disease, including poor nutritional uptake, fatigue, and myriad other problems.
    Celiac disease mostly affects people of Northern European descent, but recent studies show that it also affects large numbers of people in Italy, China, Iran, India, and numerous other places thought to have few or no cases.
    Celiac disease is most often uncovered because people experience symptoms that lead them to get tests for antibodies to gluten. If these tests are positive, then the people usually get biopsy confirmation of their celiac disease. Once they adopt a gluten-free diet, they usually see gut healing, and major improvements in their symptoms. 
    CLASSIC CELIAC DISEASE SYMPTOMS
    Symptoms of celiac disease can range from the classic features, such as diarrhea, upset stomach, bloating, gas, weight loss, and malnutrition, among others.
    LESS OBVIOUS SYMPTOMS
    Celiac disease can often less obvious symptoms, such fatigue, vitamin and nutrient deficiencies, anemia, to name a few. Often, these symptoms are regarded as less obvious because they are not gastrointestinal in nature. You got that right, it is not uncommon for people with celiac disease to have few or no gastrointestinal symptoms. That makes spotting and connecting these seemingly unrelated and unclear celiac symptoms so important.
    NO SYMPTOMS
    Currently, most people diagnosed with celiac disease do not show symptoms, but are diagnosed on the basis of referral for elevated risk factors. 

    CELIAC DISEASE VS. GLUTEN INTOLERANCE
    Gluten intolerance is a generic term for people who have some sort of sensitivity to gluten. These people may or may not have celiac disease. Researchers generally agree that there is a condition called non-celiac gluten sensitivity. That term has largely replaced the term gluten-intolerance. What’s the difference between celiac disease and non-celiac gluten-sensitivity? 
    CELIAC DISEASE VS. NON-CELIAC GLUTEN SENSITIVITY (NCGS)
    Gluten triggers symptoms and immune reactions in people with celiac disease. Gluten can also trigger symptoms in some people with NCGS, but the similarities largely end there.

    There are four main differences between celiac disease and non-celiac gluten sensitivity:
    No Hereditary Link in NCGS
    Researchers know for certain that genetic heredity plays a major role in celiac disease. If a first-degree relative has celiac disease, then you have a statistically higher risk of carrying genetic markers DQ2 and/or DQ8, and of developing celiac disease yourself. NCGS is not known to be hereditary. Some research has shown certain genetic associations, such as some NCGS patients, but there is no proof that NCGS is hereditary. No Connection with Celiac-related Disorders
    Unlike celiac disease, NCGS is so far not associated with malabsorption, nutritional deficiencies, or a higher risk of autoimmune disorders or intestinal malignancies. No Immunological or Serological Markers
    People with celiac disease nearly always test positive for antibodies to gluten proteins. Researchers have, as yet, identified no such antobodies or serologic markers for NCGS. That means that, unlike with celiac disease, there are no telltale screening tests that can point to NCGS. Absence of Celiac Disease or Wheat Allergy
    Doctors diagnose NCGS only by excluding both celiac disease, an IgE-mediated allergy to wheat, and by the noting ongoing adverse symptoms associated with gluten consumption. WHAT ABOUT IRRITABLE BOWEL SYNDROME (IBS) AND IRRITABLE BOWEL DISEASE (IBD)?
    IBS and IBD are usually diagnosed in part by ruling out celiac disease. Many patients with irritable bowel syndrome are sensitive to gluten. Many experience celiac disease-like symptoms in reaction to wheat. However, patients with IBS generally show no gut damage, and do not test positive for antibodies to gliadin and other proteins as do people with celiac disease. Some IBS patients also suffer from NCGS.

    To add more confusion, many cases of IBS are, in fact, celiac disease in disguise.

    That said, people with IBS generally react to more than just wheat. People with NCGS generally react to wheat and not to other things, but that’s not always the case. Doctors generally try to rule out celiac disease before making a diagnosis of IBS or NCGS. 
    Crohn’s Disease and celiac disease share many common symptoms, though causes are different.  In Crohn’s disease, the immune system can cause disruption anywhere along the gastrointestinal tract, and a diagnosis of Crohn’s disease typically requires more diagnostic testing than does a celiac diagnosis.  
    Crohn’s treatment consists of changes to diet and possible surgery.  Up to 10% of Crohn's patients can have both of conditions, which suggests a genetic connection, and researchers continue to examine that connection.
    Is There a Connection Between Celiac Disease, Non-Celiac Gluten Sensitivity and Irritable Bowel Syndrome? Large Number of Irritable Bowel Syndrome Patients Sensitive To Gluten Some IBD Patients also Suffer from Non-Celiac Gluten Sensitivity Many Cases of IBS and Fibromyalgia Actually Celiac Disease in Disguise CELIAC DISEASE DIAGNOSIS
    Diagnosis of celiac disease can be difficult. 

    Perhaps because celiac disease presents clinically in such a variety of ways, proper diagnosis often takes years. A positive serological test for antibodies against tissue transglutaminase is considered a very strong diagnostic indicator, and a duodenal biopsy revealing villous atrophy is still considered by many to be the diagnostic gold standard. 
    But this idea is being questioned; some think the biopsy is unnecessary in the face of clear serological tests and obvious symptoms. Also, researchers are developing accurate and reliable ways to test for celiac disease even when patients are already avoiding wheat. In the past, patients needed to be consuming wheat to get an accurate test result. 
    Celiac disease can have numerous vague, or confusing symptoms that can make diagnosis difficult.  Celiac disease is commonly misdiagnosed by doctors. Read a Personal Story About Celiac Disease Diagnosis from the Founder of Celiac.com Currently, testing and biopsy still form the cornerstone of celiac diagnosis.
    TESTING
    There are several serologic (blood) tests available that screen for celiac disease antibodies, but the most commonly used is called a tTG-IgA test. If blood test results suggest celiac disease, your physician will recommend a biopsy of your small intestine to confirm the diagnosis.
    Testing is fairly simple and involves screening the patients blood for antigliadin (AGA) and endomysium antibodies (EmA), and/or doing a biopsy on the areas of the intestines mentioned above, which is still the standard for a formal diagnosis. Also, it is now possible to test people for celiac disease without making them concume wheat products.

    BIOPSY
    Until recently, biopsy confirmation of a positive gluten antibody test was the gold standard for celiac diagnosis. It still is, but things are changing fairly quickly. Children can now be accurately diagnosed for celiac disease without biopsy. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide.

    WHY A GLUTEN-FREE DIET?
    Currently the only effective, medically approved treatment for celiac disease is a strict gluten-free diet. Following a gluten-free diet relieves symptoms, promotes gut healing, and prevents nearly all celiac-related complications. 
    A gluten-free diet means avoiding all products that contain wheat, rye and barley, or any of their derivatives. This is a difficult task as there are many hidden sources of gluten found in the ingredients of many processed foods. Still, with effort, most people with celiac disease manage to make the transition. The vast majority of celiac disease patients who follow a gluten-free diet see symptom relief and experience gut healing within two years.
    For these reasons, a gluten-free diet remains the only effective, medically proven treatment for celiac disease.
    WHAT ABOUT ENZYMES, VACCINES, ETC.?
    There is currently no enzyme or vaccine that can replace a gluten-free diet for people with celiac disease.
    There are enzyme supplements currently available, such as AN-PEP, Latiglutetenase, GluteGuard, and KumaMax, which may help to mitigate accidental gluten ingestion by celiacs. KumaMax, has been shown to survive the stomach, and to break down gluten in the small intestine. Latiglutenase, formerly known as ALV003, is an enzyme therapy designed to be taken with meals. GluteGuard has been shown to significantly protect celiac patients from the serious symptoms they would normally experience after gluten ingestion. There are other enzymes, including those based on papaya enzymes.

    Additionally, there are many celiac disease drugs, enzymes, and therapies in various stages of development by pharmaceutical companies, including at least one vaccine that has received financial backing. At some point in the not too distant future there will likely be new treatments available for those who seek an alternative to a lifelong gluten-free diet. 

    For now though, there are no products on the market that can take the place of a gluten-free diet. Any enzyme or other treatment for celiac disease is intended to be used in conjunction with a gluten-free diet, not as a replacement.

    ASSOCIATED DISEASES
    The most common disorders associated with celiac disease are thyroid disease and Type 1 Diabetes, however, celiac disease is associated with many other conditions, including but not limited to the following autoimmune conditions:
    Type 1 Diabetes Mellitus: 2.4-16.4% Multiple Sclerosis (MS): 11% Hashimoto’s thyroiditis: 4-6% Autoimmune hepatitis: 6-15% Addison disease: 6% Arthritis: 1.5-7.5% Sjögren’s syndrome: 2-15% Idiopathic dilated cardiomyopathy: 5.7% IgA Nephropathy (Berger’s Disease): 3.6% Other celiac co-morditities include:
    Crohn’s Disease; Inflammatory Bowel Disease Chronic Pancreatitis Down Syndrome Irritable Bowel Syndrome (IBS) Lupus Multiple Sclerosis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Psoriasis Rheumatoid Arthritis Scleroderma Turner Syndrome Ulcerative Colitis; Inflammatory Bowel Disease Williams Syndrome Cancers:
    Non-Hodgkin lymphoma (intestinal and extra-intestinal, T- and B-cell types) Small intestinal adenocarcinoma Esophageal carcinoma Papillary thyroid cancer Melanoma CELIAC DISEASE REFERENCES:
    Celiac Disease Center, Columbia University
    Gluten Intolerance Group
    National Institutes of Health
    U.S. National Library of Medicine
    Mayo Clinic
    University of Chicago Celiac Disease Center

    Jefferson Adams
    Celiac.com 04/17/2018 - Could the holy grail of gluten-free food lie in special strains of wheat that lack “bad glutens” that trigger the celiac disease, but include the “good glutens” that make bread and other products chewy, spongey and delicious? Such products would include all of the good things about wheat, but none of the bad things that might trigger celiac disease.
    A team of researchers in Spain is creating strains of wheat that lack the “bad glutens” that trigger the autoimmune disorder celiac disease. The team, based at the Institute for Sustainable Agriculture in Cordoba, Spain, is making use of the new and highly effective CRISPR gene editing to eliminate the majority of the gliadins in wheat.
    Gliadins are the gluten proteins that trigger the majority of symptoms for people with celiac disease.
    As part of their efforts, the team has conducted a small study on 20 people with “gluten sensitivity.” That study showed that test subjects can tolerate bread made with this special wheat, says team member Francisco Barro. However, the team has yet to publish the results.
    Clearly, more comprehensive testing would be needed to determine if such a product is safely tolerated by people with celiac disease. Still, with these efforts, along with efforts to develop vaccines, enzymes, and other treatments making steady progress, we are living in exciting times for people with celiac disease.
    It is entirely conceivable that in the not-so-distant future we will see safe, viable treatments for celiac disease that do not require a strict gluten-free diet.
    Read more at Digitaltrends.com , and at Newscientist.com

    Jefferson Adams
    Celiac.com 04/16/2018 - A team of researchers recently set out to investigate whether alterations in the developing intestinal microbiota and immune markers precede celiac disease onset in infants with family risk for the disease.
    The research team included Marta Olivares, Alan W. Walker, Amalia Capilla, Alfonso Benítez-Páez, Francesc Palau, Julian Parkhill, Gemma Castillejo, and Yolanda Sanz. They are variously affiliated with the Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), C/Catedrático Agustín Escardin, Paterna, Valencia, Spain; the Gut Health Group, The Rowett Institute, University of Aberdeen, Aberdeen, UK; the Genetics and Molecular Medicine Unit, Institute of Biomedicine of Valencia, National Research Council (IBV-CSIC), Valencia, Spain; the Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire UK; the Hospital Universitari de Sant Joan de Reus, IISPV, URV, Tarragona, Spain; the Center for regenerative medicine, Boston university school of medicine, Boston, USA; and the Institut de Recerca Sant Joan de Déu and CIBERER, Hospital Sant Joan de Déu, Barcelona, Spain
    The team conducted a nested case-control study out as part of a larger prospective cohort study, which included healthy full-term newborns (> 200) with at least one first relative with biopsy-verified celiac disease. The present study includes 10 cases of celiac disease, along with 10 best-matched controls who did not develop the disease after 5-year follow-up.
    The team profiled fecal microbiota, as assessed by high-throughput 16S rRNA gene amplicon sequencing, along with immune parameters, at 4 and 6 months of age and related to celiac disease onset. The microbiota of infants who remained healthy showed an increase in bacterial diversity over time, especially by increases in microbiota from the Firmicutes families, those who with no increase in bacterial diversity developed celiac disease.
    Infants who subsequently developed celiac disease showed a significant reduction in sIgA levels over time, while those who remained healthy showed increases in TNF-α correlated to Bifidobacterium spp.
    Healthy children in the control group showed a greater relative abundance of Bifidobacterium longum, while children who developed celiac disease showed increased levels of Bifidobacterium breve and Enterococcus spp.
    The data from this study suggest that early changes in gut microbiota in infants with celiac disease risk could influence immune development, and thus increase risk levels for celiac disease. The team is calling for larger studies to confirm their hypothesis.
    Source:
    Microbiome. 2018; 6: 36. Published online 2018 Feb 20. doi: 10.1186/s40168-018-0415-6

    Dr. Ron Hoggan, Ed.D.
    Celiac.com 04/14/2018 - There is a revolutionary new book about gluten sensitivity and celiac disease, written by Dr. Gordon Heinrichs, D.C. (whose article appears in this issue). His careers as a medical laboratory technologist, then a chiropractor, have uniquely located him to see gluten's impact on health in an entirely new way. His book critiques relevant scientific explorations and discoveries and the ensuing clinical practices. Titled "Celiac Disease & Gluten Sensitivity: A troubled past, but a promising future", this exciting book is a breath of fresh air in the field of gluten sensitivity and celiac disease. Dr. Heinrichs' thoughtful analysis of relevant data combined with the application of practical common sense explodes some of the common medical myths that claim to distinguish gluten sensitivity from celiac disease. He also explores conventional wisdom around dietary experimentation, and offers a rational approach to diagnosing gluten sensitivity. 
    The evidence Heinrichs provides raises questions about the view that we should continue to eat gluten until we can visit a gastroenterologist and get a biopsy taken. He also challenges the belief that HLA analysis is beneficial for those who are aware that gluten causes some or all of their health problems. 
    After a preview of the final draft, I can confidently predict that anyone who is interested in thoughtful, objective, and health promoting insights into gluten's impact on human health will be intrigued and motivated by the offerings of this inexpensive, powerful new ebook. I recommend it without reservation. It is very well researched and written and is now available on Amazon. I hope it will become the new best seller among books that explore the gluten syndrome.