IgG and IgA levels for a Type 1 Diabetic

[Longtee81]

Hello, I am searching for some guidance on what my labs could mean and knowledge to make sure my new Gastroenterologist steers my down the correct path.  Prior to Celiac being on my radar, I was diagnosed with Type 1 Diabetes (1996) and it has also been suspect that I have Sjogren's Syndrome four about 10 years. My new Endocrinologist performed their standard Celiac screening on 5/29/2018 and my results were quite elevated. I have posted them below along with the updated numbers 2 months later following gluten-free diet on 8/1/2018 (All Standard Ranges are <15 for reference):  TISSUE TRANSGLUTAMINASE IgA on 5/29 was >250 , on 8/1/18 had dropped to 49  TISSUE TRANSGLUTAMINASE IgG on 5/29 was 169 , on 8/1/18 had increased to >250  The TTG IgA test seemed to respond well from being gluten free from 2 months, however the TTG IgG has actually gone up by ~100. In addition to the TTG tests, they also added the following two Deamidated Gliadin tests below when they checked my kevels for the second time.  Gliadin IgG Antibody on 8/1/18 = >250 U/ml  Gliadin IgA Antibody on 8/1/18 = 81 U/ml Any thoughts on why the IgG could have increased over the last two months that I have been gluten free? I'm wondering if this could be attributed the T1 Diabetes, Sjogren's or possibly an additional undiagnosed condition. I have no idea how much T1D effects the IgG test, only that it can. I would have expected the IgA and IgG to drop together. Sorry for the long post, and thanks for any comments or suggestions!

Edited August 5, 2018 by Longtee81
Correct a lab number

[tessa25]

It's possible there is hidden gluten in your diet. I've found out that my blood test numbers go up for <20ppm gluten so gluten free labels don't mean much for me. My numbers also go up when I eat solid food. At the moment I eat steak and zucchini on the weekend and liquid diet during the week. My numbers go down much quicker on a bland liquid diet.

[Longtee81]

That's a good question.  It is possible, although I have been very careful. There is still gluten in the house and I have tried my best to avoid contamination. I have been more careful and stopped eating out for lunch the last few weeks to avoid accidental cross contamination. 

The thing that confuses me is that the TTG IgA level, which is more specific to celiac has dropped from >250 to 49, which I believe is evidence that I responded to the Gluten Free diet, but the TTG IgG level, went up by 100, which I understand is less specific to celiac.  I'm really confused why they have gone in opposite directions. 

I will have to look into and consider a liquid diet! I have definitely changed things around and am eating different foods including lots of nuts and I wonder if that could be causing me issues with antibody levels.

[tessa25]

I would try a whole foods only diet before trying a liquid diet. And my liquid diet is not a clear liquid diet. Try meat, veggies, potatoes (if they don't bother you), butter, cheese if they don't bother you. Hold off on the spicey food.

[cyclinglady]

A few months into the diet is not enough time.  It can take over a year for antibodies to come down.  Why?  The learning curve for the gluten-free is steep.  It does sound like you are being exposed to gluten instead of your other autoimmune causing elevated numbers.   As Tessa suggested a Whole Foods diet (no processed, even certified gluten free), no eating out, and beefing up your safety procedures in your home kitchen for the next six months would be wise.

The antibodies tests for celiac disease were developed to help diagnose celiac disease, but not necessarily to monitor gluten exposure.  They are the only less invasive “tools in the toolbox” though.  You should be under a GIs care and not your endo to treat and monitor celiac disease.  

The diet is critical.  For example, you  eat a lot of nuts and they are processed.  Make sure they are in whole form (after you wash them) and invest in a nut cracker. You might be more sensitive than the average celiac and 20 ppm might be too much for you.    If your blood work improves, purchase only certified or brands that other celiacs recommend.  

Consider a endoscopy with your GI if you see no improvement.  This will clarify if other autoimmune issues are causing your antibodies to stay elevated.  Most celiacs are non-responsive usually because they are getting gluten exposures.  Some have refractory celiac disease, but that is rare.  

 

 

 

[Longtee81]

On 8/6/2018 at 9:45 AM, cyclinglady said:

"It does sound like you are being exposed to gluten instead of your other autoimmune causing elevated numbers."

Thank you for the advice and suggeations to help with avoiding accidential consumption of gluten that could be causing my these levels to increase!

I have read the reference to other autoimmune conditions (T1 Diabetes, liver, thyroid, chrons) causing TtG IgG to be high, but i have never seen whether they could cause values 10x greater than normal high like mine. Also it confuses me why IgG went up while IgA dropped. 

I am under the care of a gastroenterologist, but after my first visit with him, I may be looking for a new one. He spent 10 minutes with me and told me to keep eating gluten free without any additional advice. Said we would recheck my numbers and if they had dropped significantly, i would not need to see him for another year. 

Since they haven't all dropped, I'm currently holding tight and waiting to hear back fron them for next steps. 

Thanks! 

Steve