Need help interpreting test results

[Boymom96]

Hello all! 
 

25yo female and I am looking for some direction/guidance on some of the test results I received from a celiac serology cascade that my dr ordered based on a multitude of symptoms (joint pain, ear ringing and pain that is sometimes accompanied with itching, headaches, chronic diarrhea, abdominal pain that has landed me in the ER, inflamed tongue, unexplained bruising on abdomen, legs and feet, nerve pain, ect) 

results are:

Gliadin(Deamidated) Ab, IgA-

Negative (no values given)

 

Deamidated Gliadin Abs, IgG

Your value - 23

Negative 0 - 19
Weak Positive 20 - 30
Moderate to Strong Positive >30

 

IgA

Your Value 212 mg/dL

Standard Range 87 - 352 mg/dL

Vit D, 25-Hydroxy

 Your Value 20.5 ng/mL

Standard Range 30.0 - 100.0 ng/mL

 

Vitamin B12

Your Value 498 pg/mL

Standard Range 232 - 1,245 pg/mL

My choloestorol was also on the verge on high despite a rather decent diet and exercise. I had my gallbladder removed this past July, and in an ultrasound was seen my liver is enlarged but not fatty (also I don’t drink at all). I had pre eclampsia develop in both of my pregnancies. Depression and anxiety since adolescence (25 now). 
 

both of my sons have celiac symptoms and I am wondering if that plus my tests warrant me asking their dr to do a celiac panel for them?
 

any insight would be appreciated!

[trents]

Boymom96,

Unfortunately, the antibody tests your physician ordered do not include the tTG-IGA which is the centerpiece and the most common antibody test that physicians typically order when checking for celiac disease. The tTG-IGA (tissue transglutaminase Immunoglobulin A) combines very good specificity with good sensitivity. You have a  weak positive in the Deamidated Gliadin Abs, IgG but that is a secondary test that can be run and could indicate celiac disease or some other things. It can be helpful when the total IGA is low or when someone's immune response is a little atypical for celiac disease. Your total IGA is within normal range. This might be helpful in understanding the serum antibody tests that can be run for celiac disease: https://celiac.org/about-celiac-disease/screening-and-diagnosis/screening/

I'm also surprised that the physician did not order tests to check for anemia. B12 is in the low end of normal but that one can be masked by supplementation. Serum vitamin level testing is often not helpful because it does not measure the amount actually in the tissues that has been absorbed as opposed to what is just in circulation. And supplementation can also give artificially high readings.

If your liver is enlarged you should get your liver enzymes checked. About 18% of celiacs have elevated liver enzymes. Your physician really needs to order a tTG-IGA antibody test and also a CBC (complete blood count) and a CMP (complete metabolic panel) to look for anemia and elevated liver enzymes.

Some of the symptoms you describe are classic celiac symptoms such as the abdominal pain, headaches, chronic diarrhea, and neurological issues.

It is also possible you don't have celiac disease but NCGS (non celiac gluten sensitivity). Many of the symptoms are the same but NCGS does not damage the small bowel villi.

If your child has celiac disease there is somewhere between a 10% and a 44% chance that you will have it, depending on the research referenced.

In short, I would recommend going back to your physician and ask that a tTG-IGA be run. That would be the place to start. You simply don't have enough information to draw any conclusions yet.

Finally, you should be aware that there is still a great deal of ignorance and outdated knowledge in the medical community concerning celiac disease. At appointments you need to be armed with info and assertive.

Edited November 14, 2021 by trents

[Scott Adams]

Welcome to the forum! Also, a mild positive is still a positive blood test result that indicates that you may indeed have celiac disease, so keep eating gluten daily until all testing is completed, as your doctor may want you to do an endoscopy to follow up this result. Hopefully you were eating gluten daily in the 6-8 weeks leading up to your tests, otherwise the results may not be correct.

Personally I find this relatively new “mild positive” category serves only to confuse people. Many doctors may not want to do more tests and tell patients to keep eating gluten. I’m not sure what real purpose it serves, but to me any positive blood test, even a “mild” one, indicates you likely have celiac disease, especially if you’ve got all of the symptoms you’ve described. Hopefully your doctor is willing to follow up with more tests.

[Boymom96]

On 11/13/2021 at 5:38 PM, trents said:

Boymom96,

Unfortunately, the antibody tests your physician ordered do not include the tTG-IGA which is the centerpiece and the most common antibody test that physicians typically order when checking for celiac disease. The tTG-IGA (tissue transglutaminase Immunoglobulin A) combines very good specificity with good sensitivity. You have a  weak positive in the Deamidated Gliadin Abs, IgG but that is a secondary test that can be run and could indicate celiac disease or some other things. It can be helpful when the total IGA is low or when someone's immune response is a little atypical for celiac disease. Your total IGA is within normal range. This might be helpful in understanding the serum antibody tests that can be run for celiac disease: https://celiac.org/about-celiac-disease/screening-and-diagnosis/screening/

I'm also surprised that the physician did not order tests to check for anemia. B12 is in the low end of normal but that one can be masked by supplementation. Serum vitamin level testing is often not helpful because it does not measure the amount actually in the tissues that has been absorbed as opposed to what is just in circulation. And supplementation can also give artificially high readings.

If your liver is enlarged you should get your liver enzymes checked. About 18% of celiacs have elevated liver enzymes. Your physician really needs to order a tTG-IGA antibody test and also a CBC (complete blood count) and a CMP (complete metabolic panel) to look for anemia and elevated liver enzymes.

Some of the symptoms you describe are classic celiac symptoms such as the abdominal pain, headaches, chronic diarrhea, and neurological issues.

It is also possible you don't have celiac disease but NCGS (non celiac gluten sensitivity). Many of the symptoms are the same but NCGS does not damage the small bowel villi.

If your child has celiac disease there is somewhere between a 10% and a 44% chance that you will have it, depending on the research referenced.

In short, I would recommend going back to your physician and ask that a tTG-IGA be run. That would be the place to start. You simply don't have enough information to draw any conclusions yet.

Finally, you should be aware that there is still a great deal of ignorance and outdated knowledge in the medical community concerning celiac disease. At appointments you need to be armed with info and assertive.

Thank you for the reply! I had my iron/ferritin checked in may and they were the low end of normal. I did have a CBC and Metabolic panel done, a few things came back a little high/low but dr shows no concern. the only slightly high liver enzyme is alkaline phosphate but it’s the high end of normal. They did also order a tTG/DGP Screen but it was negative. Is this the test you were referring to? Do you happen to know what else could cause the positive antigladidin igG to be positive? The labs interpretation is NCGS 
 

[trents]

No, not tTG-DGP but tTG-IGA. Actually, I don't believe the Deamidated Gliadin Abs, IgG can point to other things besides celiac disease. I misspoke about that. There are a variety of these tests because some are more specific or more sensitive than others and what one misses another can pick up on.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764583/

Some of these other tests can be helpful in discovering celiac disease in those who actually have it but atypically test negative in the tTG-IGA test. That still doesn't explain why the physician did not order the celiac panel center piece tTG-IGA test. I would ask for that one. All of the veteran celiacs who participate on this forum will attest to the fact that there is a huge amount of ignorance and out dated knowledge in the medical community with regard to celiac disease. We have found that we generally have to take our docs by the hand and guide them through the diagnostic process if we are to get proper testing done. So go armed with knowledge and be assertive. There are also home celiac test kits available for around $100 if physicians aren't cooperative. Check out the one from Imaware. 

The only way to distinguish between celiac disease and NCGS is with an endoscopy/biopsy. Many of the symptoms are the same but NCGS does not damage the small bowel lining like celiac disease does. But in reality, the antidote is the same for both: life-long strict adherence to a gluten free diet.

Edited November 15, 2021 by trents

[Scott Adams]

Yes, your positive Deamidated Gliadin Abs, IgG test means you likely have celiac disease, and a biopsy would confirm this. If the biopsy were negative, then it would seem that NCGS might be the possible diagnosis. There is currently no test for NCGS, and ~10x more people have it than celiac disease, but the treatment is the same--a gluten-free diet. Some researchers believe that some people with NCGS may be in a pre-celiac stage, and if they were to keep eating gluten could end up with villi damage (and it's possible you do have such damage now). The ttg test @trents mentioned might be a good option, if you want to be more certain of whether or not you should be gluten-free, but to me it does seem like a gluten-free diet would be the right choice for you given everything you've shared.

[trents]

Just make sure you don't begin the gluten free diet before all testing is complete.

[Wheatwacked]

With two children diagnosed with Celiac Disease, either you or their father have the genes and with positive blood work that sort of clinches it.

Depression and anxiety supported by deficient vitamin D you need to seriously supplement vitamin D to raise it up from 20.5 ng/ml. Starting in 1984 I had Seasonal Affective Disorder (SAD) that kicked every September. Six months after starting GFD in Feb 2015 I started 250 mcg of D3 a day.  After 4 days I felt better than I had in years. I continued 250 mcg (10,000 IU) day and when I was tested in January 2019 my plasma level was only 44.7 ng/ml. In August 2021 after six and a half years of 250 mcg a day my plasma finally reached 86.9 ng/ml. Even now if I skip it too long I stop answering the phone. My son, diagnosed with Celiac Disease at six months old (he looked like a Biafran Famine baby) is now 44. His is a professional ocean lifeguard here in Florida at least 40 hours a week on the beach, so gets plenty of sunshine year round.  Last week he was tested for vitamin D (at my nagging). The doctor told him his vitamin D level was low and he should start supplementing 400 IU.  In my opinion, after 30 years in the sun, 400 iu a day is just a cruel joke, indicating just how little physicians understand nutrition. 

As to your preeclampsia, borderline high cholesteral, and liver and gall bladder; that is choline deficiency. You should be eating 4 large eggs, or 15 ounces of lean beef or 30 ounces of chicken breast a day to reach the RDA for choline everyday.

https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

There are other deficiencies caused by malabsorbtion if you have villi damage, Thiamin and the other vitamin and minerals absorbed in the small intestine. Potassium deficiency is a worldwide concern because most people don't eat enough.

Quote

Vitamin D Is Not as Toxic as Was Once Thought: A Historical and an Up-to-Date Perspective
n the current issue of Mayo Clinic Proceedings, Dudenkov et al report on a retrospective study of serum 25-hydroxyvitamin D (25(OH)D) values in patients registered in the Rochester Epidemiology Project. The article reported that although serum 25(OH)D values of more than 50 ng/mL increased over the 10-year study period, vitamin D toxicity and hypercalcemia were exceedingly rare... Vitamin D intoxication associated with hypercalcemia, hyperphosphatemia, and suppressed parathyroid hormone level is typically seen in patients who are receiving massive doses of vitamin D in the range of 50,000 to 1 million IU/d for several months to years. Ekwaru et al16 recently reported on more than 17,000 healthy adult volunteers participating in a preventative health program and taking varying doses of vitamin D up to 20,000 IU/d. These patients did not demonstrate any toxicity, and the blood level of 25(OH)D in those taking even 20,000 IU/d was less than 100 ng/mL. For point of reference, a 25(OH)D level of 100 ng/mL is considered by the Institute of Medicine, the Endocrine Society, and many reference laboratories to be the upper limit of normal. 

There remains concern, however, that increasing vitamin D intake even by 400 IU/d increases the risk for kidney stones, especially in patients with a history of kidney stones. Despite this concern, there is no credible scientific literature suggesting that such vitamin D intake increases the risk for kidney stones. Similarly, data are weak regarding the association between vitamin D intake and cardiovascular calcifications. To the contrary, current evidence suggests that improvement in vitamin D status reduces the risk for hypertension, stroke, and myocardial infarction.

 MAYO CLINIC PROCEEDINGS 562 Mayo Clin Proc. n May 2015;90(5):561-564 n http://dx.doi.org/10.1016/j.mayocp.2015.03.015 www.mayoclinicproceedings.org increases the risk for kidney stones, especially in patients with a history of kidney stones.10 Despite this concern, there is no credible scientific literature suggesting that such vitamin D intake increases the risk for kidney stones.12,15 Similarly, data are weak regarding the association between vitamin D intake and cardiovascular calcifications.12 To the contrary, current evidence suggests that improvement in vitamin D status reduces the risk for hypertension, stroke, and myocardial infarction.1   https://www.mayoclinicproceedings.org/article/S0025-6196(15)00244-X/pdf

Vitamin D and Depression: Where is all the Sunshine?  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908269/

Quote

Choline – Used by doctors since 1947. Choline is essential to effectively metabolize fat, cholesterol, proteins, and carbohydrates. Experience has shown that SP Choline is been a Nutritional Essential for people who suffer severe gall bladder symptoms and/or after gall bladder removal.   https://www.justlivewell.com/gall-bladder-a-vital-organ-that-is-being-removed-at-alarming-rates/

Quote

During pregnancy, extra maternal choline reduces a woman’s risk of developing pre-eclampsia or having a baby with neural-tube defects, and babies born to moms who got ample choline have lower levels of the stress hormone cortisol. ...Zeisel said our choline intake started to drop in the 1970s with the advice to reduce dietary cholesterol. “Many adults are avoiding foods that contain choline because they are avoiding cholesterol. It gets a lot harder to get enough choline if you’re not drinking milk and eating eggs and meat.”   https://www.seattletimes.com/life/wellness/choline-the-essential-but-forgotten-nutrient/

 

[Boymom96]

Thank you all so much for the information! I have an appointment with my primary dr this Friday so I am looking to go with as much information about my own results/what to ask for. I wanted to come back with the things in my CBC and other tests that are on the verge of high low to see if you may see anything to ask/point out:

WBC- 8.9 x10E3/uL

Standard Range 3.4 - 10.8 x10E3/uL

 

RBC - 4.67 x10E6/uL

Standard Range 3.77 - 5.28 x10E6/uL

 

Hemoglobin 14.7 g/dL

Standard Range 11.1 - 15.9 g/dL

 

Hematocrit - 42.6 %

Standard Range 34.0 - 46.6 %

 

MCV - 91 fL  (borderline high)

Standard Range79 - 97 fL

 

MCH - 31.5 pg 

Standard Range 26.6 - 33.0 pg

 

MCHC - 34.5 g/dL (this usually is in the high end)

Standard Range31.5 - 35.7 g/dL

 

ERYTHROCYTE DISTRIBUTION WIDTH (LABCORP)- 13.4 %

Standard Range11.7 - 15.4 %

 

Platelets - 315 x10E3/uL

Standard Range150 - 450 x10E3/uL

 

Neutrophils - 60 % (always on the high end)

Standard Range Not Estab. %

 

Lymphocyte %- 31 % 

Standard Range Not Estab. %

 

Monocyte % - 7 %

Standard Range Not Estab. %

 

Neutrophils Absolute - 5.3 x10E3/uL

Standard Range1.4 - 7.0 x10E3/uL

 

Lymphocyte Absolute - 2.8 x10E3/uL

Standard Range 0.7 - 3.1 x10E3/uL

TSH - 0.643 uIU/mL

Standard Range 0.450 - 4.500 uIU/mL

 

BUN - 7 mg/dL (very low?)

Standard Range 6 - 20 mg/dL

 

Creatinine Serum - 0.67 mg/dL (very low)

 Standard Range 0.57 - 1.00 mg/dL

 

BUN/Creatinine Ratio - 10 (very low) 

Standard Range 9 - 23

Sodium - 142 mmol/L (high end)

Standard Range 134 - 144 mmol/L

 

Chloride - 105 mmol/L (high end)

Standard Range 96 - 106 mmol/L

 

CO2 - 19 mmol/L  (below)

Standard Range 20 - 29 mmol/L

 

Calcium - 9.8 mg/dL (high end but my calcium levels are usually 10.1-5)

Standard Range 8.7 - 10.2 mg/dL

 

Albumin - 4.5 g/dL

Standard Range3.9 - 5.0 g/dL

I went to my OB yesterday who ordered imaging on a lump found in my right breast, as well as swollen lymph nodes in my right armpit and right side of groin. Not sure if it’s relevant but figured it doesn’t hurt to include? And I am wondering if an abdominal MRI would show or be able to help diagnose intestinal damage? 

I feel like I may be worrying about nothing, but I genuinely don’t feel well. I have deep ear pain, headaches on one side or the top of my head, vision changes like double vision twice and dizzy/almost falling over, glossitis which has been painful)

Im sorry for including so much information but I have always had trouble getting a dr to explain anything or take me seriously when I ask/tell them symptoms. 
 

thank you all again for your help through this!! 

[trents]

There is nothing in your CBC/CMP blood work that suggests problems.

The breast lump and swollen lymph nodes on the same side would be a cause for concern and does need exploration.

An abdominal MRI would not likely show the kind of damage caused by celiac disease I'm thinking. It's not the correct tool for this but it could show gross inflammation of the intestinal lining I imagine. I'm thinking you would do well to pursue an endoscopy/biopsy to check the condition of the villi in the small bowel. This is the god standard diagnostic test for celiac disease and is used to differentiate it from NCGS (non celiac gluten sensitivity). If your children are experiencing celiac-like symptoms, yes, they should definitely be tested. That might also serve the purpose of providing diagnostic evidence for yourself as if they have celiac disease they got those genes from someone.

[Wheatwacked]

Keeping in mind I am not a doctor.

The swollen lymph nodes on your right side and the lump in your right breast, which may also be simply a swollen lymph node, fits with your high end of normal WBC, neutrophils and lymphocites possibly indicating a low grade infectection. The imagining ordered by the OB should help clarify.

"The following can excessively lower your BUN: Low-protein diet, malnutrition, or starvation ; Impaired liver activity due to liver disease;"   https://labs.selfdecode.com/blog/causes-of-high-or-low-blood-urea-nitrogen-bun/

Low BUN and large MCV could be related to your ongoing liver and gall bladder issues.  My intuition says that possibly might explain the lymph nodes. The BUN/Creatinine ratio indicates it is not a kidney problem.  Choline is like an honorary B vitamin.  It is definately a factor in liver disfunction. The difference between alcoholic liver and non-alcoholic fatty liver is doctors blame the alcoholic's poor diet on alchololism and pretend NAFLD is a mystery. They are both in my opinion caused by a diet difficient in Choline. Although it and B5 are typically ignored; deficiencies might come into play with malabsorbtion due to Celiac Disease. You might also ask about your homocysteine level.  Folate, choline and B5 and the other B vitamins are all interrelated in metabolizing it. Homocysteine is considered an independant risk factor for stroke and an indicator of cardiovasucular health and I think a likely indicator of overall B vitamin status.

Your TSH is in normal range, may or may not be affected by liver issues. Solving the liver may bring all of your tests closer to center of normal.  "Liver diseases are also frequently associated with thyroid test abnormalities or dysfunctions"   https://pubmed.ncbi.nlm.nih.gov/7548816/

Quote

An MCV blood test measures the average size of your red blood cells, also known as erythrocytes. If your results show that your red blood cells are larger than normal, it may indicate: vitamin B12 deficiency; A deficiency in folic acid, another type of B vitamin; Liver disease; Hypothyroidism  [which your TSH test effectively excludes.]     https://medlineplus.gov/lab-tests/mcv-mean-corpuscular-volume/

 

[knitty kitty]

10 hours ago, Boymom96 said:

 

MCV - 91 fL  (borderline high)

Standard Range79 - 97

ear ringing and pain that is sometimes accompanied with itching, headaches, chronic diarrhea, abdominal pain that has landed me in the ER, inflamed tongue, unexplained bruising on abdomen, legs and feet, nerve pain, ect) 

I had my gallbladder removed this past July, and in an ultrasound was seen my liver is enlarged but not fatty (also I don’t drink at all). I had pre eclampsia develop in both of my pregnancies. Depression and anxiety since adolescence (25 now). 

 

10 hours ago, Boymom96 said:

swollen lymph nodes  

I feel like I may be worrying about nothing, but I genuinely don’t feel well. I have deep ear pain, headaches on one side or the top of my head, vision changes like double vision twice and dizzy/almost falling over, glossitis (which has been painful).

You should have your doctor check you for B12 deficiency again and its intrinsic factor.  Your MCV is high, that means your red blood cells are getting bigger like they do with megaloblastic anemia.  And your B12 level is on the low end.  Some people can experience B12 deficiency symptoms while their B12 level is still within "normal" limits.  

All those symptoms you listed occur with B12 deficiency.  

You must keep in mind that Celiac Disease damages the small intestine in such a way that vitamins cannot be absorbed properly.  The eight B vitamins and Vitamin C are water soluble.  The body can't store them for longer than a few weeks.  The four fat soluble vitamins can be stored for longer periods, but doctors often only test for one, Vitamin D.  (And your Vitamin D level is low.)  It's extremely rare to have a deficiency in just one vitamin, especially with Celiac Disease where across the board deficiencies of vitamins and minerals are seen.  Screening for deficiencies is part of proper follow up care for Celiac Disease patients.  Discuss with your doctor the benefits of taking a B-Complex supplement.  And B12 shots.  

Do highlight the fact that you are having double vision.  B12 deficiency can permanently damage the optic nerve and your vision.  

Hope this helps

 

Edited November 17, 2021 by knitty kitty
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