Newbie! Pre Intestinal Biopsy

[trents]

KK, I don't see any real evidence from your links that leads me to believe gluten content is a deciding factor in what kind of flour that commercial entities use to make various kinds of baked goods. The first article suggests they might consider this but we don't actually know how much of a factor it really is in the commercial environment. More important might be the kind of wheat flour available in a given area where wheat is grown. And I certainly did not see much evidence in those articles about the effect of gluten content on rising properties. They did talk about it's influence on "breaking" properties. And we really don't know what kind of flour was chosen to make JDG's crackers.

That different wheat cultivars contain different amounts of gluten, you will get no argument from me there. That is common knowledge. What I question is if that factoid is actually used commercially on a consistent basis to enable one to say that in general, crackers are made from a low gluten flour or that the gluten content is the main factor in the extent to which dough rises.

My concern here with you bringing this up is that JDG seems now confused over whether his crackers have a high enough gluten content to give a valid test result and/or he's wondering if it's okay to eat gluten containing products as long as they are made from low gluten flour.

[knitty kitty]

As you are so fond of saying, "Celiac Disease must first be ruled out before an NCGS diagnosis can be made." 

Antibody tests can result in false negatives.   Diabetes and Anemia can be causes of false negatives on antibody tests.  Diabetes and Anemia are common in Celiac Disease.  

Some biopsies can show little damage.  The intestinal damage can be patchy or out of reach of biopsy implements.  Biopsies done in the early stages or in young people can show little damage.  Some of us are really good poppers and our bodies expel gluten quickly before intestinal damage shows up. 

So, looking at false negatives and no or little damage on biopsies, some doctors can fail to make a correct Celiac diagnosis.  These doctors conclude it's NCGS.  In these situations where there are such similarities between early Celiac Disease and NCGS, a genetic test is currently the only way to know for certain.  

As the years go by, more health problems can accrue due to undiagnosed Celiac.  Lots of older adults get diagnosed late in life with multiple health problems that can be attributed to Celiac Disease that was not diagnosed properly.  

Edited July 20, 2023 by knitty kitty
Typo

[knitty kitty]

In this study, consuming 3 grams of gluten vs 10 grams of gluten were compared.  Ten grams of gluten produced lots of changes in the small intestine and in antibodies.   Three grams of gluten was only enough for symptoms to show up.  

To get the high antibodies and the damaged villi, 10 grams of gluten had to be consumed.  

 

"Vh:celiac disease, VCE enteropathy score, ELISpot, gut-homing CD8 T cells, IEL counts, and HLA-DQ2-restricted gluten-specific CD4 T cells showed significant changes from baseline only at 10 g gluten; symptoms were significant at 3 g. "

Evaluating Responses to Gluten Challenge: A Randomized, Double-Blind, 2-Dose Gluten Challenge Trial

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878429/

 

Since @JDG already tested positive on antibody tests, he's eating gluten for endoscopy and biopsy.  

To get significant changes in the villi, 10 grams of gluten should be consumed.  3 grams of was enough to bring on symptoms.

Crackers don't have the same amount of gluten as chewy pizza crust does.  

@JDG says he's tolerating the crackers well...no symptoms.  

Is @JDG eating enough gluten prior to biopsy to promote villi damage (10 grams) when he isn't even showing symptoms (3 grams)???

Here's what the study says...

"While the 3 g dose was sufficient to initiate an immune response, as detected by several biomarkers such as IL-2, the 10 g dose was required for enteropathy within the study time frame. Based on our data, we would suggest that gluten challenge should be conducted over longer durations and/or using doses of gluten of ≥ 3 g/day to ensure sufficient histological change can be induced."

 

No!  Gluten containing flours are not safe no matter what level gluten they contain.  Beer has gluten molecules that are soluble in alcohol.  Beer is not safe.  

[trents]

18 minutes ago, knitty kitty said:

In this study, consuming 3 grams of gluten vs 10 grams of gluten were compared.  Ten grams of gluten produced lots of changes in the small intestine and in antibodies.   Three grams of gluten was only enough for symptoms to show up.  

To get the high antibodies and the damaged villi, 10 grams of gluten had to be consumed.  

 

"Vh:celiac disease, VCE enteropathy score, ELISpot, gut-homing CD8 T cells, IEL counts, and HLA-DQ2-restricted gluten-specific CD4 T cells showed significant changes from baseline only at 10 g gluten; symptoms were significant at 3 g. "

Evaluating Responses to Gluten Challenge: A Randomized, Double-Blind, 2-Dose Gluten Challenge Trial

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878429/

 

Since @JDG already tested positive on antibody tests, he's eating gluten for endoscopy and biopsy.  

To get significant changes in the villi, 10 grams of gluten should be consumed.  3 grams of was enough to bring on symptoms.

Crackers don't have the same amount of gluten as chewy pizza crust does.  

@JDG says he's tolerating the crackers well...no symptoms.  

Is @JDG eating enough gluten prior to biopsy to promote villi damage (10 grams) when he isn't even showing symptoms (3 grams)???

Here's what the study says...

"While the 3 g dose was sufficient to initiate an immune response, as detected by several biomarkers such as IL-2, the 10 g dose was required for enteropathy within the study time frame. Based on our data, we would suggest that gluten challenge should be conducted over longer durations and/or using doses of gluten of ≥ 3 g/day to ensure sufficient histological change can be induced."

 

No!  Gluten containing flours are not safe no matter what level gluten they contain.  Beer has gluten molecules that are soluble in alcohol.  Beer is not safe.  

Agreed! But, we still don't know how much gluten JDB is consuming with his cracker eating. I hope he's consuming enough of them daily to compensate for them possibly being made from low gluten flour. This has been a good discussion since it highlights the fact that different wheat flour products may vary significantly in the amount of gluten they contain. So, when we recommend two slices of wheat bread or the equivalent, there needs to be some thought and even research into making sure that happens when its not wheat bread.

[knitty kitty]

https://bakerpedia.com/different-amounts-gluten-flour/

"The flour with the lowest amount of gluten in it is cake flour containing only 7-9% gluten. It is of course used in cake, but also muffins and delicate cookies. All-purpose flour has 8-11% gluten in it. It can be used to make things like waffles, pie crusts, pastries, and cookies. Bread flour has the highest amounts of gluten at 12-14%, and works well in yeast products."

https://www.bobsredmill.com/blog/baking-101/breaking-difference-bread-flour-vs-purpose-flour/

"Here’s a brief rundown of the key differences between bread flour vs. all purpose flour:

Bread flour has a higher protein content (around 13% more), which leads to more stability, form and rise in the dough, allowing it to lift and hold shape

All purpose flour has a lower protein content, resulting in lighter, shorter breads, which makes it an ideal flour for cookies, cakes and more

All purpose flour contains less gluten than bread flour

The higher content of gluten in bread flour makes it ideal for airy, chewy bread, rather than dense bread."

 

[knitty kitty]

Several Celiac organizations say 10 grams of gluten should be eaten before testing.  If one slice of bread is equivalent to 2 grams, five slices of bread should be consumed to get ten grams.

 

https://www.beyondceliac.org/celiac-disease/the-gluten-challenge/

"You will need to eat a three to 10 grams of gluten per day, and two grams is roughly equivalent to a slice of bread."

https://www.celiac.ca/healthcare-professionals/diagnosis/gluten-challenge/

The adult patient eats high amounts of gluten (typically 8-10 gm of gluten a day, equivalent to approximately 4-6 slices of bread a day) for 6-8 weeks. 

https://www.coeliac.org.au/s/article/Gluten-Challenge

It is reasonable to aim for 10 grams of gluten daily (the dose can be halved for children i.e. 5 grams).

[trents]

The 20 ppm of gluten set as the commercial standard for "gluten free" is based on a 10 mg per day "safe" threshold for celiacs. https://www.glutenfreewatchdog.org/news/what-does-10-mg-of-gluten-look-like/

The article from the link above states that one slice of wheat bread contains about 3.5gm of gluten.

So, the two slices of wheat bread daily guideline from the Mayo Clinic would seem to be inadequate. Maybe three slices would be better.

Seems like we are running into significant variations in information as we explore this topic.

[knitty kitty]

@trents, you posted earlier...

"I don't see any real evidence from your links that leads me to believe gluten content is a deciding factor in what kind of flour that commercial entities use to make various kinds of baked goods. The first article suggests they might consider this but we don't actually know how much of a factor it really is in the commercial environment. More important might be the kind of wheat flour available in a given area where wheat is grown. And I certainly did not see much evidence in those articles about the effect of gluten content on rising properties."

This article explains....

https://www.livestrong.com/article/400891-what-is-the-difference-between-bread-flour-high-gluten-flour/

And...high gluten flour

https://www.bakersauthority.com/collections/commercial-grade-high-gluten-flours

And...

https://www.bakersauthority.com/collections/commercial-grade-high-gluten-flours/products/king-arthur-sir-lancelot-hi-gluten-flour

"This unbleached flour is milled from the finest hard red spring wheat to give an extra chew to your bread and a higher rise to your whole grain loaves. As the highest-gluten flour around, it's key to helping you bake lusty, chewy artisan breads, and whole-grain breads with a hearty, lofty texture. Try it in pizza and bagel recipes - it'll add toothsome quality and bakery-worthy interior."

And...Cake flour 

https://www.bakersauthority.com/products/ardent-mills-american-beauty-cake-flour

"Cake flour is a flour that is very finely milled from soft winter wheat. It has a lower protein content than all-purpose flour, and it is finer, lighter, and softer. It’s also bleached, so the color is paler and the grain is less dense. Since the cake flour has a lower protein content it has less gluten. Gluten is what makes the food you bake chewier, which is often not good for cakes. Cakes are best if light, soft and moist, which is why cake flour is the best type of flour for making your favorite cakes. Who doesn't like an airy, moist cake?"

Edited July 20, 2023 by knitty kitty
Add more information

[trents]

Okay, maybe higher gluten content makes bread rise more but you the kind of leavening agent is a big factor as well. Many people just use all purpose baking flour to create a wide variety of wheat foods, from pizza crust to biscuits to cake to loaf bread.

[knitty kitty]

Yes.  All-purpose baking flour is right in the middle, gluten-content wise.  

Edited July 20, 2023 by knitty kitty
Typo

[JDG]

Thank you everyone for contributing to my.post. I am happy to learn any and all.informatuin regarding this topic. I will say I did contact my GI office to confirm that saltine crackers would be sufficient for my gluten challenge. I have been eating a whole sleeve of them each day so far. I have yet to try a Guinness but I intend on having one, I just need to make sure I wont have anything going on for a day or so after as I

If I have a reaction I am prepared to tough it out in bed all day! I did try 3 different types of gluten free buns this weekend as I had a BBQ, it was the first "bread" I have ate all year. 2 of them were awful but the 3rd brand was nice. They come frozen .

Thanks again for posting and please any info you can provide hwre I greatly appreciate!

 

J

[trents]

18 minutes ago, JDG said:

Thank you everyone for contributing to my.post. I am happy to learn any and all.informatuin regarding this topic. I will say I did contact my GI office to confirm that saltine crackers would be sufficient for my gluten challenge. I have been eating a whole sleeve of them each day so far. I have yet to try a Guinness but I intend on having one, I just need to make sure I wont have anything going on for a day or so after as I

If I have a reaction I am prepared to tough it out in bed all day! I did try 3 different types of gluten free buns this weekend as I had a BBQ, it was the first "bread" I have ate all year. 2 of them were awful but the 3rd brand was nice. They come frozen .

Thanks again for posting and please any info you can provide hwre I greatly appreciate!

 

J

How much sodium are you getting in an entire sleeve of saltine crackers? How's your blood pressure?

[JDG]

2 hours ago, trents said:

How much sodium are you getting in an entire sleeve of saltine crackers? How's your blood pressure?

It is roughly 935mg of sodium, which is alot but not if that isball i ha e all day! Which pretty much is the case. I have been in a whole , clean unprocessed unpreserved diet since January so, I am well below daily saodium intake! 

[Wheatwacked]

JDG, Do you know your vitamin D blood test results?  There is research that higher levels of vitamin D can protect the villi against the antibodies, perhaps explaining why, even though more than 40% worldwide have the genetic markers, only 1/2% of them are diagnosed with Marsh 3 damage.  Observationally, vitually everyone diagnosed with villi damage have low or deficient D, while I have found reports on homeostasis levels of vitamin D (80 ng/ml or 200 nmol/L depending on the lab) with villi damage, even with high antibody test results.

Though primarily considered gastrointestinal diseases, Celiac Disease and NCGS affect many other of our systems.  There are over 200 symptoms that may respond to a gluten free diet.  The connection between Celiac Disease and gluten wasn't found until 1953 that Dicke, Weijers, and van de Kamer identified gluten as the cause of the symptoms.

Research is also indicating that there may be other genes related to Celiac, not yet identified so not tested for.  Maybe those are the NCGS genes.  Maybe not.

Other vitamin intakes are affected by malabsorption due to villi damage, but also from food avoidance.  Interesting to note that most symptoms we suffer with Celiac are not caused by external influences.

      Vitamin D: A Critical Regulator of Intestinal Physiology1,25(OH)2D3 suppression of the production of IFNγ and IL‐17 by T cells and induction of regulatory T cells is known to protect against intestinal inflammation.

Perhaps the actions of the Royal College of Physcians back in the 1950s to inhibit vitamin supplements in most countries has done a greater disservice to world health than is recognized.

Personally, as my vitamin D levels went up I experienced less gut response to gluten.  At 72, I am getting healthier while I watch relatives in their 40's starting to deteriorate. and suffer from the aches, pains and metabolic disorders that I used to have.

    "  Why do so many trials of vitamin D supplementation fail? the actions of vitamin D at the cellular level are increasingly understood, but deficiency persists globally. Observational studies in humans have shown that better provision of vitamin D is strongly associated, dose-wise, with reductions in current and future health risks... RCTs, however, have used designs evolved for testing drugs while vitamin D is a nutrient."

 

[JDG]

No I do not know any vitamin blood level counts. Though I am curious, I will look into getting tested. I do know that since March I have been getting more than adequate outdoor sunlight as well as my diet being 75% plant, whole food based, and 25% animal (minimaly processed) food. I have not felt as good now at 52 than I did when I was 21 year old Marine. Excercise has also been key I have been fortunate enough to work from home for many years but never took advantage of that for my health but have this year and it definitely has contributed to my.overall well being at this point. I just want to find out if I have Celiac or NCGS and how much if any damage has been done. 

[JDG]

Had Guinness today with lunch at 1p. Eastern Daylight Savings Time. No issues at this point also ate full meal since having guinness! At this point if I can handle 3 more at one sitting I dont need a biopsy or diagnosis I will be fine, avoid all gluten with exception of Guinness, which obviously because of its healthy nutritional profile and possibly the best tasting substance on earth, counter acts any negative reaction from the gluten in its malted barley. I will update after biopsy and if anything changes but consider me content with whatever the outcome is! 

[JDG]

Gluten challenge! Well after having 1 guinness on monday w lunch and having no issues, I had 3 maybe 4 on thursday evening around 8pm. I am just now feeling normal from the gluten reaction! Ill stick to just 1 guinness however that is like saying your going to eat 1 potato chip. Oh well just passing on info!