What should I do with these test results?

[Jack Common]

I have test results like this:

• The Tissue Transglutaminase IgA antibody - normal
• The Tissue Transglutaminase IgG antibody - 6.6 U/ml (for the lab I did the tests 0.0 - 3.0 is normal)
• Immunoglobulin A - 1.91 g/l
• IgA Endomysial antibody (EMA) - normal
• IgG Endomysial antibody (EMA) - normal
• Deamidated gliadin peptide IgA - normal
• Deamidated gliadin peptide IgG - 46.1 U/ml (for the lab I did the tests 0.0 - 6.0 is normal)

I'm confused. I know the Tissue Transglutaminase IgA antibody with Immunoglobulin A results are quite strong. IgA Endomysial antibody is also a good indicator. But the levels of deamidated gliadin peptide IgG and the Tissue Transglutaminase IgG antibody.

My doctor says I can have Non-Celiac Gluten Sensitivity or IBS or functional dyspepsia. I see that I have symptoms related to consuming gluten food but I think it can be fructans, carbs from FODMAP, because gluten food has a lot of it. I also noticed I have intolerance to other FODMAP food as well.

I believe I don't have celiac disease and my symptoms can be more related to IBS or functional dyspepsia. But what do these two results mean? Because it's not clear I don't eat food with gluten but it's also not a good way. Unfortunately, biopsy is not available in my town. What should I do? 

[trents]

No. Your TTG-IGA is normal. And why do you say your Immunoglobulin A results at 1.91 g/l are strong? What is the reference range for that? You do not supply the reference range in your post. And by the way, that test is not for celiac disease per se. It is what we call "total IGA" and the value of measuring it is that if it is low, i.e., if you are IGA deficient, it will suppress individual IGA antibody test scores. Can you supply the reference range for that one?

Your TTG-IGG is high and your DGP-IGG is high. These are second tier celiac disease tests and not considered as specific or reliable as the IGA tests but certainly can indicate celiac disease, particularly in the situation where someone is IGA deficient or has been on a gluten reduced diet for a significant period of time.

Here is a primer for understanding celiac disease blood antibody tests: 

 

[Jack Common]

The normal range for total iga in the lab is from 0.7 to 4 g/l 

[Jack Common]

1 hour ago, trents said:

No. Your TTG-IGA is normal. And why do you say your Immunoglobulin A results at 1.91 g/l are strong? What is the reference range for that? You do not supply the reference range in your post. And by the way, that test is not for celiac disease per se. It is what we call "total IGA" and the value of measuring it is that if it is low, i.e., if you are IGA deficient, it will suppress individual IGA antibody test scores. Can you supply the reference range for that one?

Your TTG-IGG is high and your DGP-IGG is high. These are second tier celiac disease tests and not considered as specific or reliable as the IGA tests but certainly can indicate celiac disease, particularly in the situation where someone is IGA deficient or has been on a gluten reduced diet for a significant period of time.

Here is a primer for understanding celiac disease blood antibody tests: 

 

 

My results:

The Tissue Transglutaminase IgA antibody - 0.5 U/ml (for the lab I did the tests 0.0 - 3.0 is normal)

The Tissue Transglutaminase IgG antibody - 6.6 U/ml (for the lab I did the tests 0.0 - 3.0 is normal)

Immunoglobulin A - 1.91 g/l (for the lab I did the tests 0.7 to 4 g/l is normal)

IgA Endomysial antibody (EMA) - < 1:10 titer (for the lab I did the tests < 1:10 titer is normal)

IgG Endomysial antibody (EMA) - < 1:10 titer (for the lab I did the tests < 1:10 titer is normal)

Deamidated gliadin peptide IgA - 0.3 U/ml (for the lab I did the tests 0.0 - 6.0 is normal)

Deamidated gliadin peptide IgG - 46.1 U/ml (for the lab I did the tests 0.0 - 6.0 is normal)

[trents]

Then you are not IGA deficient.

If you have been abstaining from gluten for weeks or months before the blood draw was done to test for antibodies, your IGA test scores are invalid. You must be eating regular amounts of gluten for weeks/months prior to testing in order for the testing to be valid. If you remove gluten, the antibody levels begin to subside.

[trents]

Then you are not IGA deficient.

If you have been abstaining from gluten for weeks or months before the blood draw was done to test for antibodies, your IGA test scores are invalid. You must be eating regular amounts of gluten for weeks/months prior to testing in order for the testing to be valid. If you remove gluten, the antibody levels begin to subside.

Regardless of whether you have celiac disease or NCGS the treatment is the same, life-long abstinence from gluten.

[RMJ]

Thank you for including the lab normal ranges!

You could try going strictly gluten free for six months then repeat the blood tests.  If the IgG tests that are now positive decrease on a gluten free diet it would indicate that gluten makes your body create autoantibodies that attack itself.
 

[Jack Common]

9 hours ago, trents said:

Then you are not IGA deficient.

If you have been abstaining from gluten for weeks or months before the blood draw was done to test for antibodies, your IGA test scores are invalid. You must be eating regular amounts of gluten for weeks/months prior to testing in order for the testing to be valid. If you remove gluten, the antibody levels begin to subside.

Regardless of whether you have celiac disease or NCGS the treatment is the same, life-long abstinence from gluten.

I decided to look at what I bought before doing tests:

• 03.05.2024 - one loaf
• 08.05.2024 - one loaf
• 13.05.2024 - one loaf
• 20.05.2024 - one loaf

29.05.2024 is the date I did the tests.

I don't remember what I was eating from 20.05.2024 to 29.05.2024. How long I was eating that loaf bought at 20.05.2024. But I started the diet after doing the tests.

 

[trents]

To put this in perspective, the guidelines for the "gluten challenge" (i.e., for those wanting testing after having been on a gluten free diet for a significant amount of time) are as follows: 10g of gluten daily (about the amount in 4-6 pieces of bread) for at least two weeks before testing. It can come from loaf bread, muffins, biscuits, cereal, noodles, cake, whatever, so it is an amount of gluten equivalent to 4-6 slices of bread.

[Jack Common]

18 minutes ago, trents said:

To put this in perspective, the guidelines for the "gluten challenge" (i.e., for those wanting testing after having been on a gluten free diet for a significant amount of time) are as follows: 10g of gluten daily (about the amount in 4-6 pieces of bread) for at least two weeks before testing. It can come from loaf bread, muffins, biscuits, cereal, noodles, cake, whatever, so it is an amount of gluten equivalent to 4-6 slices of bread.

So do you think I need to follow a gluten free diet for another four months to have been on the diet for six months because I've already been for two months. Then start consuming gluten in proportions you've written for at least two weeks and after that do all these blood tests again? What can it give me? And do I need to do all the tests before starting getting gluten to see what levels I have after 6 months on the diet?

[trents]

No, you do not need to do all the tests again before starting the gluten challenge and I would give the gluten challenge 4 weeks of at least 10g of gluten daily instead of just two weeks just to make sure. Ask for the following tests at the end of the gluten challenge:

Total IGA

TTG-IGA

DGP-IGA

DGP-IGG

[Jack Common]

2 hours ago, trents said:

No, you do not need to do all the tests again before starting the gluten challenge and I would give the gluten challenge 4 weeks of at least 10g of gluten daily instead of just two weeks just to make sure. Ask for the following tests at the end of the gluten challenge:

Total IGA

TTG-IGA

DGP-IGA

DGP-IGG

Do you think my test results are not so valid so I need to check again but this time doing it right? Why do I need to wait so much time before starting the gluten challenge? By the way thank you for your help.

[RMJ]

Trents and I are suggesting two different things.

I suggested gluten free  for six months to see if the results went down without gluten. For that you would not do a gluten challenge.

If you want to see what the results would be if you ate more gluten you could start that gluten challenge that trents suggested right now.

[Jack Common]

44 minutes ago, RMJ said:

Trents and I are suggesting two different things.

I suggested gluten free  for six months to see if the results went down without gluten. For that you would not do a gluten challenge.

If you want to see what the results would be if you ate more gluten you could start that gluten challenge that trents suggested right now.

Yes, I understand your point. But I don't understand why trents suggests to do the challenge so I asked.

It all sounds so disappointing because it's not simple to diagnose what I have. I might be crazy.

And if I do what you say and then do what trents says it still might be not clear. If your guess about my results getting down was right, what would it mean. And if after gluten challenge the results were the same, what would it mean.

Thanks for your support.

 

[trents]

My suggestion for doing the gluten challenge is based on the assumption that it is not all clear that you were not eating enough gluten to give valid tests results in the first place. It is the shortest route to establish whether or not you are dealing with celiac disease, though if you do have celiac disease, you may also have other issues connected with food that may have originated from celiac disease.

[RMJ]

Since a biopsy isn’t an option, I think both of us are suggesting you see if changing the amount of gluten you eat changes the antibody levels. Trents is suggesting you try eating more, I’m suggesting that you try eating less - especially if cutting gluten from your diet makes you feel better.  If there is a correlation it indicates celiac disease.

[Jack Common]

My old results are:

• The Tissue Transglutaminase IgA antibody - 0.5 U/ml (for the lab I did the tests 0.0 - 3.0 is normal)
• The Tissue Transglutaminase IgG antibody - 6.6 U/ml (for the lab I did the tests 0.0 - 3.0 is normal)
• Immunoglobulin A - 1.91 g/l (for the lab I did the tests 0.7 to 4 g/l is normal)
• IgA Endomysial antibody (EMA) - < 1:10 titer (for the lab I did the tests < 1:10 titer is normal)
• IgG Endomysial antibody (EMA) - < 1:10 titer (for the lab I did the tests < 1:10 titer is normal)
• Deamidated gliadin peptide IgA - 0.3 U/ml (for the lab I did the tests 0.0 - 6.0 is normal)
• Deamidated gliadin peptide IgG - 46.1 U/ml (for the lab I did the tests 0.0 - 6.0 is normal)

 

Then I didn't eat gluten for six months and after I started a gluten challenge.

Before the challenge I did some tests as RMJ had suggested to do.

My results:

• The Tissue Transglutaminase IgG antibody - 0.5 U/ml (for the lab I did the tests < 20 U/ml is normal))
• Deamidated gliadin peptide IgG - 28 U/ml (for the lab I did the tests < 20 U/ml is normal)

 

As trents suggested I ate 6 slices of wheat bread before the tests during the challenge.

My results:

• The Tissue Transglutaminase IgA antibody - 2.0 U/ml (for the lab I did the tests < 20 U/ml is normal)
• The Tissue Transglutaminase IgG antibody - 2.0 U/ml (for the lab I did the tests < 20 U/ml is normal)
• Immunoglobulin A - 1.31 g/l (for the lab I did the tests 0.7 to 4 g/l is normal)
• Deamidated gliadin peptide IgA - 2.0 U/ml (for the lab I did the tests < 20 U/ml is normal)
• Deamidated gliadin peptide IgG - 2.13 U/ml (for the lab I did the tests < 20 U/ml is normal)

 

As I can understand I don't have celiac disease.

[trents]

I would agree. The tests do not indicate you have celiac disease. So, if you are convinced that when you eliminate gluten from your diet your symptoms improve, I would conclude you have NCGS.

[Jack Common]

I think I don't have any symptoms now. I have some fogginess but I'm not sure whether it's gluten.

I think the gut related problems I described above were caused because I had giardiasis. It was treated and now I feel much better.

However I started a gluten free diet after the parasite treatment so it's a bit unclear what was the reason.

I'm going to repeat the tests after 2 months from now eating gluten to be sure it was giardiasis.

Is it enough to do just "Deamidated gliadin peptide IgA" and "The Tissue Transglutaminase IgA antibody"? Because my Immunoglobulin A result is normal IgG tests are not necessary if I understand it right.

By the way, Merry Christmas!

[trents]

I would say the tTG-IGA would be sufficient.

[Jack Common]

Thank you for your help!

[knitty kitty]

@Jack Common,

You could do a DNA test to see if you have any of the known genes for Celiac Disease.  If you don't have any genes for celiac disease, look to another source for your health problems.  If you do have celiac disease genes and have improvement on the gluten free diet, you probably have active Celiac.  Further testing would be beneficial.

Keep in mind that different gluten containing breads have different amounts of gluten.  Think thick chewy pizza crust and artisan breads, and whole wheat breads for the gluten challenge.  Cookies and pastries do not contain as much gluten.  

Since your blood tests were inconclusive, continuing with the gluten challenge may be needed to provoke a stronger autoimmune reaction sufficient for antibodies to get into the blood stream.  

 

 

[Brandy969]

5 hours ago, knitty kitty said:

@Jack Common,

You could do a DNA test to see if you have any of the known genes for Celiac Disease.  If you don't have any genes for celiac disease, look to another source for your health problems.  If you do have celiac disease genes and have improvement on the gluten free diet, you probably have active Celiac.  Further testing would be beneficial.

Keep in mind that different gluten containing breads have different amounts of gluten.  Think thick chewy pizza crust and artisan breads, and whole wheat breads for the gluten challenge.  Cookies and pastries do not contain as much gluten.  

Since your blood tests were inconclusive, continuing with the gluten challenge may be needed to provoke a stronger autoimmune reaction sufficient for antibodies to get into the blood stream.  

 

 

What markers /genes are these DNA test? 

[trents]

Early on,  DQ2 and DQ8 were the primary genes that have been connected to the potential to develop celiac genes but more recent genetic research suggests there may be more.

[Brandy969]

3 hours ago, trents said:

Early on,  DQ2 and DQ8 were the primary genes that have been connected to the potential to develop celiac genes but more recent genetic research suggests there may be more.

Thank you! I didn’t know this!