Need Help Interpreting Enterolab Results

[stephanie19]

I just received my results from Enterolab on the tests I ordered (the complete gluten panel--gene and stool tests; and stool tests for casein, egg, yeast, and soy sensitivity). Here they are:

A) Gluten Sensitivity Stool and Gene Panel Complete

Fecal Antigliadin IgA 24 (Normal Range <10 Units)

Fecal Antitissue Transglutaminase IgA 16 Units (Normal Range <10 Units)

Quantitative Microscopic Fecal Fat Score 346 Units (Normal Range <300 Units)

Fecal anti-casein (cow's milk) IgA antibody 21 Units (Normal Range <10 Units)

HLA-DQB1 Molecular analysis, Allele 1 0501

HLA-DQB1 Molecular analysis, Allele 2 06xx

Serologic equivalent: HLA-DQ 1,1 (Subtype 5,6)

C) Egg, Yeast, and Soy Food Sensitivity Stool Panel

Fecal anti-ovalbumin (chicken egg) IgA antibody 6 Units (Normal Range <10 Units)

Fecal Anti-Saccharomyces cerevisiae (dietary yeast) IgA 6 Units (Normal Range <10 Units)

Fecal Anti-Soy IgA 18 Units (Normal Range <10 Units)

As I understand it, the IgA results indicate that I am sensitive to gluten, casein, and soy, but not to eggs or yeast. Am I right on this? Do the actual numbers show anything? (i.e., are they especially high or low, and does this say anything about the severity of the sensitivity?)

My main questions are about the things I bolded:

-First, what exactly does the Microscopic Fecal Fat Score indicate? In the interpretation of the results, it said, "You have an autoimmune reaction to the human enzyme tissue transglutaminase, secondary to dietary gluten sensitivity." This is Greek to me--what does this actually mean?

-Second, what in the world do the HLA-DQB1 alleles mean, and what is the Serologic equivalent? It said in the interpretation of my results that this means that I am predisposed for gluten sensitivity but not full-blown celiac. Is there any other information that can be garnered from this genetic information?

If any of you can help me out with this, I would really appreciate it. Since I invested the money in the tests, I want to fully understand what they mean! From lurking on this board while waiting for my results, I know there are lots of self-educated food intolerance experts here, so I'm hoping you won't mind sharing some of your knowledge with me. I thought about contacting Enterolab with my questions, but then I thought I could probably get just as much help, or maybe more, by posting here first!

Thanks in advance,

Stephanie

[confused]

I will answer a few questions to the best of my knowledge.

Yes you need to stay away from gluten, casein and soy, your body is reacting to these substances.

Fecal fat score means you have malabsorption going on, so gluten has attacked your intenstines.

You do not have the celiac genes that are identified for celiac, but that does not mean you do not have celiac. There are still genes out there that have not been identified YET for celiac. I for one am dq 6 and dq7 and i did test positive for celiac threw blood work.

Now sometimes after 6 months or an yr, you can re-introduce casein and soy and see if it still causes you problems, some people cant have them for life, but it seems some others who have tested positive can go back to eating them. Gluten does need to be avoided for life.

Im sure others will chime in with more information.

paula

[AndreaB]

Stephanie,

You are gluten, soy and casein intolerant, with a low malabsorption score. Any one of the three could have contributed to the malabsorption, or it could be something else.

Remove all three from your diet. If after 6-12 months you see no improvement then continue looking for the cause. I would recommend staying off of those during the search for what is the contributing cause though. In my opinion it would be best to stay off of gluten for good, but that is each persons decision. If none of your symptoms improve or go away then gluten is just one thing that's bringing you down.

You have double DQ1, which has been linked with neurological manifestations of gluten intolerance.

Oh, you also have an elevated ttg which I think means that your body is mounting an attack and further consumption of gluten could lead to further autoimmune diseases down the road. I'm hazy on this though so please clarify with someone else or do further research on it.

[pedro]

Hi Stephanie.

This is from the EnteroLabs website.

First Question:

Is gluten-induced intestinal damage causing malabsorption reversible?

Gluten-induced intestinal damage is fully reversible provided gluten-free dietary treatment is strict and permanent. However, the length of time to full healing and disappearance of malabsorption depends on the severity and disease duration at onset of treatment. Hence, children and those with more mild disease at onset of treatment will resolve malabsorption quicker, usually within 6-12 months. Some adults with severe disease, or those who do not quickly grasp or employ strictness to their gluten-free diet, may have continued nutrient malabsorption for longer periods. If intestinal malabsorption persists beyond 18-24 months, dietary and clinical re-evaluation should be undertaken. Unlike antibody levels, our malabsorption test is a measure of disease severity in the intestine. Values from 300 to 500 malabsorption units represent mild malabsorption; 500-1000 moderate; 1000-1500 severe; and greater than 1500 very severe malabsorption (and possibly indicating a combination of gluten-induced intestinal damage and insufficient pancreatic enzyme secretion).

Why do I need a gluten-free diet if I do not have intestinal damage?

So that you do not get it, or damage of any other organ. Prevention is the key to lasting health. Once disease sets in, it is much harder and takes more healing energy to reverse than it does to prevent it. An ounce of preventive health eradicates a ton of disease. Do not wait for villous atrophy, osteoporosis, autoimmune disease, or even symptoms to treat gluten sensitivity; prevent it all!

Second Question

Why are gene results so complicated, and which genes predispose to gluten sensitivity/celiac sprue?

Gene tests for gluten sensitivity, and other immune reactions are HLA (human leukocyte antigen), specifically HLA-DQ, and even more specifically, HLA-DQB1. The nomenclature for reporting HLA gene results has evolved over the last two decades as technology has advanced. Even though the latest technology (and the one we employ at EnteroLab for gene testing) involves sophisticated molecular analysis of the DNA itself, the commonly used terminology for these genes in the celiac literature (lay and medical) reflects past, less specific, blood cell-based (serologic) antigenic methodology. Thus, we report this older "serologic" type (represented by the numbers 1-4, e.g., DQ1, DQ2, DQ3, or DQ4), in addition to the integeric subtypes of these oldest integeric types (DQ5 or DQ6 as subtypes of DQ1; and DQ7, DQ8, and DQ9 as subtypes of DQ3). The molecular nomenclature employs 4 or more integers accounting together for a molecular allele indicated by the formula 0yxx, where y is 2 for DQ2, 3 for any subtype of DQ3, 4 for DQ4, 5 for DQ5, or 6 for DQ6. The x's (which commonly are indicated by 2 more numbers but can be subtyped further with more sophisticated DNA employed methods) are other numbers indicating the more specific sub-subtypes of DQ2, DQ3 (beyond 7, 8, and 9), DQ4, DQ5, and DQ6. It should be noted that although the older serologic nomenclature is less specific in the sense of defining fewer different types, in some ways it is the best expression of these genes because it is the protein structure on the cells (as determined by the serologic typing) that determines the gene's biologic action such that genes with the same serologic type function biologically almost identically. Thus, HLA-DQ3 subtype 8 (one of the main celiac genes) acts almost identically in the body as HLA-DQ3 subtype 7, 9, or other DQ3 sub-subtypes. Having said all this, it should be reiterated that gluten sensitivity underlies the development of celiac sprue. In this regard, it seems that in having DQ2 or DQ3 subtype 8 (or simply DQ8) are the two main HLA-DQ genes that account for the villous atrophy accompanying gluten sensitivity (in America, 90% of celiacs have DQ2 [a more Northern European Caucasian gene], and 9% have DQ8 [a more southern European/Mediterranean Caucasian gene], with only 1% or less usually having DQ1 or DQ3). However, it seems for gluten sensitivity to result in celiac sprue (i.e., result in villous atrophy of small intestine), it requires at least 2 other genes also. Thus, not everyone with DQ2 or DQ8 get the villous atrophy of celiac disease. However, my hypothesis is that everyone with these genes will present gluten to the immune system for reaction, i.e., will be gluten sensitive. My and other published research has shown that DQ1 and DQ3 also predispose to gluten sensitivity, and certain gluten-related diseases (microscopic colitis for DQ1,3 in my research and gluten ataxia for DQ1 by another researcher). And according to my more recent research, when DQ1,1 or DQ3,3 are present together, the reactions are even stronger than having one of these genes alone (like DQ2,2, DQ2,8, or DQ8,8 can portend a more severe form of celiac disease).

Is milk protein sensitivity as bad as gluten sensitivity and do I need to be strict with a dairy-free diet?

Research showing a high association of antibodies to cow's milk proteins in people who react similarly to gluten has been around for over 40 years. More recent research has now confirmed that these reactions to cow's milk proteins (mainly casein but also lactalbumin, lactoglobulin, and bovine serum albumin) are indeed epidemiologically related to autoimmune diseases such as diabetes, psoriasis, eczema, and asthma, among others. While formal studies of dairy-free diets, either alone or in combination with gluten-free, have not yet been conducted on a wide scale, the idea of a gluten-free/casein-free diet is not new, having been employed for decades by many health practitioners. From my objective assessment of this field, and my personal experience with my own dietary elimination for health, I recommend complete avoidance of all dairy products in anyone found to be immunologically sensitive to cow's milk protein by our tests, and anyone with an established autoimmune or chronic immune disease. I predict future research will support this recommendation. Do not bury your head in the sand waiting for such studies. Do your own study and go gluten-free/dairy-free.

Stephanie when I received my results from EnteroLabs they were similiar to yours. I called EnteroLabs in regards to the Casein, and they told me that I have to br off the Casein or any dairy products forever, because the reaction I have to dairy products is equivalent to the reaction I get from gluten, yes including the destruction to the villi. This was very hard for me. I can deal better with finding foods that are gluten-free, but is hard to find then as a combination, at least for me.

I hope this helps you. The bottom line is that you have to stay away from any of the offending foods that is damaging you intestine, you can clearly see it from the malabsortion test.

Take care, and best regards to you.

[mftnchn]

I may be wrong about this, but I don't think it has yet been proven that other food allergies or sensitivities cause the same intestinal villi damage that occurs with celiac I did just read yesterday that the casein protein is very similar molecularly to the problematic gluten protein, but didn't see that in a scientific article.

What I understand with food allergies and food sensitivities is that there is a whole range of responses. Sometimes you can never tolerate any amount of the food.

Other times after your gut has been healing for awhile you can reintroduce foods to some degree depending on your tolerance. After staying away from it you can do a food challenge. If it is okay, try eating it once every 4 days for awhile, if no problems, you probably can resume it more normally, or else back off to the degree that you tolerate it.

Also there can be some cross-reactions with foods that have very similar proteins. You should be able to find this information by searching about food allergies/intolerances.

Good luck!